COVID-19: Providing Electroconvulsive Therapy (ECT)

This guidance is for ECT services during the COVID-19 pandemic. It covers three pathways of care and should be read in conjunction with official guidance for maintaining services within health and care settings.

Patients receiving electroconvulsive therapy (ECT) are usually among the most psychiatrically unwell and are likely to be severely affected by a halt to treatment. Despite this, many care providers reduced their provision of ECT services during 2020, mainly because of the required infection control procedures and the staffing difficulties imposed by the pandemic.

It is recognised that ECT can involve aerosol generating procedures, including, but not restricted to:

  • bag-mask ventilation,
  • removal of an artificial airway resulting in a cough reflex.
However, in January 2021, official guidance on maintaining healthcare services was jointly published by the Department of Health and Social Care, Public Health Wales, Public Health Agency Northern Ireland, Health Protection Scotland/National Services Scotland, Public Health England and NHS England. Consequently, local mental health care providers across the UK should now have safely resumed their ECT services.

The official guidance was last updated on 29 September 2021, setting out three pathways of care, stratified by COVID-19 risk. These pathways are listed below, with updated summary information for each relating to the delivery of ECT.

It is anticipated that most inpatients and outpatients receiving ECT will be in the low-risk pathway. Less commonly, patients may be in the medium-risk pathway, particularly if they are inpatients on wards where there have been recent COVID-19 cases. Very few patients receiving ECT will be in the high-risk pathway.

This group includes:

  • asymptomatic patients, who have had a negative PCR test result within 72 hours, and have had no known COVID-19 contact or exposure in the last 14 days.

For these patients:

  • support workers, trainees, students and others may be present during treatment
  • only a standard level of PPE need be worn by staff, comprising: gloves (single-use); apron (single-use); fluid-resistant surgical mask (extended use possible); and eye protection (only in unusual cases where the spraying or splashing of bodily fluids, such as saliva, is anticipated)
  • there is no requirement to dispose of all waste as infectious waste
  • there is no requirement for additional cleaning of the treatment room
  • patients can be recovered in a recovery room, even if an AGP has been performed
  • there is no additional requirement for ventilation or 'down time' prior to treating the next patient.

This group includes:

  • asymptomatic patients who are awaiting a PCR test result
  • asymptomatic patients who decline PCR testing
  • asymptomatic patients with COVID-19 contact or exposure in the last 14 days.

The following precautions apply:

  • support workers, trainees, students and others may be present during treatment
  • airborne PPE must be worn by all staff present, comprising: gloves (single-use); apron or gown (single-use); FFP3 respirator mask (extended use possible) or hood (re-usable); and eye protection (goggles/visor, single-use or re-usable)
  • all waste generated in the treatment and recovery rooms should be treated as infectious waste
  • all re-usable equipment, including the ECT equipment and monitoring equipment, and all surfaces in the treatment room, must be decontaminated after each patient using a chlorine-based product
  • patients must be recovered in the treatment room following an AGP, but may be transferred to a recovery room if no AGP has been performed
  • following an AGP, 'down time' for required ventilation must be observed prior to the treatment room being cleaned in preparation for the next patient.

This group includes:

  • patients who are confirmed COVID-19 positive by a SARS-CoV-2 polymerase chain reaction (PCR) test
  • symptomatic patients, suspected to have COVID-19, who are awaiting a PCR test result
  • patients with no available PCR test result, who are having ECT in extreme emergencies in which the presence of COVID-19 symptoms cannot be assessed.

The following precautions apply:

  • patients must be treated last on the list
  • only those absolutely necessary for the performance of the procedure should be present in the treatment area: the patient, a psychiatrist, a psychiatric nurse, an anaesthetist and an operating department practitioner
  • airborne PPE must be worn by all staff present, comprising: gloves (single-use); gown (single-use); FFP3 respirator mask (extended use possible) or hood (re-usable); and eye protection (goggles/visor, single-use or re-usable)
  • all waste generated in the treatment and recovery rooms should be treated as infectious waste
  • all re-usable equipment, including the ECT equipment and monitoring equipment, and all surfaces in the treatment room, must be decontaminated after each patient using a chlorine-based product
  • patients must be recovered in the treatment room following an AGP, but may be transferred to a recovery room if no AGP has been performed
  • following an AGP, 'down time' for required ventilation must be observed prior to the treatment room being cleaned in preparation for the next patient.
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