key: cord-0981267-cofkzsx1 authors: Bang, Ji-In; Lee, Ho-Young; Cho, Young Seok; Choi, Hongyoon; Chong, Ari; Eo, Jae Sun; Kim, Ji Young; Kim, Tae Sung; Kwon, Hyun-Woo; Lee, Eun Jeong; Lee, Eun Seong; Park, Hye Lim; Park, Soo Bin; Shim, Hye-kyung; Song, Bong-Il; Yoo, Ik Dong; Lee, Kyung Jae; Lee, Hong Jae; Han, Su Ha; Lee, Jin Seo; Park, Jung Mi; Kim, Sung Hoon title: KSNM/KSID/KOSHIC Guidance for Nuclear Medicine Department Against the Coronavirus Disease 2019 (COVID-19) Pandemic date: 2020-08-11 journal: Nucl Med Mol Imaging DOI: 10.1007/s13139-020-00660-9 sha: 58b0a193bd48c5556b728159046fe14f073ff8a2 doc_id: 981267 cord_uid: cofkzsx1 The dramatic spread of Coronavirus Disease 2019 (COVID-19) has profound impacts on every continent and life. Due to human-to-human transmission of COVID-19, nuclear medicine staffs also cannot escape the risk of infection from workplaces. Every staff in the nuclear medicine department must prepare for and respond to COVID-19 pandemic which tailored to the characteristics of our profession. This article provided the guidance prepared by the Korean Society of Nuclear Medicine (KSNM) in cooperation with the Korean Society of Infectious Disease (KSID) and Korean Society for Healthcare-Associated Infection Control and Prevention (KOSHIC) in managing the COVID-19 pandemic for the nuclear medicine department. We hope that this guidance will support every practice in nuclear medicine during this chaotic period. Since the first reports of Coronavirus Disease 2019 in Wuhan, China, the infection had spread worldwide rapidly and COVID-19 has reached pandemic levels. In South Korea, since its outbreak in February 2020, COVID-19 has affected profoundly every aspect of communities. The human-to-human transmission of COVID-19 provides challenges for all healthcare facilities and healthcare providers. In the face of the COVID-19 pandemic, the Korean Society of Nuclear Medicine (KSNM), Korean Society of Infectious Disease (KSID), and Korean Society for Healthcare-Associated Infection Control and Prevention (KOSHIC) have prepared the guidance for the nuclear medicine department to minimize confusion and ensure that nuclear medicine physicians and technicians continue to provide their services while protecting the patients and workers and preventing the transmission of the virus. The Quality Control Committee of KSNM reviewed several reports and recommendations previously published by the European Association of Nuclear Medicine (EANM) [1] , Society of Nuclear Medicine and Molecular Imaging (SNMMI), American Society of Nuclear Cardiology (ASNC) [2] , International Atomic Energy Agency (IAEA), and others [3] [4] [5] [6] . This guidance is basically in compliance with the COVID-19 guidelines of the Korea Centers for Disease Control and Prevention (KCDC) [7] [8] [9] [10] . Finally, this document was prepared in cooperation with KSID and KOSHIC. KSNM emphasize that this guidance must be considered in the context of following the state and hospital infection control policies and flexibly applied according to changes in circumstances and evidence. General Principles During COVID-19 Pandemic 1. In a pandemic situation, such as COVID-19, if necessary, the condition of the scheduled patient can be checked in advance to adjust the examination schedule. 2. Non-urgent, elective studies or therapy should be postponed in COVID-19-confirmed or COVID-19-suspected patients. Rescheduling the studies/therapy must be done in a discussion with the referring clinicians. 3. Only urgent studies or therapy could be performed in COVID-19-confirmed or COVID-19-suspected patients whenever clinically appropriate. The priority of study/ therapy should be based on a case-by-case in-depth discussion between nuclear medicine physicians and referring clinicians. In case of performing the urgent studies/ therapy, consult with the infection control offices of each institution to comply with the infection control rules of own. 4. COVID-19-suspected patients should undergo COVID-19 testing before performing the studies/therapy. 5. Lung ventilation scan should not be performed in any COVID-19-confirmed or COVID-19-suspected patients. 6. Low-dose radioiodine therapy may be considered in case of acute hyperthyroidism patients who are unable to tolerate anti-thyroid medications. As low-dose radioiodine therapy (lower than 1.2 GBq of I-131) can be performed in an outpatient setting in South Korea, COVID-19infected patient can be administrated low-dose radioiodine in the isolation room or negative pressure room without any additional monitoring related to radioiodine therapy. Consideration During the Study/Therapy & Mainly use disposable instruments or items. Do not reuse disposable items such as oxygen masks, nasal prongs, suction tubes, or suction lines. The protocol for reusable devices is as follows: 1) Cleaning 1) After use, the equipment contaminated with blood, body fluids, secretions, and feces should be delivered to a washing room with care not to contaminate the surrounding environment. 