COVID -19

COVID-19 Resources - 21 August

 21 August 2020

Due to the evolving nature of the pandemic, we have added links below for current COVID-19 resources for members and trainees:

  • RACS email sent on Wednesday 18 August 2020 - Click here
  • International Registry of Otolaryngologists - Head and Neck Surgeons with COVID-19 - Young Otolaryngologists - International Federation of Otolaryngologic Societies (YO-IFOS) - Click here
  • Neurosurgery guideline - Click here

ASOHNS COVID-19 Update - 10 August

10 August 2020

The ASOHNS’ COVID-19 Working Group has reviewed and supports the new guidelines issued by the Infection Control Expert Group on 6 August titled “COVID-19 Guidance on the use of personal protective equipment by health care workers in areas with significant community transmission”.

These guidelines can be viewed online – click here

The guidelines support increased protection given the current situation in Victoria and can be implemented in any location where there is significant community transmission.

We encourage health care institutions and workplaces to provide a reliable supply of appropriate PPE to clinicians to perform their duties safely.

Further, ASOHNS recommends that where P2 / N95s are not available for aerosol-generating procedures, and deferral of care does not pose an unacceptable risk of harm to a patient, we support our members deferring procedures until the risk of inadvertent exposure is considered at an acceptable level for that clinician, or until appropriate PPE is provided.

RACS communicated to Victorian fellows on Friday 7 August. A copy is included below as it will be relevant for us all to consider for our patients.

We are hopeful that the steps taken in Victoria to reduce community transmission will protect our colleagues.

For members and trainees in Victoria, please know that you are in our thoughts and if we can support you in any way, please let me know.

I am attending a meeting on Thursday 13 August with RACS and Dr Nick Coatsworth, Deputy Chief Medical Officer, and will keep you informed on any changes to guidelines following that meeting,

Kind regards,

Suren Krishnan OAM FRACS

ASOHNS President


Guidance on delay to elective surgery post recovery from SARS-CoV-2 infection (issued on 5 August 2020)

Dear colleagues, 

We are pleased to share guidance for elective procedures post COVID. This was agreed to at the Victorian meeting of College state chairs and presidents last week. It provides good guidance for all our members in a rapidly developing field.

Background
The severity and duration of SARS-CoV-2 infection is variable between individuals. There is increasing evidence of an incidence of post infection impairment despite significant gaps in our understanding as to how long the respiratory (1), cardiovascular (2) and other systems may be affected. It appears that infection (communicability) recovery is much quicker than physiologic recovery. 

Available evidence suggests patients who had SARS-CoV-2 infection diagnosed within seven days before or up to 30 days after surgery are at significant risk of post-operative complications including increased morbidity and mortality.(3) 

There are insufficient additional data to provide universal recommendations on the optimum timing of necessary, planned surgery following recovery from active infection with SARS-CoV-2. Therefore, a cautious approach is recommended. Decisions regarding surgical timing will require careful consideration of the possible sequelae of the infection, the urgency of the required surgery and the expected physiological impact on the patient.

Guidelines
A minimum of eight weeks of being symptom free prior to undergoing all but minor elective surgical procedures is recommended.

Patients should have a formal clinical review prior to surgery that particularly addresses the state of the cardiac and respiratory systems. This is recommended for all patients post known SARS-CoV-2 infection and is especially important in those who have any persisting 

Not ready for care?
If, on careful consideration of the nature and severity of any persisting problems, delay is considered the safer course of action for an individual patient, we recommend treatment is delayed until the balance of risks and benefits are more in the patient’s favour, even for a Category 1 (within 30 days) case.

This guidance will be updated when more evidence of the longer term’s effects of infection with SARS-CoV-2 is available.

References

1. Zhao Y, Shang Y, Song W, Li Q, Xie H, Xu Q, et al. Follow-up study of the pulmonary function and related physiological characteristics of COVID-19 survivors three months after recovery. EClinicalMedicine. 2020 Jul;100463.

2. Puntmann VO, Carerj ML, Wieters I, Fahim M, Arendt C, Hoffmann J, et al. Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19). JAMA Cardiol [Internet]. 2020 Jul 27 [cited 2020 Aug 3]; Available from: https://jamanetwork.com/journals/jamacardiology/fullarticle/2768916

3. Nepogodiev D, Bhangu A, Glasbey JC, Li E, Omar OM, Simoes JF, et al. Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study. The Lancet. 2020 Jul;396(10243):27–38.
 

