NEW DELHI, June 5: ENT (Ear, Nose, Throat) procedures are the riskiest, only next to dental treatment, with respect to transmission of coronavirus. SARS-CoV-2 virus enters the lungs mostly through nasal-mouth-throat route. The virus damages the lungs leading to its dysfunction and death takes place from oxygen insuffiency.

There is no cure for coronavirus but certainly it can be prevented. At the moment of writing this, the infection cases detected so far globally is 66,98,370 and the casualties 3,93,142. Symptomatic treatment led to recovery of 32,44,574 patients, out of the total cases.

The Health Ministry has issued detailed guidelines and SOPs this high-risk ENT speciality has to follow to minimise the spread of coronavirus infection among ENT doctors, other staff, patients and their attendants.

Teleconsultation can avoid crowding in hospitals and reduce the need for physical examination in many cases. Physical consultation must also follow appointments to reduce crowding. Social distancing should be maintained in clinics and hospitals.

Patients entering ENT OPD should be screened using screening proforma and thermal screening. Those showing corona symptoms should be sent to dedicated covid clinics. They should wear face mask, hand-sanitise and maintain social distancing.

The ENT OPD room should be well-ventilated. Doctors should wear Level I PPE kit (N95 mask, gown, gloves, goggles/ face shield) in OPD chamber.

Endoscopy (Nasal endoscopy, 90 rigid or flexible endoscopy for larynx) should be avoided in OPD rooms. It may preferably be performed in a separate demarcated area with Level II PPE kit (Cover-all gown, N-95 mask, gloves and goggles). Doctors should wera gloves and refrain from eating/drinking during OPD timings.

Because of risk of aerosol generation during biopsies and endoscopies, all HCP (doctors, nursing staff and technical assistants) need to wear Level II kit (Cover-all gown, N-95 mask, gloves and goggles) during these procedures. The Ministry has issued additional SOPs for on this.

Patients should be screened for COVID 19 before admission.

The hospital and clinics should ensure that there are adequate facilities for hand washing and sanitisation for the patients and health staff. Posters must be displayed in wards and OPDs about the do's and don'ts. The OPD rooms and wards should be properly ventilated. Distancing of at least 2 metres in between patient beds is mandatory. Visitors should not be allowed.

Aerosol-generating patients and procedures must be taken special care of, like procedures in nasal and oral cavity, nasogastric tube insertion, tracheostomy etc.

Regular cleaning is required to keep ward/OPD covid-free. Freshly prepared 1% sodium hypochlorite can be used as a disinfectant for cleaning and disinfection, leaving the solution for 10 minutes. Alcohol (e.g. isopropyl 70% or ethyl alcohol 70%) can be used to wipe down surfaces where the use of bleach is not suitable, e.g. metals.

Before each patient contact equipments should be sanitised with 70% alcohol-based rub/spirit swab. Endoscopes can be sterilized by immersing in 2% glutaraldehyde solution for 20 minutes.

ENT surgical procedures are associated with very high transmission risk because upper aerodigestive tract is the post of entry, nidus and exit route for the coronavirus.

Corona positive patients may be operated only in emergency cases and that too in designated OT for covid patients. When not practical, the operating room for such cases must be dedicated and as close as possible to the entrance of the OT block.