The COVID-19 Outbreak Action Plan for Endoscopy Services in a Tertiary Hospital in East Malaysia

The COVID-19 Pandemic continues to evolve and its effects will leave a lasting impact on all levels of health care delivery system long after the dust settles. The Endoscopy unit which is an integral component of gastroenterology services has been recognised as a potential portal of transmission with prospective ascertainment of endoscopist exposure to infectious particles during GI procedures. The State of Sabah recorded its first COVID-19 positive case on March 12th, 2020. To date there has been a total number of 402 confirmed cases and 8 deaths recorded in this state. At our Endoscopy unit, a new Action Plan was introduced to the existing framework as a response measure to ameliorate the risk of nosocomial transmission. The strategies drawn up were predicated on local statistics of clinical presentation, recognised mode of transmission and clinical urgency of performing a procedure. Postponement of all elective cases at our unit was a major decision justified by reports of community spread of COVID-19 infection. Local data which disclosed a large proportion of asymptomatic COVID-19 patients, were a crucial factor in our decision to subject every patient under the semi urgent list to RT-PCR testing prior to an endoscopic procedure. These policies were executed with the objective of protecting our workforce and minimising the risk of nosocomial transmission in the unit. Though it may not address every clinical eventuality, our aim with these risk management strategies, is to maintain zero percent infection while continuing to provide optimal endoscopy services.