key: cord-0994657-vn3ngaxh
authors: Rex, Douglas K.; Vemulapalli, Krishna C.; Lahr, Rachel E.; McHenry, Lee; Sherman, Stuart; Al-Haddad, Mohammad
title: Endoscopy staff are concerned about acquiring COVID-19 infection when resuming elective endoscopy
date: 2020-05-16
journal: Gastroenterology
DOI: 10.1053/j.gastro.2020.05.038
sha: 5da1ea8ec7a5b29b17d91cf902b83e7a3ff278f9
doc_id: 994657
cord_uid: vn3ngaxh

nan

As elective endoscopy resumes in the U.S., little is known about the concerns of endoscopy staff regarding their risk of acquiring COVID-19 by returning to work. We investigated this issue with a survey of endoscopists and staff at a single academic center delivering outpatient endoscopy services. Table 1 ) on April 10, 2020. Staff were eligible if they were endoscopists, nurses, technicians, or registration staff and had direct contact with patients. Six research assistants administered all surveys by telephone. The first and final surveys were conducted April 14 and 24, 2020, respectively. After inquiring about protective measures in question 12, each respondent ranked up to 3 protective measures they considered most important. Indiana permitted the resumption of elective surgical procedures including endoscopy on April 27, 2020 [1] .

To calculate the mean value score for protective measures, we assigned score 0 to "no value", 1 to "little value", 2 to "important, should be done" and 3 to "critical". When respondents provided up to 3 most important protective measures, we assigned a score of 3 for the top measure, 2 for the second most important, and 1 if a third was ranked.

Chi-square and Fisher's test were used as appropriate to compare responses by role (endoscopists versus other staff). McNemar's test was used to compare the level of concern about returning to work before and after critically important safety measures (deemed by each participant) were in place. Significance was set at 0.05. All analyses were performed using SAS Version 9.4 (SAS Institute, Charlotte, NC, USA).

There were 140 eligible staff. Assuming 75% of respondents would have high concern for infection with the same safety measures used before the pandemic, a sample size of 100 had power of 80% to show a 30% decrease in concern after safety measures were implemented (discordant responses ~ 50%) at 0.05 significance.

We reached 106 staff by telephone (28 endoscopists) and the overall participation rate was 94.3% (6 declined to participate).

Among respondents, 78 were women. Mean age was 45.9 +/-11.1 years. Eighty-three were married or living with a partner, 60 had children at home, and 8 had parents at home or were caretakers of parents. Twenty-five were endoscopists, 48 nurses, 16 worked in registration or assessment, and 11 were technicians. Information regarding COVID-19 infection was provided by 67 respondents, of whom 2 (3%) had test proven symptomatic infection, 4 (6%) had symptoms consistent with COVID-19 without testing, and 61 (91%) had neither symptoms nor positive testing.

When asked whether they would be willing to return to work with the pre-pandemic safety Table 2 ). Four respondents preferred daily COVID-19 testing, 49 weekly, and 47 said it did not matter. Table 1 shows perceptions regarding specific protective measures. Four measures were ranked important or critical by ≥ 90% of respondents: patients wear surgical masks at all times, and patients are screened for fever, COVID-19 symptoms, and COVID-19 exposure (Table 1) .

However, when respondents ranked the 3 most important measures, the highest scores were for "all patients undergo … point of care testing for COVID-19; positives are not allowed to enter" (total score 135), followed by "all procedure room staff are provided N-95 masks" (total score 96), and "patients wear masks from initial contact until discharge…" (total score 80). If all measures considered critical were instituted, the fraction very or somewhat concerned was 35% (95% CI: 25.7-45.2), which was lower than the 66% with only pre-COVID measures (p < 0.001).

When asked how effective a treatment for COVID-19 should be to eliminate the need for critical protective measures, 35 responded 75% effective, 23 responded 100% effective, 9 said ≤50% effective, and 33 said the measures should be in place regardless of effective treatment. Without an effective treatment or vaccine, 80% anticipated long-term need for protective measures.

