Readiness and Response
Alvino and Caughell ( 2021 ) add that , “ Perioperative leaders , key partners , and facility experts ( infection preventionists ) should consider state and local orders or advisories , community transmission , and available HCW and supply resources when developing COVID-19 infection prevention and control strategies . They also should maintain flexibility and provide a nimble response to accommodate changing conditions , evolving recommendations , and local resource availability . Key stakeholders ( facility leaders ; infection prevention , engineering , occupational health and safety , and supply chain personnel ) should form a strong partnership and engage in ongoing communication to design a comprehensive and sustainable plan for managing COVID-19 in the perioperative environment .”
They advise adoption of the CDC ’ s Hierarchy of Controls model , which categorizes occupational hazard control solutions – elimination , substitution , engineering controls , administrative controls , personal protective equipment – and prioritizes them from most to least effective . Alvino and Caughell ( 2021 ) say this Hierarchy of Controls model “ is a useful tool that facility leaders can adapt to manage patient and personnel safety in the perioperative environment .”
Another helpful tool is a toolkit about COVID-19 developed by AORN in Mid-February 2020 to inform and assist perioperative nurses during the pandemic .
“ We knew there would be questions that needed answers . We wanted to anticipate what perioperative clinicians may ask and provide those answers in a timely manner ,” says AORN ’ s Kyle . “ With so much misinformation and conflicting information coming from different sources , we knew that providing reliable information from reputable sources would be an imperative .”
Kyle adds , “ It also provided resources intended to inform clinicians who face shortages of supplies like surgical masks , gowns , and drapes . Before our board of directors made the difficult , but wise , decision to cancel our ( 2020 ) annual Global Conference and Expo , we used the toolkit to inform members and exhibitors about what precautions we and the expo venue were taking to keep them safe while attending the meeting . It now includes information that has become available from other societies and medical journals for the most up-to-date and reliable information about the spread of COVID-19 and how healthcare workers can protect themselves by selecting and using PPE properly .”
For example , the toolkit provides a link to Nebraska Medicine ’ s Biocontainment Unit webpage , which includes resources written by national experts on communicable disease containment and treatment . The toolkit also contains links to a Strategic National Stockpile fact sheet and information from the World Health Organization ( WHO ) and the Association for Professionals in Infection Control and Epidemiology ( APIC ). This information would apply to any respiratory communicable disease .
“ We hope that perioperative nurses use the resources we have assembled to inform interdisciplinary decisions about how to respond to COVID-19 in their communities and healthcare organizations ,” Kyle says . “ For example , places where the outbreak has led to municipalities declaring states of emergency , the response is different than those places where the outbreak has not yet reached . Specific patient populations may also require different responses within a healthcare organization . Those organizations whose services are focused on the most fragile and vulnerable to the disease may require different practices than those that serve less vulnerable populations .”
The toolkit provides resources for evidence-based decision-making at the facility level . Perioperative nurses will persevere and be leaders during these trying times , Kyle predicts .
“ Perioperative RNs are known for their ability to remain calm under pressure , focusing all efforts on patient care ,” she says . “ We do this as part of an interdisciplinary team every day .” The toolkit recommends perioperative nurses lead the way in practicing common-sense prevention measures , as outlined by the CDC , including :
• Avoid close contact with people who are sick .
• Avoid touching eyes , nose , and mouth with unwashed hands .
• Wash hands often with soap and water for at least 20 seconds , especially after eating , blowing your nose , coughing , sneezing , or going to the bathroom .
• Use hand sanitizer that is at least 60 percent alcohol whenever soap and water are not available .
• Stay home when sick .
• Cover coughs and sneezes with a tissue and throw it in the trash .
• Clean and disinfect frequently touched objects and surfaces with household cleaning agents .
Perioperative nurses and others in healthcare should follow the CDC ’ s recommendations regarding PPE use .
“ Use only what you need for each patient ,” Kyle says . “ Plan ahead . Have a contingency plan for obtaining supplies from alternative vendors . Consider reusables when possible , and work with the materials management department to define this contingency plan before a shortage situation arises at your facility .”
Addressing the ongoing supply chain-related issues , Kyle comments , “ The trend in supply chain prior to the pandemic was just-in-time , in other words , to minimize inventory on hand . When supply chain disruptions occurred before the pandemic , finding an alternate supplier was usually relatively simple . During the pandemic , there were few alternate suppliers . When you couple that with fierce competition for the same essential supplies , like respiratory protection for front-line healthcare workers , it becomes very clear very quickly that a paradigm shift is in order . Running a lean service is sustainable as long as the unexpected does not happen . Today ’ s world is not predictable , and if we want to be successful in delivering safe healthcare , we need to prioritize contingency planning in all of the areas that we learned were vulnerable during the pandemic .”
Safely Resuming Surgery : A Roadmap for Readiness
As of press-time in August 2021 , COVID cases have begun to escalate , attributed to the spread of the Delta variant . But in April 2020 , when the COVID-19 surge was waning in different parts of the country , pent-up demand to resume elective surgeries began to build , and a roadmap to guide readiness , prioritization and scheduling had been developed by the American College of Surgeons ( ACS ), American Society of Anesthesiologists ( ASA ), Association of periOperative Registered Nurses ( AORN ) and American Hospital Association ( AHA ). This joint statement provides key principles and considerations to guide healthcare professionals and organizations regarding when and how to do so safely .
The statement notes facilities should not resume elective procedures until there has been a sustained reduction in the