**9. Endoscopy room and equipment**

The separation of clean and contaminated rooms should be implemented for the endoscopy room, sign-in room, and recovery room. One-way flow for equipment and patients is the recommended approach [10]. The traffic flow in the endoscopy room should be organized to make efficient and easy movement for patient, HW, and any equipment needed. It also prevents any infection or contamination within the room [30].

The size of the endoscopy room is determined by the complexity of the procedure. A procedure such as ERCP, which needed specialized equipment, requires bigger space. The room has to have enough space and supporting facilities for vital equipment such as oxygen source, suction source, and uninterruptible power supply. The room needs to be checked and monitored periodically even in the external aspect such as temperature and humidity [28]. The recovery room also needs to have appropriate spaces and provide comfortable conditions that can keep the patient's privacy [28].

For suspected or confirmed COVID-19, GIE is recommended to be performed in a negative pressure room [29]. Endoscopy room surfaces and floor should be disinfected using chlorine after the procedure. New and clean bed sheets should be provided. The endoscopes should be disinfected according to standard protocol [10].

Ventilation in the endoscopy room is important since SARS-CoV-2 spreads into the air. The virus may spread in aerosol-generating procedures such as EGD or ERCP. Negative pressure rooms can prevent the aerosol-containing virus to spread wider in the air. If negative pressure rooms are not available, then portable high-efficiency particulate air (HEPA) filters may be a reasonable alternative [9].

After the procedure is completed, patients will be directed into a recovery room. The patient is provided with a surgical mask and other PPEs depending on their COVID-19 status. It is also recommended to differentiate among patients to prevent cross-infections of COVID-19. The staff who cleaned used equipment and room has to wear PPE including a head cap, gown, surgical mask, face shield, shoe covers, and gloves, since they will be cleaning and potentially contacting with scopes, surfaces, and equipment after procedures [10, 24].

SARS-CoV-2 is reported to be cleared using disinfectant containing hydrogen peroxide, alcohol, and chlorine. Any high-contacted surface and equipment have to be disinfected after each endoscopic procedure. Ultraviolet irradiation and ozone treatment can be advanced sterilization methods in an endoscopy room [10]. The frequency of disinfection can differ regarding the risk of the patient's status. In suspected or confirmed COVID-19 patients (high-risk), at least two times disinfection processing is suggested to minimize contamination; meanwhile, in negative COVID-19 patients (low-risk), it can be done once according to the applicable standard [9].