Assuming pre-COVID-19 infection control measures, endoscopists were more often unwilling to return to work compared to non-physician staff (80% vs. 30%; p < 0.001), and more often very or somewhat concerned (88% vs. 59%; p = 0.007). There were 4 measures that 100% of endoscopists considered important or critical (Table 1) . N-95 masks were considered important or critical by more endoscopists than other staff (p = 0.006; Table 1 ). The fraction considering both patient COVID testing and N-95 masks important or critical was 96% for endoscopists and 66.7% for other staff combined (p = 0. 004). With protective measures considered critical in place, the fraction remaining very or somewhat concerned decreased from pre-COVID (from 88% to 28% for endoscopists, p < 0.001; for all others combined from 59% to 37%; p = 0.004).

We identified substantial concern among endoscopy staff regarding resuming elective endoscopy and acquiring COVID-19. After instituting new protective measures viewed as critical, 35% remained very or somewhat concerned.

Assuming pre-COVID safety measures, endoscopists expressed greater concern than other staff.

This might reflect factors such as greater exposure of endoscopists during procedures compared to other staff or greater awareness of GI society recommendations endorsing N-95 masks for endoscopy [2] [3] [4] [5] , or other unknown factors. Our survey is not able to explain the differences between endoscopists and other staff, but both groups perceived lower risk associated with new safety measures that they considered critical.

Study strengths include the response rate (94%) and inclusion of staff with a variety of patient care roles. Limitations include the single center, which could limit generalizability. Staff perceptions may change as new information appears [6] . We did not assess the participants' baseline knowledge of COVID-19 facts and infection control recommendations that could have shaped their opinions.

Endoscopy center leaders should be aware of the potential for substantial anxiety among their staff regarding returning to work during the COVID pandemic, and consider safety measures and educational programs to reduce potential fears and provide a safe work environment. *Number of respondents with given response. Number scoring no value (score 0) or little value (score 1) are not shown **Mean response score among those who did not respond "not sure"/"don't know" ***When respondents were asked to rank up to 3 measures as most critical, the highest rank measure was given a score of 3, and any second and third ranked measures received scores of 2 and 1, respectively. This column is the sum of all top 3 ranking scores for all 100 respondents

State of Indiana Executive Order 20-24: Resumption of elective and non-urgent medical procedures 2020

Use of Personal Protective Equipment in GI Endoscopy

Hi this is ______, research assistant to Dr. Rex in the Division of Gastroenterology at Indiana University. I'm calling to ask if you would be able to answer a brief survey on your willingness to return to work after the return of the endoscopy unit's normal functioning hours. This survey is a research study only and is being conducted by Dr Rex. This study was not commissioned by IUH or by the ASCs for making decisions about patient care in the endoscopy units. The results are for research only and should not be expected to influence future policy at the endoscopy units.

I'll be reading some material to you so that the survey questionnaire is standardized. The actual protective steps in place for staff and patients once the endoscopy unit becomes fully operational again are currently under review and will not be determined by the results of this survey. Completing this survey will take us an estimated 5-10 minutes. Your participation is entirely voluntary and your responses will be kept confidential and anonymous. We hope to talk to about 100 staff members. Are you willing to help us by participating in the survey? reducing your concern about returning to work. Your choices include: no value, a little value, important-should be done, critical for your confidence, and not sure/don't know.When we are finished with going through these, I'll ask you to rank the ones that you consider to be the most important for increasing your confidence about the safety of returning to work. Don't worry, I'll read them back to you so you don't need to try and rank them the first time through.12. Please rate the value of each of the following measures in reducing your concern about returning to work? Thanks for participating in this research study. The questions in the survey should not be considered to indicate that any of the mentioned steps are either necessary or effective, or that they will be available for use in the endoscopy center. This survey is a research study, and should not expected to influence practice in the ASCs.Supplementary Table 2 . Level of concern about acquiring COVID-19 infection by returning to work, assuming same infection control measures as February 2020 and after initiation of safety practices considered critical by the respondents Level of concern about returning to work with regard to becoming infected with COVID-19