RECOMMENDATIONS FOR PERFORMING OROPHARYNGOSCOPY IN CHILDREN AND ASSOCIATED CARE DURING COVID-19 PANDEMIC
IAPO – Interamerican Association of Pediatric Otorhinolaryngology
Regarding the diagnosis of PHARINGOTONSILITIS and the performance of OROPHARYNGOSCOPY and considering that CHILDREN have an IMPORTANT role in the community transmission of coronavirus and that a significant number of Otolaryngologists and Pediatricians were infected and unfortunately died from COVID-19, it is RECOMMENDED:
I- For children with acute oropharyngeal complaints, who seek EMERGENCY FACILITIES the medical provider must be suitably attired with the appropriate PPE as listed below. For the clinical diagnosis of streptococcal pharyngitis / tonsillitis, microbiological confirmation is always required by Quick Strep A test or by culture. Remember that viral processes are accompanied by runny nose, cough and conjunctival hyperemia.
Ia. In children with suspected viral conditions that have a significant impact on their well being (RSV, Influenza, Parainfluenza, Adenovirus) or bacterial (Mycoplasma, Chlamydia or Bordetella) among others, rapid test for Influenza and / or RSV or molecular panels for diagnosis of viral agents along with Coronavirus test should be performed. This increases the chance to determine a specific diagnosis, reassure families (by excluding diagnosis of COVID-19) and the management with the appropriate treatment according to the microbiological diagnosis.
II- Children with acute episodes who seek EMERGENCY FACILITIES most likely have more severe cases of pharyngotonsillitis (viral or bacterial)- as they did not follow the restrictions recommendations.
III- The exam of the mouth and oropharynx and the performance of nasal and pharyngeal swabs should be performed using the same care and attire recommended for patients suspected of COVID-19 in an aerosol-generating situation.
IIIa. The use of a disposable waterproof gown, N95 mask, goggles, and gloves (perform the indicated sequence of attire) before entering the exam room or isolation box.
IIIb. The N95 mask is for individual use and may be reused by the same professional. It can be reused as long as it is clean and intact. The presence of facial hair where the mask contacts with the face (beard, mustache, sideburns), drastically reduces its protective capacity and should be avoided. *
IIIc. Only the people involved in the procedure should stay in the room. The door must remain closed.
IIId. The exam room must be thoroughly cleaned and disinfected after the patient leaves the room.
IIIe. Pediatricians and Otolaryngologists who are immunosuppressed or pregnant women should not provide care to patients with suspected COVID-19.
IV- In large hospitals, with Pediatrics and Otorhinolaryngology Departments it is recommended to divide them in at least two teams (ideally including other health professionals and collaborators) that will take care of inpatients or emergency patients every 1 or 2 weeks. Measures must be taken to avoid contact between professionals from different teams.
*According to the IPOG (International Pediatric Otolaryngology Group) COVID19 Survey (published on April 1, 2020) the use of the N95 / FFP3 mask is only available to 58% of the medical providers during clinical procedures that generate aerosols in 306 Pediatric Otorhinolaryngology Departments and Institutions from all the continents (around 100 represented IAPO).
Departamento de Otorrinolaringologia do Hospital Pequeno Príncipe: Lauro João Lobo Alcantara, Rodrigo Guimaraes Pereira, Fabiano Bleggi Gavazzoni, André Ataide, Elise Zimmermann Mathias, Trissia maria Farah Vassoler, Ian selonke, Juliana Benthien Cavichiolo, Mirian Beatriz Grupenmacher, Leila Crisgiovani, Rafaela Mabile Sobreiro