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Prevention of nosocomial SARS-CoV-2 transmission in endoscopy: international recommendations and the need for a gold standard
  1. John Ong1,2,3,
  2. Gail B Cross1,4,
  3. Yock Young Dan1,5
  1. 1 Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  2. 2 Department of Engineering, University of Cambridge, Cambridge, UK
  3. 3 Gastroenterology Specialty Training Programme, East of England Deanery, Cambridge, United Kingdom
  4. 4 Division of Infectious Diseases, National University Hospital, Singapore
  5. 5 Division of Gastroenterology and Hepatology, National University Hospital, Singapore
  1. Correspondence to Dr John Ong, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; jo401{at}

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Over 3000 healthcare workers (HCW) in China are suspected of having coronavirus disease 2019 (COVID-19) and over 1700 tested positive.1 These statistics underline the need for robust preventative measures against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Endoscopy departments are fertile grounds for viral spread because aerosolisation of bodily secretions occurs during procedures. A single viral-shedding patient with a high viral load can contaminate an entire endoscopy room with the virus that remains viable for up to 3 days, putting uninfected patients and HCWs at risk.2 3

Singapore previously had the largest cohort of COVID-19 patients outside China in the early phases of the outbreak. Given its novelty, the effectiveness of new preventative measures implemented within our endoscopy services was unknown. To determine best practice, we conducted systematic searches of literature and official websites for gastroenterology and endoscopy societies (n=28) in the 15 most-affected countries to scrutinise recommendations and associated evidence. Methodology is available on request.

In summary, we found careful patient selection was commonly …

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