Practical considerations for spirometry during the COVID-19 outbreak
The COVID-19 pandemic has left many industries with questions of how they can continue to operate and maintain protocols without putting anyone at risk of contracting this highly contagious disease. One particularly illusive solution is how can spirometry tests be conducted?
A review published in the Pulmonology Journal aims to summarize the main differences and similarities among recommendations by different international organizations. In doing so, this should bring clarity to providing respiratory services to outpatients during the COVID-19 pandemic.
This study showed a synthesis of national and international guidelines allowing practicing physicians to adapt and shape the way to organize their outpatient services locally. There is generally good agreement on the importance of limiting pulmonary function testing to selected cases only. However, significant differences concerning the subsets of candidate patients, as well as on the management of adequate room ventilation, were observed.
The first table in the report summarizes the recommendations on performing Pulmonary Function Tests (PFTs). Through the table it has been determined that it is recommended that only patients who urgently require PFTs should be tested. Providing patients with a drive by option, allows for them to remain in the safety of their vehicles for testing. This also reduces the chances of the personnel contracting the virus. It is also recommended that patients visit the clinic or practice on their own as this will reduce the amount of people in the waiting rooms. Regularly cleaning the device ensures that there will be no cross contamination.
There is a recommended waiting period of 30 minutes between patients, to ensure that the testing room or space has enough time to ventilate.
The use of nose clips, disposable filters and careful cleaning of equipment with alcohol based solutions after each use is highly recommended. Steps taken for better ventilation have brought some medical examinations to be done outside, where the patient even remains in their own personal vehicle.
In a position statement released by the South African Thoracic Society, in line with other international respiratory societies, recommendations were given in order for clinics and professionals to provide safe and effective testing during the pandemic. SATS recommends the following guidelines in order for clinics to have a safe environment:
- Personnel that are performing tests should be assessed for high risk factors for severe COVID-19 disease. High risk personnel should not perform PFTs.
- Patients undergoing lung function tests should be screened using a detailed COVID-19 questionnaire
- For asymptomatic patients should undergo a PCR test before having a PFT test performed on them.
- Testing capacity should be reduced to 50% of the original testing capacity, in order to ensure that social distancing is maintained. As well as to ensure that there is adequate testing time.
- Contact time between patients and clinicians should be minimised where possible. Use of instructional videos and other means of teaching patients how to perform forced expiration and other manoeuvres.
- PFTs should be done in a well ventilated environment, and only the patient and limited personnel should be in the room. Before testing commences, the room should be disinfected and ventilated.
- Personnel should be supplied with the appropriate PPE, as well as provided with an understanding of the correct way to use it.
- Surfaces should be sanitized after each patient to ensure the environment is sterile.