Kind regards

Dr Tony Sparnon                                Mr Matthew Hadfield
President                                            Chair, Victorian State Committee


Disclaimer

The Australian Society of Otolaryngology Head and Neck Surgery has developed this information as guidance for its members. This is based on information available at the time of writing and the Society recognises that the situation is evolving rapidly, so recommendations may change. The guidance included in this document does not replace regular standards of care, nor do they replace the application of clinical judgement to each individual presentation, nor variations due to jurisdiction or facility type.

The Australian Society of Otolaryngology Head and Neck Surgery Limited is not liable for the accuracy or completeness of the information in this document. The information in this document cannot replace professional advice.

 

 

Resources on COVID-19 statistics of confirmed cases - 28 April

28 April 2020

This resource was developed arising from yesterday’s webinar with Dr Coatsworth, hosted by RACS.

In the webinar, Dr Bridget Clancy identified an opportunity to help rural surgeons understand what their local prevalence is, by linking to resources with this information to add to the COVID-19 resources hub at RACS.

Australian state and territory health jurisdictions provide maps and charts of confirmed cases by locality classifications, whereas others provide tabulated data.

Summarised below is a list of resources which will be useful for surgeons to gauge their local regional prevalence of positive cases. 

Queensland

New South Wales

Australian Capital Territory

Victoria

Tasmania 

South Australia

Western Australia

Northern Territory

 

 

COVID-19 Update - 24 April

24 April 2020

ASOHNS GUIDELINES ADDRESSING THE COVID-19 PANDEMIC –
THE RE-INTRODUCTION OF ELECTIVE SURGERY

Please click here for PDF version

The Minister for Health, The Hon. Greg Hunt MP announced on Tuesday 21st April 2020, the easing of elective surgery restrictions imposed on the 26th of March 2020. The Australian Government, States and Territories, have made this decision after close consultation with peak surgical bodies and key stakeholders including The Australian Society of Otolaryngology, Head and Neck Surgery.

This decision is made recognising the effect on the lives and well-being of patients who have had their elective surgery deferred. The planned re-introduction of elective surgery is to be conducted in a staged and controlled process. It will balance the need to maintain capacity to treat COVID-19 patients with the need to increase the availability of elective surgery in a safe and equitable way, taking into account the well-being of patients and health care workers.

ASOHNS continues to monitor the daily progress of the pandemic and its impact on the community. In conjunction with the Royal Australasian College of Surgeons and with regular consultations with the office of the Chief Medical Officer, the Society reviews the evolving scientific information related to the virus and the threats it poses to patients, its members and trainees.

Alerted by the international experience with COVID-19, which has been grave with high incidence of disease and serious morbidity and mortality, the Australian Government introduced a range of restrictions and public health policy.

The rapid and effective response of the people of Australia to abide by rules of social distancing, hand and surface hygiene and quarantine when advised, has led to excellent levels of virus containment.

Public Health data shows that the prevalence of the SARS Covid-2 virus in the Australian community at present is about 6 per 100,000 of population. The advice from the office of the Chief Medical Officer suggests that these are very low levels and that using triage symptoms to assess patients will very accurately predict the ability to identify a patient with COVID-19 disease. The risk of a patient with no triage symptoms, subsequently developing COVID-19 positivity is estimated at 1 per 100,000.

However, the office of the Chief Medical Officer has acknowledged the concerns of surgeons, anaesthetists, theatre nurses and other hospital staff, and supports conducting a study into asymptomatic carriage of COVID-19 in elective surgery patients to further inform testing policy.
 
In lieu of this current low prevalence of disease the office of the Chief Medical Officer has recommended that there is no indication to conduct COVID-19 testing preoperatively in patients with no triage symptoms of COVID-19.

However, we recommend that all hospitals, day surgeries and practices should have established risk management procedures to identify any patients that have respiratory symptoms that may indicate COVID-19 such that surgery or procedures are deferred where possible and COVID-19 testing requested.
 