2) The washing place should be separated from the space used for cleaning other items or other patients. After immersing the contaminated equipment in a washing space, wash the product carefully to avoid splashing. 3) Wash enough to remove blood, body fluids, secretions, and feces from remaining. Staff undertaking cleaning should wear KF94 or N95 masks, long-sleeved waterproof gowns, goggles or face shields, hats, shoe covers or rubber boots, and double gloves (outer gloves are rubber gloves). 2) Disinfection and sterilization 1) Depending on the risk level of the device (according to the Spaulding Classification of medical equipment/devices), non-critical devices require low-level disinfection, semicritical devices require high-level disinfection/sterilization, and critical devices must be sterilized. & General principle 1) Personnel responsible for cleaning or disinfection should complete the infection prevention education. 2) Employees should wear PPE (KF94 or N95 respirators, full-body protective clothing or aprons, goggles or face shields, shoe covers or rubber boots, double gloves (outer gloves are rubber gloves)) when cleaning or disinfecting. If there are organic substances on the surface of the environment, it cannot be properly disinfected. Therefore, wipe the surface before disinfecting the environment. 4) In order to prevent the possibility of microbial spraying, cleaning should be performed using a cleaning solution or a mop moistened with a disinfectant, rather than a cleaning method using a broom or a vacuum cleaner. 5) Instead of spraying disinfectants, thoroughly clean the surface of the environment using a clean towel moistened with the disinfectant or a commercially available disinfecting tissue (towel). Use cleaning tools as disposable as possible or exclusively. However, when the cleaning tool is reused, the used cleaning tool is sterilized using an appropriate disinfectant and then dried and stored. & Disinfection of a patient's space (area) 1) In the case of the space (area) used by the patient, mark the place where contamination was confirmed before cleaning and disinfecting the surface and seal the contaminated object (to prevent others from being exposed). 2) Ventilation before, during, and after cleaning/ disinfection (disinfection after ventilation for 1 h based on 6 air cycles per hour). . & Thoroughly ensure that pathogens are not exposed to personnel handling the laundry or surrounding environment during the entire process of collecting, transporting, and washing laundry. & Waste related to COVID-19 patients is managed by the rules of hospital infectious control policy. & Sharp tools, such as needles or blades, are collected in containers for impervious and non-permanent waste, and containers should be stored in the place where the items are used. & Simple infectious waste contaminated or possibly contaminated with COVID-19 patients' sample is autoclaved and discarded. Radioactive waste should be discarded in compliance with national regulation with caution not to contaminate the staff or area. Considering that outbreaks of novel viruses have been periodically appearing these days, nuclear medicine staffs should get used to guidance and policies for infectious disease in working place to protect patients, worker themselves, and furthermore valuable medical resources. Basically, this guidance can be applied in case of any other human-to-human transmission disease for operating the nuclear medicine department. Also, always bear in mind the rapid change in the situation; this guidance should be used in conjunction with the current government and local hospital policies. COVID-19 pandemic: guidance for nuclear medicine departments Guidance and best practices for nuclear cardiology laboratories during the coronavirus disease 2019 (COVID-19) pandemic: an information statement from ASNC and SNMMI COVID19-nuclear medicine departments, be prepared! Policies and guidelines for COVID-19 preparedness: experiences from the University of Washington Suggestions for safety and protection control in Department of Nuclear Medicine during the outbreak of COVID-19 COVID-19: guidance for infection prevention and control in nuclear medicine Standard guideline for healthcare-associated infection control and prevention. Korean Center for Disease Control and Prevention and Korean Society for Healthcare-Associated Infection Control and Prevention Korean Society for Healthcare-Associated Infection Control and Prevention Guidelines in response to coronavirus disease for local government. Korea Centers of Disease Control and Prevention Disinfection guidelines to prevent the spread of COVID-19 at public and multi-purpose facilities. Korea Centers of Disease Control and Prevention Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations Ethical Approval This work does not contain any studies with human participants or animals performed by any of the authors.Informed Consent Not applicable.