P4100 - Long-Term Follow Up Data from a Prospective Quality Improvement Intervention for the Prevention of Corneal Abrasions During Endoscopic Procedures in the Post-COVID-19 Era

Reza Milano, MD, MPH¹, Shida Haghighat, MD, MPH², Chunsu Jiang, MD³, Frederick Soriano, RN, BSN¹, Daniel A. Sussman, MD, MSPH¹, Jamie S. Barkin, MD, MACG¹, Sean Bhalla, MD¹, Sunil Amin, MD, MPH¹, Shria Kumar, MD, MSCE¹, Jodie A. Barkin, MD, FACG^4
1University of Miami Miller School of Medicine, Miami, FL; ²UCLA, Los Angeles, CA; ³GI North, Cumming, GA; ⁴University of Miami Miller School of Medicine, Boca Raton, FL

Introduction: Corneal abrasion (CA) is the most common ocular adverse event from non-ocular surgery under sedation. CA is a known but rare complication after endoscopy. Patients undergoing endoscopy after COVID-19 pandemic onset were required to wear surgical masks during all endoscopic procedures and peri-procedurally in the recovery area, resulting in an increased rate of CA. Our aim was to document the rate of CA before and after implementing universal surgical mask taping to nose bridge and bilateral eye taping prior to endoscopy.

Methods: All patients undergoing endoscopy at our academic tertiary referral center were screened for symptoms of CA in the endoscopy recovery area and via nurse phone call post-procedure. All CA were reported using an adverse event reporting system. Use of a surgical mask for all patients undergoing endoscopy was mandatory from 3/1/2020 to 4/3/2023. CA reporting prompted a QI intervention on 9/1/2020 consisting of taping the surgical mask to the nose bridge to prevent caudal migration and bilateral eye taping. Adverse event rates of CA (AER-CA) were compared to a historical control of the endoscopy unit for the 14 months prior to COVID-19 (BASELINE, 1/1/2019-2/29/2020), during the COVID-19 era prior to QI intervention (COVID PRE-QI, 3/1/2020-8/31/2020), and during/after the COVID-19 era post-QI intervention (POST-QI, 9/1/2020-4/3/2023). AER-CA were compared using Fisher’s Exact test.

Results: A total of 47,309 endoscopic procedures were performed with sedation during the COVID PRE-QI and POST-QI periods. BASELINE AER-CA was 0.03% (3/10,715). AER-CA of COVID PRE-QI was 0.09% (4/3,243). The POST-QI AER-CA was 0 (0/44,066 procedures). The POST-QI AER-CA was significantly lower compared to BASELINE (p< 0.01), COVID PRE-QI (p< 0.01), and overall PRE-QI (p< 0.01) periods.

Discussion: Changes to patient safety protocols in the COVID-19 era presented new challenges. Complications in the intra- and peri-endoscopic periods included increased CA likely from caudal migration of surgical masks. The increase in AER-CA in the COVID PRE-QI era compared to BASELINE (p 0.055), and a significant decrease in AER-CA in the POST-QI period suggests that iatrogenic CA are a significant but easily preventable complication of endoscopy. Implementation of a simple QI intervention with taping of the surgical mask to nose bridge and taping eyes closed is an efficacious method of preventing CA in patients undergoing endoscopy and should be made routine practice.


Disclosures:


Reza Milano, MD, MPH¹, Shida Haghighat, MD, MPH², Chunsu Jiang, MD³, Frederick Soriano, RN, BSN¹, Daniel A. Sussman, MD, MSPH¹, Jamie S. Barkin, MD, MACG¹, Sean Bhalla, MD¹, Sunil Amin, MD, MPH¹, Shria Kumar, MD, MSCE¹, Jodie A. Barkin, MD, FACG⁴. P4100 - ­Long-Term Follow Up Data from a Prospective Quality Improvement Intervention for the Prevention of Corneal Abrasions During Endoscopic Procedures in the Post-COVID-19 Era, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.