Perioperative Nursing & COVID-19 :
Leadership and Learning Throughout the Pandemic and Beyond
By Kelly M . Pyrek
One of the hallmarks of quality healthcare is being able to care for patients by following the known and accepted evidence at the time , even while evaluating and assimilating new research constantly flowing out of the medical literature . Clearly aware that the COVID-19 pandemic was a fluid situation , the surgical services community declined the comfort that a static position offers and instead opted to go with the flow . As Stannard ( 2021 ) observes , “ Because the science is still evolving , there is much we do not know . However , as clinicians , we cannot wait for definitive answers ; patients and their families need our care and expertise now .”
Nowhere is that more evident than in the operating room ( OR ), and as Stannard ( 2021 ) confirms , “ Globally , we are confronting this advancing crisis together , while creating and adapting policies , protocols , and workflows locally . True to our collective spirit , we are leading , learning and supporting one another together as one perioperative community . The power of this communal perioperative group is even more obvious now – our community is global , interconnected , interwoven , and activated , and is committed to sharing best practices and lessons learned to advance perioperative care .”
Improving and Innovating
The significance of ongoing learning is underscored , Stannard ( 2021 ) says , because “ the situation on the ground is far from settled . The virus mutates ; our therapies improve ; the science continues to inform ; and clinicians nimbly adapt to the ever-changing practices , surgical populations , and safety protocols . Early groundbreaking research has demonstrated that surgical patients with COVID-19 are at higher risk for post-operative mortality . As such , we must continue to learn , improve and innovate .”
The great unknown associated with SARS-CoV-2 hit home in the OR , where early in the pandemic , perioperative teams were concerned about transmission of SARS-CoV-2 in the operating room and other procedural settings , confirms Erin Kyle , DNP , RN , CNOR , NEA-BC , editor-in-chief of the Guidelines for Perioperative Practice for the Association of periOperative Registered Nurses ( AORN ). “ Because of the knowledge that we have about aerosol-generating procedures and surgical smoke , we knew that the OR had the potential to be a hazardous practice area during the COVID-19 pandemic ,” she says . “ Many patients receive general anesthesia for surgical procedures , and that involves intubation . Intubating patients is an aerosol-generating procedure so that hazard was relatively well-understood . What we didn ’ t know for certain was the potential for transmission through surgical smoke and other aerosols generated during procedures outside of the airway .”
Maintaining evidence-based principles and practices in the OR despite the immensely challenging scenarios in which perioperative personnel found themselves was critical .
Alvino and Caughell ( 2021 ) acknowledge that , “ The perioperative setting is unique in that it exposes clinicians and personnel to increased risks through the invasive nature of surgical care .”
Risk management through infection prevention and control ( IP & C ) was top-of-mind for all healthcare personnel , but no more so than for perioperative professionals .
Alvino and Caughell ( 2021 ) remind us that , “ The perioperative team provides specialized and often complex treatment in a unique environment of care , requiring infection prevention strategies designed specifically for surgical patients and healthcare workers in the OR . Team members have a responsibility to provide safe care for patients undergoing operative and other invasive procedures . The invasive and technical nature of surgical care presents infection-related exposure risks ( to pathogens ) as well as other harmful exposure risks ( radiation ). It is important to mitigate the risk of SARS-CoV-2 transmission among both surgical patients and perioperative personnel by using real-time bedside interventions in addition to system-wide strategies .”
“ Infection prevention has always been and remains a priority for perioperative teams ,” says AORN ’ s Kyle . “ Prevention of infectious disease transmission is a major focus of perioperative RNs and teams in all phases of care and the evidence-based guidelines that are in place in the OR and other procedural areas have stood the test of time , outbreaks , and now this pandemic . What we did have to respond to , was the change in availability of personal protective