Minimizing endoscopist facial exposure to droplets: Optimal patient‐endoscopist distance and use of a barrier device

Abstract

Background and Aim Minimizing endoscopist exposure to bodily fluids is important for reducing the risk of infection transmission. This study investigated the patient‐endoscopist vertical distance necessary to minimize an endoscopist's facial exposure to a patient's visible droplets during upper gastrointestinal endoscopy and the ability of a new device to prevent droplets from reaching the endoscopist's face. Methods A model was developed to simulate a patient experiencing a forceful cough during an upper gastrointestinal endoscopy with a model endoscopist. Fluorescent dye was expelled from the model patient's mouth towards the model endoscopist during simulated coughs; dye adhesion to the model endoscopist's face was evaluated using ultraviolet light. The simulation was repeated with the model patient positioned 70–100 cm above the floor, with and without a barrier to shield the patient's face. The accuracy of the cough simulation model and the relationship between patient‐endoscopist vertical distance and endoscopist's facial exposure were evaluated. Results The flow dynamics of the cough simulation model were similar to that of an actual human cough. There was a significant inverse correlation between the patient‐endoscopist vertical distance and the model endoscopist's facial exposure, with positive exposures decreasing from 87% at 70 cm to 0% at 100 cm (P < 0.001). The barrier device prevented facial exposure to droplets at all distances. Conclusions We found that positioning the patient at least 100 cm below the top of the endoscopist's head or using a barrier device minimized the endoscopist's facial exposure to visible droplets during upper gastrointestinal endoscopy.