Personal protective equipment is a critical element of staff safety and the use of PPE should be in accordance with national guidelines. In summary these are:

  • In asymptomatic patients standard universal precautions and a standard surgical mask worn well with careful donning and doffing techniques is sufficient for all procedures.
  • Current evidence suggests that viral load in aerosol generating procedures is low and      droplet precautions with standard surgical masks is sufficient.
  • Patients with acute respiratory symptoms either fever > 38 degrees OR acute respiratory symptoms (eg. Cough, shortness of breath, sore throat)
  • COVID-19 positive patients should have surgery deferred until they recover from COVID-19 disease.
  • COVID-19 positive patients having aerosol generating procedures should have      maximal PPEs, which include N95 masks and eye protection and PAPR where   available and staff are trained and supervised in their use.

ASOHNS encourages members to consider either innovation or modification of techniques to minimise aerosol exposure. For example, advice from international experience is regularly provided including a 2 Microscope Drape method to reduce aerosolization in mastoid surgery from ENT UK. 

https://www.entuk.org/sites/default/files/Safer%20FESS%20in%20the%20COVID%20Era%20for%20ENTUK%20.pdf
 
The Australian Government recognises that the selection of patients to undergo elective surgery will ultimately be a clinical one.

The following guiding principles have been recommended by the Australian Health Protection Principal Committee (AHPPC) and endorsed by National Cabinet:

  • Procedures representing low risk, high value care as determined by specialist societies
  • Selection of patients who are at low risk of post-operative deterioration
  • Children whose procedures have exceeded clinical wait times
  • Assisted reproduction
  • Endoscopic procedures
  • Screening programs
  • Critical dental procedures.

We recommend you access guidelines produced by the Department of Health, including “Restoration of Elective Surgery” due for release on 23 April 2020.

The executive of ASOHNS agree with government that that the selection of patients to undergo elective surgery will ultimately be a clinical one. ASOHNS encourages members to understand disease prevalence in their region and be aware of and alert occurrence of new clusters of COVID-19 and incorporate public health messages into their clinical judgement and decision making.

ASOHNS, in response to enquiries from members, has widely consulted with the presidents and representatives of the various sub-specialty societies. These include the New Zealand Society of Otolaryngology, Head and Neck Surgery, the Australia & New Zealand Society of Paediatric Oto Rhino Laryngology, the Australasian Rhinologic Society, Australasian Academy of Facial Plastic Surgery and the Australia and New Zealand Head and Neck Cancer Society.

The following guidelines are provided as procedures considered to represent low risk and high value care:


PAEDIATRICS
Catego
ry 1
Urgent airways including foreign bodies
Malignancy
Bleeding not controlled with conservative treatment
Infection not responding to conservative treatment


Category 2
Chronic suppurative otitis media with complication /cholesteatoma
Tonsillectomy / Adenoidectomy for moderate-severe OSA
Middle Ear Ventilating Tubes +/_ adenoidectomy for protracted hearing loss
Cochlear implant - following meningitis or after failed implant
Parotid, Thyroid, other head and neck lumps


Category 3
Infective or Inflammatory Disease treatable by medication
e.g. Recurrent Acute Tonsillitis / Sinusitis / Allergic Rhinitis
 
OTOLOGY
Category 1
Malignancy involving Temporal Bone
 
Category 2
Chronic suppurative otitis media with complication /cholesteatoma
Middle Ear Ventilating Tubes for protracted hearing loss


Category 3
For patients over 18 category 3 cases would include
Surgery for implantable hearing assistive devices
 
RHINOLOGY (SINO-NASAL SURGERY)

Category 1
Paranasal sinus malignancy, 
Examples:

  • SCC/ adenocarcinoma/ adenoidcystic carcinoma
    Inflammatory disease with complication or at high risk of complication. 

