key: cord-0807793-ma3ndg41 authors: Tarantini, Giuseppe; Fraccaro, Chiara; Chieffo, Alaide; Marchese, Alfredo; Tarantino, Fabio Felice; Rigattieri, Stefano; Limbruno, Ugo; Mauro, Ciro; La Manna, Alessio; Castiglioni, Battistina; Longoni, Matteo; Berti, Sergio; Greco, Francesco; Musumeci, Giuseppe; Esposito, Giovanni title: Italian Society of Interventional Cardiology (GISE) position paper for Cath lab‐specific preparedness recommendations for healthcare providers in case of suspected, probable or confirmed cases of COVID‐19 date: 2020-04-11 journal: Catheter Cardiovasc Interv DOI: 10.1002/ccd.28888 sha: ffba777376718ef2a0dd74a8eab90e2bfacd240f doc_id: 807793 cord_uid: ma3ndg41 COVID‐19 pandemic raised the issue to guarantee the proper level of care to patients with acute cardiovascular diseases and concomitant suspected or confirmed COVID‐19 and, in the meantime safety and protection of healthcare providers. The aim of this position paper is to provide standards to healthcare facilities and healthcare providers on infection prevention and control measures during the management of suspected and confirmed cases of 2019‐nCoV infection accessing in cath‐lab. The document represents the view of the Italian Society of Interventional Cardiology (GISE), and it is based on recommendations from the main World and European Health Organizations (WHO, and ECDC) as well as from the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI). new coronavirus, SARS Cov-2, transmission, prevention, infections, healthcare protection With the spread of deadly SARS-Cov-2 (2019-nCoV) infection worldwide, it is essential to be prepared to manage suspected, probable or confirmed cases of coronavirus disease 2019 (COVID-19) patients, who need nondeferrable invasive procedures in cath lab. 1-3 SARS-Cov-2 has the same stability on aerosol and surface of SARS-Cov- 1, 4 but the rate of transmission is higher. 5 This seems related to the higher viral load in upper respiratory tract, and the potential for persons infected with SARS Cov-2 to transmit the virus while asymptomatic. 6, 7 It has been shown that on Diamond Princess cruise ship, 17 .9% of these passengers were asymptomatic carriers of COVID- 19 . 8 Others found that the proportion of pre-symptomatic transmission was 48-62% for Singapore and Tianjin respectively. 9 Most secondary cases of virus transmission of SARS-CoV-2 appear to be occurring in community settings rather than healthcare settings. Notwithstanding, the healthcare setting is also vulnerable to the introduction and spread of SARS-CoV-2, and its environmental stability contributes to transmission of the virus in healthcare settings. To this regard, it has been reported that 41% of COVID transmission in Wuhan were hospital related. 10 It is then fundamental to guarantee a proper protection of healthcare workers (HCWs) for their own health, to minimize the risk of spreading the infection to other health care providers and patients, and finally to guarantee the proper level of care in cath lab in case of suspected or confirmed COVID-19 patients. [11] [12] [13] This position paper summarizes the view of the Italian Society of Interventional Cardiology (GISE), on the base of World Health Organization (WHO), European Centre for Disease Prevention and Control (ECDC) and Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) recommendations. [14] [15] [16] [17] [18] [19] [20] [21] [22] [23] [24] The aim is to provide standards to healthcare facilities and • Apron (for aerosol-generating procedures such as intubation) • Shoe covers due to the risk of splash from organic material or chemicals. It is advised to alert the anesthesiologist beforehand to consider the opportunity of elective intubation before patient arrival in cath lab. In any case, the crash cart must contain: 1. Heat and moisture exchanger (HME) filters to be placed on any interface (mask, circuit, endotracheal tube, supraglottic devices, introducer/exchange pipes) A safe doffing area should be identified in each cath lab, in particular if no anteroom or exists. If no anteroom is available, doffing of PPE could be done inside the lab, at the end of procedure and when the patient has been transferred away. Only facial respirator must be removed outside the contaminated area. 1. Avoid any contact with your face, hair and eyes before of completing the entire doffing process. 8. All useful material for interventional cardiology must be stored inside the lab (for instance a full-size series of catheters, balloon-catheters and stents), avoiding entry and exit of the staff members during procedure. 9 . Any useful drugs have to be prepared in advance. 10 . Supervised donning PPE for all the member of the staff (it is suggested to have at least one physician and one nurse sterile and one nurse and one technician nonsterile). 11 . Only when all is prepared, accept the patient in cath lab. 12. If in spontaneous breathing, the patient must wear a surgical mask before entry the lab. 2. Supervised doffing as previously described; if no anteroom is available, doffing of PPE could be done inside the room, at the end of procedure and when the patient has been transferred away. Only facial respirator must be removed outside the contaminated area. 3. Dispose of all waste according to protocols (do not squeeze contaminated material into the container). 4 . Treat used tissues in accordance with standard procedures. 5. Get out of the operating room and keep the door closed for at least an hour prior to performing a terminal clean (in particular for a neutral pressure room). 6. Reuseable equipments have to be decontaminated according to the manufacturer's instructions (i.e., lead apron). 7. Notification of any new confirmed case. 8 . A record of all staff providing care for suspected or confirmed 2019-nCoV cases must be maintained. 9. If at any point a member of the staff feels as he/she has been exposed to the pathogen, follow facility protocols. 10 . Staff who have been provided care to confirmed 2019-nCoV cases, should be vigilant for fever and any respiratory symptoms in the 14 days following the last exposure to a confirmed case, and follow internal protocols. ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: task force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the American College of Cardiology's (ACC) Interventional Council and the Society of Cardiovascular Angiography and Intervention (SCAI)Catheterization laboratory considerations during the coronavirus (COVID-19) pandemic: from ACC's interventional council and SCAI Consensus document of the interventional cardiology and heart rhythm associations of the Spanish Society of Cardiology on the management of invasive cardiac procedure rooms during the COVID-19 coronavirus outbreak. 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World Health Organization 2020 Critical preparedness, readiness and response actions for COVID-19 Infection prevention and control during health care when novel coronavirus (nCoV) infection is suspected. Interim Guidance Geneva 2020 Rational use of personal protective equipment for coronavirus disease 2019 (COVID-19) Advice on the use of masks in the community, during home care and in health care settings in the context of the novel coronavirus (2019-nCoV) outbreak. Interim guidance European Centre for Disease Control and Prevention. Interim infection prevention and control recommendations for patients with confirmed coronavirus disease 2019 (COVID-19) or persons under investigation for COVID-19 in healthcare settings Safe use of personal protective equipment in the treatment of infectious diseases of high consequence Stockholm: ECDC Interim U.S. guidance for risk assessment and public health management of healthcare personnel with potential exposure in a healthcare setting to patients with coronavirus disease (COVID-19) Procedura Area Critica SIAARTI/SIAARTI%20-%20Covid19%20%20Percorso%20Area%20 Controllo Delle Vie Aeree Gestione del Paziente Critico Affetto da Coronavirus: Raccomandazioni per la Gestione Locale Available from The authors declare no potential conflict of interest.