Management of an endoscopy center during the outbreak of COVID-19: Experience from West China Hospital

Table 1 Endoscopy indigestive endoscopy center of West China Hospital during the COVID-19 pandemic

	March 1, 2019 –April 10, 2019	March 1, 2020-April 10, 2020
Routine gastroscopy	1414	616
Routine colonoscopy	903	438
Painless gastroscopy	4709	3325
Painless colonoscopy	3312	2462
Enteroscopy	24	30
Capsule gastroscopy	57	40
EUS	309	224
Diagnostic endoscopy	10728	7135
Removal of foreign body in UGI tract	109	70
Hemostasis of varicose veins	111	77
Hemostasis of non-varicose veins	25	19
Stent placement in UGI tract	1	4
Stent placement in LGI tract	2	6
Esophageal EMR	1	0
Gastric EMR	161	30
Colorectal EMR	569	177
Esophageal ESD	24	23
Gastric ESD	41	23
Colorectal ESD	14	9
POEM	5	0
ERCP	168	124
EUS-FNA	21	25
EUS + stent drainage	0	1
STER	8	7
ESTD	35	48
Therapeutic endoscopy	1295	643

UGI: Upper gastrointestinal; LGI: Lower gastrointestinal; EMR: Endoscopic mucosal resection; ESD: Endoscopic submucosal dissection; POEM: Peroral endoscopic myotomy; ERCP: Endoscopic retrograde cholangiopancreatography; EUS: Endoscopic ultrasonography; EUS-FNA: Endoscopic ultrasound-guided fine-needle aspiration biopsy; STER: Submucosal tunneling endoscopic resection; ESTD: Endoscopic submucosal tunnel dissection; COVID-19: Coronavirus disease 2019.

Table 2 Prevention and control measures for each location

Location	Occupational protection	Reserved supply	Environmental management			Screening and treatment
			No special pollution	Special pollution	Air disinfection	Screening method	No abnormalities	Suspected patients
Reservation office	Long sleeve overalls; medical surgical mask; disposable medical cap; plastic gloves/nitrile gloves	Infrared  temperature measuring gun Thermometer; 75% alcohol. Free hand-washing disinfection	Surface disinfection: 75% alcohol Floor disinfection: 500 mg/L chlorine-containing disinfectant Frequency: 1-2 times/d	Secretion pollution: 2000 mg/L chlorine-containing disinfectant Frequency: immediate	Continuous fresh air exchange	Ask about symptoms and signs and epidemiological history Temperature measurement	Make an appointment	Stop appointment Send to fever clinic of emergency department
Reception and guidance area	Long sleeve overalls; medical surgical mask; disposable medical cap; plastic gloves /nitrile gloves	Infrared  temperature measuring gun Thermometer; 75% alcohol Free hand-washing disinfection	Surface disinfection: 75% alcohol Floor disinfection: 500 mg/L chlorine-containing disinfectant Frequency: 1-2 times/d	Secretion pollution: 2000 mg/L chlorine-containing disinfectant Frequency: immediate	Continuous fresh air exchange	Ask about symptoms and signs and epidemiological history Temperature measurement Fill in the preliminary screening form	Lead to secondary waiting area	Stop appointment Send to fever clinic of emergency department
Secondary waiting area	Long sleeve overalls; medical surgical mask; disposable medical cap; Plastic gloves/nitrile gloves; Patients and families wear masks all the time	Infrared  temperature measuring gun Thermometer; 75% alcohol Free hand-washing disinfection	Surface disinfection: 500 mg/L chlorine-containing disinfectant; Floor disinfection: 500 mg/L chlorine-containing disinfectant; Frequency: 1-2 times/d; Doorknob and chairs disinfection: 1000 ppm chlorine-containing disinfectant (2 or 3 times/d)	Secretion pollution: 2000 mg/L chlorine-containing disinfectant; Frequency: Immediate	Continuous fresh air exchange	Check the preliminary screening table, symptoms and signs, and epidemiological historyTake temperature if necessary	Prepare endoscopic diagnosis and treatment	Stop diagnosis and treatment Send to fever clinic of emergency department
Examination room	Long sleeve overalls; disposable waterproof isolated clothing; Medical surgical face mask and glasses; Disposable medical cap; latex gloves; special shoes; The assistant is the same as the reservation office	Free hand-washing disinfection (per room)	Surface disinfection: 75% alcohol Floor disinfection: 1000–2000 mg/L chlorine-containing disinfectant Frequency: 2 or 3 times/d	Secretion/blood pollution: 2000 mg/L chlorine-containing disinfectant Frequency: Immediate	Continuous fresh air exchange Automatic air disinfector Time: 2 h Frequency: 2 times/d	Check the preliminary screening table, symptoms and signs, and epidemiological historyTake temperature if necessary	Endoscopic diagnosis and treatment	Stop diagnosis and treatment; Send to fever clinic of emergency department
Resuscitation room	Long sleeve overalls; medical surgical mask; disposable medical cap; plastic gloves/nitrile gloves	Free hand-washing disinfection (per bed)	Surface disinfection: 75% alcohol Floor and sofa disinfection: 1000–2000 mg/L chlorine-containing disinfectant Frequency: 1 or 2 times/d	Secretion/blood pollution: 2000 mg/L chlorine-containing disinfectant Frequency: immediate	Continuous fresh air exchange Automatic air disinfector Time: 2 h Frequency: 2 times/d	Make sure they wear the mask when the patient leaves the resuscitation room; Publicity and education for family members
Disinfection room	Long sleeve overalls; Disposable waterproof isolated clothing; medical surgical face mask and glasses; disposable medical cap; latex gloves; special shoes	Free hand-washing disinfection	Surface disinfection: 500 mg/L chlorine-containing disinfectant Floor disinfection: 500 mg/L chlorine-containing disinfectant Frequency: 1 or 2 times/d	Secretion/blood pollution: 2000 mg/L chlorine-containing disinfectant Frequency: Immediate	Keep the storage cabinet ventilated, clean and dry	Suspend use of glutaraldehyde, and use peracetic acid for disinfection/sterilization
Office area	Personal clothes; Mask; All personnel are not allowed to come to the office with protective isolated clothing	Free hand-washing disinfection	Surface disinfection: 1000 mg/L chlorine-containing disinfectant Floor disinfection: 1000 mg/L chlorine-containing disinfectantFrequency: 2 or 3 times/d Doorknob disinfection: 75% alcohol (2–4 times/d)		Continuous fresh air exchange	Workers shall pack and seal the soiled bags in time
Staff for confirmed or suspected patients	Long sleeve overalls; disposable waterproof isolated clothing; medical protective clothing; protective face mask; protective glasses; N95 mask; protective shoe cover; double latex gloves	Free hand-washing disinfection; inside/outside the door of operation room	Surface disinfection: 2000 mg/L chlorine-containing disinfectant Floor disinfection: 2000 mg/L chlorine-containing disinfectant Frequency: Immediately after operation		Continuous fresh air exchange automatic air disinfector Time: 2 h/time Frequency: immediately after each operation	Operation room: Room 1; isolation corridor; staff: 2 doctors, 2 nurses and 2 anesthesiologists. All items prepared before operation, including environmental disinfection items. All remaining items shall be taken out after removing the outer package after the end of disinfection. All medical wastes shall be treated as hazardous wastes. After the final disinfection, the medical staff shall wait for 20 min for fresh air exchange, then remove the isolation protection facilities, turn on the sterilizer, after 30 min of disinfection, take off the mask and leave the inspection room. Disinfect the door handle again outside the door and have hand hygiene