AGA issues formal recommendations for PPE during gastrointestinal procedures

Based on a review of available evidence, we have published guidance for clinicians in Gastroenterology: AGA Institute Rapid Recommendations for Gastrointestinal Procedures During the COVID-19 Pandemic. AGA recommends increasing personal protective equipment (PPE) during all GI procedures during the coronavirus pandemic, as well as triaging procedures following a decision-making framework outlined in the recommendations document. This guidance expands upon the joint society guidance released March 31. Join the authors in a discussion on these recommendations in AGA Community.

RECOMMENDATIONS

• MASKS

• 1. In health care workers performing upper GI procedures, regardless of COVID-19 status*, AGA recommends use of N95 (or N99 or PAPR) instead of surgical masks, as part of appropriate personal protective equipment. (Strong recommendation, moderate certainty of evidence)
• 2. In health care workers performing lower GI procedures regardless of COVID-19 status*, AGA recommends the use of N95 (or N99 or PAPR) masks instead of surgical masks as part of appropriate personal protective equipment. (Strong recommendation, low certainty of evidence)
• 3. In health care workers performing upper GI procedures, in known or presumptive COVID-19 patients, AGA recommends against the use of surgical masks only, as part of adequate personal protective equipment. (Strong recommendation, low certainty of evidence)

• LIMITED RESOURCE SETTINGS

• 4. In extreme resource-constrained settings involving health care workers performing any GI procedures, regardless of COVID-19 status*, AGA suggests extended use/re-use of N95 masks over surgical masks, as part of appropriate personal protective equipment. (Conditional recommendation, very low certainty evidence)

• GLOVES

• 5. In health care workers performing any GI procedure, regardless of COVID-19 status, AGA recommends the use of double gloves compared with single gloves as part of appropriate personal protective equipment. (Strong recommendation, moderate certainty of evidence)

• NEGATIVE PRESSURE ROOMS

• 6. In health care workers performing any GI procedures with known or presumptive COVID-19, AGA suggests the use of negative pressure rooms over regular endoscopy rooms when available. (Conditional recommendation, very low certainty of evidence)

• ENDOSCOPIC DISINFECTION

• 7. For endoscopes utilized on patients regardless of COVID-status, AGA recommends continuing standard cleaning endoscopic disinfection and reprocessing protocols. (Good practice statement)

• TRIAGE

  Download the triage decision support tool and quick reference chart for social sharing
• 8. All procedures should be reviewed by trained medical personnel and categorized as time-sensitive or not time-sensitive as a framework for triaging procedures. (Good practice statement)
• 9. In an open access endoscopy system where the listed indication alone may provide insufficient information to make a determination about the time-sensitive nature of the procedure, consideration should be given for the following options (i) a telephone consultation with the referring provider or (ii) a telehealth visit with the patient or (iii) a multidisciplinary team approach to facilitate decision-making for complicated patients. (Good practice statement)
• *These recommendations assume the absence of widespread reliable rapid testing for the diagnosis of COVID-19 infection or immunity

For a detailed discussion, review the full publication in Gastroenterology. This rapid recommendation document was commissioned and approved by the AGA Institute Clinical Guidelines Committee, AGA Institute Clinical Practice Updates Committee, and the AGA Governing Board to provide timely, methodologically rigorous guidance on a topic of high clinical importance to the AGA membership and the public. Our goal is to protect health care providers and patients from coronavirus during GI procedures.