Old Threat, New Enemy: Is Your Interventional Radiology Service Ready for the Coronavirus Disease 2019?

Abstract

A new coronavirus was discovered after a cluster of pneumonia cases emerged in Wuhan City, Hubei Province, China, in December 2019 [1,2] and has since spread widely within China and to several countries. The World Health Organisation (WHO) declared the epidemic a Public Health Emergency of International Concern on 30 Jan 2020 and advised all countries to be prepared.Despite the timely and robust response compared to the 2003 Severe Acute Respiratory Syndrome (SARS) epidemic, the epidemic continues to worsen. The lessons gleaned from our experience during the SARS epidemic [3,4] are still very relevant today as we get our interventional radiology (IR) service ready for this epidemic. While the following measures we propose may appear strict, it is prudent to be more proactive when dealing with a novel infection.First, patients with different infection risks are segregated by place where possible, or by time otherwise, to prevent cross-infections. This will entail performing procedures on isolated patients separate in place and time from other patients. Given the evidence of asymptomatic transmission [5], it may become necessary for all staff to wear a minimum of personal protective equipment for all procedures.Second, segregation of staff. For groups covering multiple hospitals, segregation of manpower to different sites will minimise the risk of cross-transmission. If intra-hospital transmission occurs, segregation of staff within institutions into independent teams will be needed to prevent shutdown of the entire team should a quarantine be required.Third, careful vetting and prioritising of requests, to assess both the infection risks and the urgency of each procedure. We have chosen to reduce our workload to allow for ramping up of infection control measures. One approach is to continue with urgent and elective oncologic procedures, while postponing an appropriate number of other elective cases. The IR clinic plays an important role in this regard for us to triage these patients and communicate directly the measures taken to protect them. Electronic medical records should make this process easier as clinical information is instantly available.Fourth, movement of isolated patients should be minimised, with a strong preference for portable bedside ultrasoundguided procedures. Transfers to predesignated procedural rooms may be inevitable for complicated cases. Potential routes should be planned with relevant colleagues in the institution to ensure swift and safe transfers.Fifth, enhanced workflows within the procedural suites should be structured and rehearsed so that each member is clear about his or her role. This will invariably require more manpower and time than usual.Lastly, strict adherence to WHO's infection prevention and control recommendations. Emphasis should be made to all staff that good infection control measures, hand hygiene, and careful donning and doffing of appropriate personal protective equipment remain our best defence. Where required, staff should be trained in the use of particulate (N95)

Preparing your intensive care unit for the COVID-19 pandemic: practical considerations and strategies

“…Workflows and service continuity for isolated patients who require emergency operations or interventional procedures should be determined. Dedicated operating theatres, radiology, and interventional suites, along with respective subspecialty teams, were designated in our institution [75,76].…”

Contribution of Interventional Radiology to the Management of COVID-19 patient

“…US-guided thoracic interventions like pleural drainage is a safe and practical procedure that can be performed at the bedside with due arrangements for operator's safety in case of infectious patients [3]. The versatility of US-guided procedures fits well with the need to entail procedures on isolated patients in separate places and times [4]. In fact, the possibility to perform the procedure at the bedside avoids the spread of disease outside the dedicated COVID-19 ward and does not require discontinuation of assisted ventilation.…”

Adapting to a new normal? 5 key operational principles for a radiology service facing the COVID-19 pandemic

“…The triage, categorization, and segregation of patients of varying risks during this pandemic continues to be an operational necessity ( Fig. 2) [4]. Given the heterogeneous patient population coursing through any radiology department, definitions of how to categorize patients into non-suspect, suspect, and confirmed COVID-19 cases allow ground staff to understand which patients they can use standard precautions on versus those that require enhanced measures and additional personal protective equipment.…”

“…For general radiography and ultrasound, we have leveraged upon the use of portable examinations to minimize patient movement. For examinations, we lack portable capability for, including MRI and CT, carefully planned routes of transportation ensure minimal spread of pathogen and contact with personnel [4]. Simulation of these transfers have helped identify gaps in the process and should be carefully rehearsed.…”

“…Further, as far as possible, we have performed examinations for all suspect or confirmed cases in negative pressure CT and MRI rooms, installed in response to our previous 2003 severe acute respiratory syndrome (SARS) pandemic, and use full personal protective equipment [8]. Meticulous vetting of examinations is being made to ensure examinations are being done appropriately and add value to patient care [4]. Decontamination for portable x-ray machines includes surface cleaning to the entire machine with standard anti-microbial wipes.…”