Examples:

  • Orbital abscess, brain abscess, mucoceles
  • Trauma e.g. Fractured skull and CSF leak
  • Fungal sinusitis in immunocompromised patient
     

Category 2
Sinus conditions that cause disability or could compromise the health of the patient if left for longer than 90 days;
Examples:

  • Benign tumours of the paranasal sinuses e.g. Inverting papilloma/JNA
  • Unilateral disease with suspicion of malignancy 
  • Sphenoid sinusitis
  • Inflammatory disease-causing disabling pain or discomfort and/or compromising overall health and wellbeing of a patient

Examples:

  • Facial pain requiring regular potent analgesia
  • Severe sinusitis in brittle asthmatic
  • Nasal obstruction in patient OSA and unable to use CPAP
  • Functional rhinoplasty to facilitate use of CPAP in patient with OSA
     

Category 3
For patients over 18 category 3 cases would include
Long standing Septal deviation
Turbinate surgery
Surgery for recurrent acute sinusitis without complications.
Cosmetic rhinoplasty  
 
LARYNGOLOGY, HEAD & NECK SURGERY
Category 1

Endoscopy for suspected malignancy
Surgery for Malignancy of the Upper Aero Digestive Tract
Airway obstruction
Bleeding from Head and Neck lesion
Infective/ Inflammatory diseases requiring surgical drainage 
 
Category 2
Surgery for benign Head and Neck Lesions
e.g. Parotidectomy / Thyroidectomy / Removal of benign lesions 
 
Category 3

Procedures of a cosmetic nature
e.g. Revision of scar, Cosmetic rehabilitation of facial palsy

These guidelines will be regularly reviewed and will be subject to change depending on the COVID-19 disease prevalence, the impact on health and safety of members and the impact on health facilities having to deliver elective surgery and maintain public health measures such as social distancing and hand and surface hygiene.


This first stage of reinstating elective surgeries will require health administrators to monitor supplies of personal protective equipment (PPE), ICU and bed capacity, while preparing for the next phase. To limit the volume of procedures performed, the government has asked that facilities cap operating lists volumes at 25 per cent of volume prior to 26 March 2020. Members are asked to liaise with their local health facilities.
 

The Australian, states and territory governments have put in place clear timeframes to monitor and review the situation. An overall review will be undertaken at two weeks and at four weeks based on:

  • The number of positive cases, in both healthcare workers and patients, linked to increased activity
  • PPE use and availability
  • The volume of procedures and hospital/system capacity.

Resource Links for COVID-19 Information - 2 April

Telehealth COVID-19 MBS Update - 6 April

30 March 2020

Effective from 6 April 2020

All services provided using the MBS telehealth items must be bulk billed for Commonwealth concession card holders, children under 16 years of age, and patients who are more vulnerable to COVID-19.

For all other patients, bulk billing is at the discretion of the provider, so long as informed financial consent is obtained prior to the provision of the service. 

More information on these items is available at: http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Factsheet-TempBB.

These services are for non-admitted patients. 

COVID-19 for ENT Surgeons - Dr Nathan Creber - 27 March

27 March 2020

COVID-19 for ENT Surgeons - Dr Nathan Creber - Click here or on image below
 

Resource Links for COVID-19 Information - 26 March

Further guidance for ENT Surgeons during the COVID-19 pandemic

22 March 2020

Statement from ASOHNS dated 22 March 2020

please read all the way to the end.

 This is in addition to the guidance from Friday 20 March, 

ASOHNS GUIDELINES ADDRESSING THE COVID 19 PANDEMIC

PDF Version - Click here
The Australian Society of Otolaryngology, Head and Neck Surgery is aware of the serious threat and implications of the COVID 19 pandemic. The society continues to monitor the daily progress of the pandemic and its impact on the community.

The Society is regularly reviewing the evolving scientific information related to the virus and in particular, the threat it poses to its members and its trainees.

Today the executive, in conjunction with representatives from council and the chair of the board have constituted a COVID 19 Committee. This committee will comprise the President, the Vice President, the Immediate Past President, the Secretary and the CEO. This committee will meet regularly and respond to enquiries from members, represent the interests of the community at large and the interests of its members and its trainees. The committee will provide regular updates and guidelines and links to informative resources.

The international experience to date suggests that oto-rhino laryngologist, head and neck surgeons are among the most susceptible health professional group to the COVID 19 virus. There have been recent reports of one death and two ventilated members of the otolaryngology, head and neck surgical community in the United Kingdom. There have been reports of the dissemination of infection from a patient of unknown COVID 19 status to 14 members of an endoscopic skull-base surgical team in China. There are also reliable reports of multiple deaths in ENT surgeons in Italy, Iran and China.

These recent events have added to the information that the executive has had to consider. The following guidelines have been formulated with the interests of members and trainees, their families and their medical, nursing and allied health colleagues in their workplace, and patients in mind.

