Safe Nasendoscopy Assisted Procedure (SNAP)
The SNAPe-i is easily fitted onto all conventional surgical masks, the patient then wears the mask and aligns the SNAPe-i with their nostril. This enables the surgeon to perform a nasendoscopy while minimising their risk of infections should the patient cough or splutter.
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In 2012, Ajuth George and Chris Coulson ear, nose, and throat (ENT) surgeons from University Hospitals North Midlands and Queen Elizabeth Hospital Birmingham founded Endoscope-i. The team also consists of Mark Price, Senior Lecturer in Engineering Aston University and Simon Pargeter, Technical Director.
With the COVID-19 crisis, the team researched on how it would be safe to continue performing nasendoscopic procedures. They have created a resealable port in surgical masks, the SNAPe-i, to give access for endoscopes through personal protective equipment (PPE). The SNAPe-i is easily fitted onto all conventional surgical masks, the patient then wears the mask and aligns the SNAPe-i with their nostril. This enables the surgeon to perform the procedure whilst minimising their risk of infections from patients with confirmed COVID-19 or possible COVID-19.
Nasendoscopy is an endoscopic procedure where an ENT surgeon examines a patient's nose, throat, and voice box - principally to diagnose medical conditions (often cancer) and to assess the success of therapeutic interventions. Approximately 500,000 procedures are performed per year in the UK. The procedure is carried out in the out-patient clinic with the patient awake, but due to the typical mild coughing and sneezing during this procedure it has been classified as aerosol generating procedure – a known significant risk factor for contracting COVID-19.
The severity of COVID-19 infection has been linked to increased viral load and exposure meaning that healthcare workers are particularly vulnerable to this virus. Those performing investigations of the upper aero digestive tract are vulnerable to aerosol production and droplet exposure which could potentially transmit viral particles.
To restore general clinical practice ENT-UK have highlighted several steps. Evidence supports the use of patients wearing a mask during nasoensoscopy. A mask fitted with a valve mechanism has demonstrated to be far more superior in efficiency when reducing particle production that wither not wearing a mask or wearing a mask with a hole put into it. Therefore, creating a medical device for the specific purpose of safe nasoendoscopy to reduce droplet spread will ensure a safely adopted process that can adhere to a standard operating protocol.
The team have designed a safety device for clinical use - initially during the COVID crisis, but believe that it will become a standard operating procedure and business as usual PPE for all ENT departments in the UK and potentially worldwide after the pandemic. The device created is a resealable port mask. The SNAPe-i is easily fitted onto all conventional surgical masks, the patient then wears the mask and aligns the SNAPe-i with their nostril. This enables the surgeon to perform the procedure to minimise their risk of infections should the patient cough or splutter.
Our aim is to get clinicians safely back to performing appropriate investigations and so, deliver high quality healthcare despite the pandemic. We believe the SNAP device enables this.
Chris Coulson ENT surgeon and CEO of Endoscope-i
Impact & Outcomes
ENT surgeons have a high chance of contracting COVID-19. ENT surgeons around the world are now approaching nasendoscopies with extreme caution, using appropriate PPE. But despite this there is a reluctance to perform the procedure and as a result there will be missed diagnoses. However, with the development of SNAPe-i, it has created a safer way to approach the procedure.
There are many positive impacts and outcomes from the SNAPe-i. For example, a leak test was conducted in-vitro using a surrogate florescent aerosol test. There were 3 conditions that were analysed looking at any potential contamination. When comparing a standard surgical mask, the same mask fitted with SNAPe-i and no mask, it was clear that there was no leakage through the SNAPe-i device. There was no contamination through the mask with the SNAP fitted. This demonstrates the effectiveness of the SNAPe-i.
SNAP is currently undergoing close clinical evaluation during the COVID-19 pandemic. By following current guidance set out by ENT-UK, BLA, RCSLT and BAHNO, endoscopy continues to be performed for the selected assessment of only high-risk patients.
These examinations would normally take place without the added protection of the SNAP mask. The outcomes being assessed were:
- Ease of passage of the scope through the SNAP mask
- Success of performing the procedure
- Induction of an aerosol generating cough or sneeze
- Trauma caused during endoscopy or by the SNAP device
- Health of the performing endoscopist and supporting staff
The results demonstrate a reduction on particle production when the SNAP mask is worn during endoscopy. The overall particle values are extremely small reflecting on the clean clinical environment, use of FULL PPE and examination protocols. Therefore, the SNAPe-i enables the surgeon to perform the procedure and minimise their risk of infection should the patient cough or splutter.