key: cord-1042402-32exlqly authors: Leitmeyer, Katharina; Felton, Mark; Chadha, Neil K. title: Strategies for restarting Pediatric Otolaryngology outpatient clinics after a pandemic-related shutdown such as from COVID-19 date: 2020-10-01 journal: Int J Pediatr Otorhinolaryngol DOI: 10.1016/j.ijporl.2020.110414 sha: c98bfdd4f9737a95b9dc6a5137a54555cc7473cb doc_id: 1042402 cord_uid: 32exlqly The novel coronavirus 19 SARS-CoV2 caused a change in the practice of Otolaryngology around the globe. The high viral load in the nasal cavity, nasopharynx and airway subjects Otolaryngologists to a high risk of catching the virus during aerosol generating procedures. After the first outbreak wave has subsided, many teams are now discussing how our ‘new normal’ practice will look. We share our guidelines on restarting elective clinical work in order to create a safe environment for patients and staff in a Pediatric Otolaryngology outpatient clinic. Otolaryngology around the globe. The high viral load in the nasal cavity, nasopharynx 65 and airway subjects Otolaryngologists to a high risk of catching the virus during 66 aerosol generating procedures. After the first outbreak wave has subsided, many 67 teams are now discussing how our 'new normal' practice will look. We share our 68 guidelines on restarting elective clinical work in order to create a safe environment for 69 patients and staff in a Pediatric Otolaryngology outpatient clinic. Main Text 110 Our team consists of five Pediatric Otolaryngologists. For restarting elective clinics, a 112 maximum of two physicians will run clinics simultaneously. One surgeon will be 113 running an initially reduced elective operating list, with a plan to increase cases up to 114 full operating capacity over four weeks. The rest of the physicians will work remotely 115 from home performing telehealth clinics, with telehealth being shown to be helpful for 116 the families despite some challenges (7). One Resident and one Fellow are The use of portable HEPA purifiers could be considered as recommended by 136 Only equipment required for each individual patient is to be out during a consultation, 138 with all dirty and unused equipment removed at the end of each consultation. A filter 139 on the suction should be considered. Thorough cleaning of surfaces with >70% 140 alcohol wipes must be performed after every patient visit as it is known that the virus 141 can remain on surfaces for hours to days (9). 142 143 All patients are evaluated via a physician telehealth consultation to be triaged. Full 145 history is taken and a provisional plan formulated, including whether in-person 146 appointment is required, and to determine if a trans-nasal flexible fiberoptic-147 laryngoscopy (FFL) will be needed. If the patient needs to be seen in person, a clinic 148 appointment will be scheduled and COVID-19 screening will be performed by phone. 149 No COVID-19 testing will be required in asymptomatic patients. Only one parent will 150 be allowed to accompany the child to the clinic. It is requested that face masks are 151 worn. They are informed to call the MOA on their arrival to the hospital. If an empty 152 examination room is available, they will be directed to come to the clinic to that 153 specific room. If not, they will be asked to wait outside the hospital or in their car until For a normal Ear Nose Throat (ENT) examination, the physician is wearing contact 165 and droplet protections (mask with a face shield or goggles, gown, gloves). For 166 aerosol generating procedures we recommend using a N95 mask with goggles or 167 PAPR (if available) as recommended by Howard, but local guidelines should be 168 followed for PPE (10). FFL should be performed by using a camera, screen and 169 video capture equipment to maximize the distance between the patient and the 170 physician and limit the time needed to scope. In view of the often difficult compliance 171 in children during FFL, we recommend considering N95 masks even in asymptomatic 172 patients. The use of a pre-prepared modified mask for the patient with a hole for the 173 scope should also be considered to cover the nose and the mouth during the 174 endoscopy depending on the age and the compliance of the patient. A significant 175 reduction of aerosol spread has been shown (11). The scope is wiped and stored in a 176 covered box before transport for sterilization. 177 178 3. Discussion 179 The first phase of the pandemic changed the practices of Otolaryngologists all over 180 the world to a largely emergency-driven service (4,5). With reducing COVID-19 case 181 numbers in many countries and lockdown measures being eased, Otolaryngologists 182 are working towards restarting their elective clinics. Telehealth has been useful in 183 recent weeks and will continue to play an important role in the future, especially with 184 reduced ability to see as many patients face-to-face as previously (12) . Avoiding 2. World Health Organization (WHO). WHO Director-General's opening remarks 201 at the media briefing on COVID-19: 11 SARS-CoV-2 viral load in upper respiratory 204 specimen of infected patients COVID-19 and ENT Pediatric 206 otolaryngology during the COVID-19 pandemic. Guidelines of the French 207 Association of Pediatric Otorhinolaryngology Eur Ann Otorhinolaryngol Head Neck Dis Safety recommendations for evaluation and 211 surgery of the head and neck during the COVID-19 pandemic. 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