 

IMPLICATION FOR PATIENTS

Patients will only be provided with time-sensitive or emergent care

  • This includes both office-based and surgical care
  • The Society recognises that “time sensitivity” and “urgency” is determined by individual surgeons, recognising that surgeons need to be aware of the potential risks to both themselves and to their staff
  • This judgment must always take into account each individual patient’s medical condition, social circumstances, and needs.

IMPLICATION FOR MEMBERS

It is imperative that members are aware that individual decisions made have potential risks to both themselves and their staff.

In Private Practice

  • Delay all routine elective clinic visits
  • Where possible use telephone and video consults and be familiar with criteria for specialist Medicare billing item numbers
  • Use PPE and masks, particularly when performing endoscopy
  • Delay elective and non-urgent admissions
  • Delay inpatient and outpatient elective surgical and procedural cases
  • When providing time-sensitive or emergent care undertake precautions such as using P2 N95 masks and adhering to anaesthetic standards advised by the ASA. Ensure that staff providing post-operative care undertake precautions
  • Although not absolutely definitive, preoperative COVID 19 testing and knowledge of COVID 19 status may assist in surgical plan and post-operative care. In the absence of confirmed COVID 19 negative status (by 2 tests more than 24 hours apart), it should be assumed that patients are COVID 19 unknown and should be treated as though they are positive.

In Public hospital practice

  • Undertake only Emergency and Urgent Category 1 cases, such as cancer, threatened airway and bleeding
  • Delay all routine elective clinic visits
  • Where possible use telephone and video consults
  • Divide teams to minimise contact and risk of transmission of virus
  • Although not absolutely definitive, preoperative COVID 19 testing and knowledge of COVID 19 status may assist in surgical plan and post-operative care
  • It is important that members unite and work with the general population, medical community and regulatory agencies to minimize the risk of the COVID 19 virus transmission from human to human in order to limit the development of new cases.
  • It is emphasised that this strategy provides the best chance to not overwhelm facilities with a limited supply of hospital beds, ICU beds, ventilators, and other critical supplies.
  • Disposable medical supplies and protective equipment are scarce, where protection cannot be guaranteed, procedures must be avoided, as we must conserve these for use where they are needed most.
  • Avoid congregation and ensure social distancing and the 1.5m rule
  • All clinical and academic meetings should be conducted using electronic applications
 

IMPLICATIONS FOR TRAINEES
 
The COVID 19 pandemic will have significant implications to training. It will limit clinical experience in managing outpatients, ward inpatients and training in surgical skills.
At all times the safety and well-being of trainees is important. At all times ensure you are in a safe working environment. The guidelines provided by ASOHNS relating to COVID 19 also apply to trainees. Where there is a shortage of PPE, do not perform any upper airway examinations.
 
If you have any concerns about the safety of your working environment, please contact the SET Program Administrator, ASOHNS. 
 
Evidence regarding COVID 19 as it relates to pregnancy is still being collected. We strongly recommend that pregnant trainees should not continue to work at this time.  
 
Specific implications to training include:

  • The possibility that competencies may not be met and that time spent in training may be increased.
  • The possibility that new applications to the training program will not be considered for the year beginning 2021.
  • The final fellowship examinations will be cancelled in May 2020 by RACS and a decision on the September 2020 fellowship examination will be made in June.
  • Above all maintain self-safety utilising PPE when consulting and performing procedures
  • Apply ENT UK tracheostomy guidelines
  • Delay all non-urgent emergency hospital procedures

 

SUMMARY
 
These are surreal and challenging times for all. The Society will try to address issues as best we can pre-emptively. Necessarily, it will respond to the issues identified as this epidemic evolves. It will continue to represent the interest of its members and already has contacted state and federal jurisdictions as well as the office of the Chief Medical Officer.
 
Our current position is to recommend 
“Limiting all non-essential planned surgeries and procedures, until further notice” based on preservation of needed resources and the safety of patients and medical personnel.
 
Above all stay safe, practice social distancing, regular hand hygiene and the 1.5 m rule. 
 
Let’s work together and support each other. 

 

 

Guidance for ENT surgeons during the COVID-19 pandemic - 20 March

20 March 2020

PDF Version - click here


The information contained in this document is subject to change due to the rapidly changing environment. This guidance is intended to complement rather than replace existing advice. These are challenging times and we are concerned about the health and safety of members, trainees and patients.
 
Most importantly, protect yourself and prevent the spread through the practice of 

  • good hygiene (cover cough, wash hands, avoid touching your face)
  • stay at home if you are sick,
  • self-isolation, and
  • social distancing and avoid shaking hands

Risk to healthcare workers through transmission of COVID-19 is primarily through droplet spread. Otolaryngologists are exposed to a high reservoir of viral load as we are dealing with the nose and airway. 1, 2, 3  
 
There is reliable information coming from the US indicating that otolaryngology is a high-risk group from COVID-19 infection. There is anecdotal evidence that a single endoscopic case in China reportedly infected 14 people who were in the operating room. There is a presumed high risk in any procedures involving the airway. The current recommendation is to reconsider the need for non-urgent surgery in particular sinonasal, tonsils and oral cavity. 

 

Current US advice is that pre-operative COVID-19 status should be prioritised for all procedures involving the upper and lower respiratory tract, and eventually all patients requiring endo tracheal intubation. In COVID-19 positive patients, endoscopic sinus cases should be conducted only with PAPR (Powered air-purifying respirator). 
 
The Australian Society of Anaesthetists guidelines are supported and are very much aligned with procedures for ENT surgeons as they are experts in airway management. 4
 
National and local guidelines from the Department of Health and others should be adhered to. State and Territory guidelines as well as individual hospital advice will also be frequently updated. 5
 
RACS advice for all fellows, trainees and IMGs as at 18 March is available here: 
https://mailchi.mp/surgeons/racs-covid19-update-326446?e=6f1443f171
 
ENT may not seem to be in the frontline with COVID-19 but we do have a key role to play, and this must be planned. All the data from China, Iran, Italy and most recently the UK suggests that ENT surgeons are an extremely high-risk group therefore we need to be vigilant to protect ourselves.Hospitals need to ensure ENT surgeons are supplied with the necessary PPE in order to avoid fatalities.
 
In response to pressures on the health system, elective surgery will be curtailed. Non-elective patients will continue to need care. We should seek the best local solutions to continue the proper management of these patients whilst protecting ourselves through proper supply of protective equipment. We understand that resources are under pressure for the response to COVID-19, however the experience overseas highlights the necessity for PPE for ENTs. 
 
We will be involved in airway management. We may also need to work outside of our specific areas of training and expertise, in the exceptional circumstances we may face.
 
We need in particular to consider patients who are vulnerable to the consequences of catching COVID-19, including those with a tracheostomy or respiratory compromise and patients with immune suppression – such as patients with head and neck cancer – either during or soon after treatment. 
 
There are multiple resources of information and we will need to make decisions based on our own personal circumstances within our practices, depending on the size of the rooms, waiting areas, staffing, etc. Signs on the door of your room and messages confirming appointments should communicate to patients who are feeling unwell to stay home and not attend their appointment. Telehealth options are available through the MBS for vulnerable / isolated patients.
 
Important recommendations:

  • Avoid powered atomisation – use actuated pumps sprays or similar soaked pledgets for topical        anaesthesia
  • Elective airway surgery patients (sinonasal, nasopharyngeal, oropharyngeal, laryngeal and tracheal) should be tested for COVID-19, where and when available, and be shown to be negative before proceeding; for acute cases specific PPE should be utilised; patients should be advised to practice hand hygiene and social distancing prior to surgery
  • Limit intervention in the clinic/rooms as much as possible and wear appropriate protection
  • Postpone any COVID-19 positive cases, anyone with recent travel history, anyone with potential symptoms of COVID-19 or anyone with COVID-19 contacts
  • Advice should be given to all COVID-19 negative patients undergoing elective surgery to practice social distancing and hand hygiene between the time of testing until the time of surgery.

Personal Protective Equipment (PPE)
 
We also need to protect ourselves and the appropriate use of personal protective equipment (PPE).
 
Any clinician assessing patients suspected or confirmed to be infected with COVID-19 should wear appropriate PPE. Training on the use of PPE is important to reduce the risk of transmission of COVID-19. Most hospitals are conducting PPE sessions, please attend. 
 
The highest regime for PPE for negative COVID-19 tested patients would be a fluid resistant surgical mask, single-use impermeable disposable gown, gloves and eye protection if blood and or body fluid contamination to the eyes or face is anticipated. This applies to examinations including flexible and rigid nasendoscopy. 
 
P2/N95 masks are recommended for COVID-19 positive patients / suspected positive patients requiring aerosol generating procedures – this includes intubation, open suctioning, tracheostomy, high speed drilling and bronchoscopy. Please also refer to guidance from your Local Health District and consult with your local infectious diseases team if in any doubt and note that guidance on this may change.
We have attempted and are continuing to attempt to gain selective access to PPE, but this is proving to be very difficult. We will continue to assist our members as much as possible.
 
Sterilisation of equipment practices are unchanged from standard procedures.


The following table outlines levels of precaution for different scenarios in the hospital environment:

Patient Category Precautions Example
Community precautions Hand hygiene 
Avoid hand shaking
Cough etiquette
 
Non-COVID-19 proven patients in theatre or in rooms Hand hygiene
Standard PPE
Hat 
Mask 
Gloves
Routine care of COVID-19 patient Droplet precautions Inpermeable gown
P2/N95 mask
Disposable hat
Goggles
Gloves
Procedures in COVID-19 patient Airborne precautions P2/N95 mask
Disposable hat
Face shield 
Gloves

 

References:


1. Consensus statement: Safe Airway Society principles of airway management and tracheal intubation specific to the COVID-19 adult patient group, Med J Aust 16 March 2020, David J Brewster, Nicholas C Chrimes, Thy BT Do, Kirstin Fraser, Chris J Groombridge, Andy Higgs, Matthew J Humar, Timothy J Leeuwenburg, Steven McGloughlin, Fiona G Newman, Chris P Nickson, Adam Rehak, David Vokes and Jonathan J Gatward
https://www.mja.com.au/journal/2020/212/10/consensus-statement-safe-airway-society-principles-airway-management-and

2. ENT UK
https://www.entuk.org/advice-ent-examination-reduce-chances-droplet-spread-and-viral-transmission

3. American Academy of Otolaryngology Head and Neck Surgery
https://www.entnet.org/content/academy-supports-cms-offers-specific-nasal-policy

4. Australian Society of Anaesthetists (ASA)
The ASA has developed guidelines based on current evidence and may be subject to change as more information becomes available. They are intended for anaesthetists in Australia. For the latest version, please visit https://asa.org.au/covid-19-updates/ 


5. Department of Health information 

Federal Government Department of Health 
https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert?utm_source=health.gov.au&utm_medium=redirect&utm_campaign=digital_transformation&utm_content=health-topics/novel-coronavirus-2019-ncov


ACT COVID-19 Advice
https://www.health.act.gov.au/health-professionals/chief-health-officer-alerts

NSW COVID-19 Advice
https://www.health.nsw.gov.au/Infectious/diseases/Pages/coronavirus.aspx

NT COVID-19 Advice
https://health.nt.gov.au/health-alerts/novel-coronavirus-covid-19

QLD COVID-19 Advice
https://www.health.qld.gov.au/clinical-practice/guidelines-procedures/novel-coronavirus-qld-clinicians

 

SA COVID-19 Advice
https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/clinical+resources/clinical+topics/infectious+disease+control/novel+coronavirus+%282019-ncov%29+infection+for+health+professionals

TAS COVID-19 Advice
https://www.dhhs.tas.gov.au/publichealth/communicable_diseases_prevention_unit

VIC COVID-19 Advice
https://www.dhhs.vic.gov.au/health-services-and-general-practitioners-coronavirus-disease-covid-19

WA COVID-19 Advice
https://ww2.health.wa.gov.au/Articles/A_E/Coronavirus


Disclaimer

The Australian Society of Otolaryngology Head and Neck Surgery has developed this information as guidance for its members. This is based on information available at the time of writing and the Society recognises that the situation is evolving rapidly, so recommendations may change. The guidance included in this document does not replace regular standards of care, nor do they replace the application of clinical judgement to each individual presentation, nor variations due to jurisdiction or facility type.


The Australian Society of Otolaryngology Head and Neck Surgery Limited is not liable for the accuracy or completeness of the information in this document. The information in this document cannot replace professional advice.