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 .”
rate of new COVID-19 cases in the area for at least 14 days . The facility also should have adequate numbers of trained staff and supplies , including personal protective equipment ( PPE ), beds , ICU and ventilators to treat non-elective patients without resorting to a crisis-level standard of care .
The timing for resuming elective surgery is one of the eight principles and considerations to guide physicians , nurses and facilities in their resumption of elective surgery care , for operating rooms and all procedural areas , factoring in : timing , testing , adequate equipment , prioritization and scheduling , data collection and management , COVID-related safety and risk mitigation surrounding a second wave and other issues including the mental health of health care workers , patient communications , environmental cleaning and regulatory issues .
Highlights include :
• Implement a policy for testing staff and patients for COVID-19 , accounting for accuracy and availability of testing and a response when a staff member or patient tests positive .
• Form a committee – including surgery , anesthesiology and nursing leadership – to develop a surgery prioritization policy , which factors in previously canceled and postponed cases , and allot block time for priority cases , such as cancer and living donor organ transplants .
• Adopt COVID-19-informed policies for the five phases of surgical care , from preoperative to post-discharge care planning .
• Collect and assess COVID-19 related data that will be used to frequently re-evaluate and reassess policies and procedures .
• Create and implement a social distancing policy for staff , patients and visitors in non-restricted areas in anticipation of a second wave of COVID-19 activity .
The roadmap emphasizes the importance of building institution / health system-wide capacity , a wise strategy for COVID-19 and future pandemics . Critical action steps include :
• Ensuring that facilities should be able to safely treat all patients requiring hospitalization without resorting to crisis standards of care
• Ensuring institutions ’ capability to provide care across all services , staffing , and specialties
• Ensuring that the facility has an appropriate number of ICU and non-ICU beds , PPE , testing reagents and supplies , ventilators , medications , anesthetics and all medical and surgical supplies
• Ensuring the institution has an available number of trained and educated staff appropriate to the planned surgical procedures , patient population and facility resources . As the roadmap observes , “ Given the known evidence supporting healthcare worker fatigue and the impact of stress , can the facilities perform planned procedures without compromising patient safety or staff safety and wellbeing ?”
• Addressing case prioritization and scheduling . As the roadmap advises , “ Facilities should establish a prioritization policy committee consisting of surgery , anesthesia and nursing leadership to develop a prioritization strategy appropriate to the immediate patient needs .” Prioritization policy committee strategy decisions should address case scheduling and prioritization and should account for the following :
• List of previously cancelled and postponed cases
• Objective priority scoring ( MeNTS instrument )
• Specialties ’ prioritization ( cancer , organ transplants , cardiac , trauma )
• Strategy for allotting daytime “ OR / procedural time ” ( block time , prioritization of case type )
• Identification of essential healthcare professionals and medical device representatives per procedure
• Strategy for phased opening of operating rooms
• Identify capacity goal prior to resuming ( such as outpatient / ambulatory cases start surgery first followed by inpatient surgeries ; or all operating rooms simultaneously , which will require more personnel and material )
• Strategy for increasing “ OR / procedural time ” availability ( such as extended hours before weekends )
• Identify issues associated with increased OR / procedural volume
• Ensure primary personnel availability commensurate with increased volume and hours ( e . g ., surgery , anesthesia , nursing , housekeeping , engineering , sterile processing , etc .) as well as ensure adjunct personnel availability ( pathology , radiology , etc .)
• Ensure supply availability for planned procedures ( anesthesia drugs , procedure-related medications , sutures , disposable and non-disposable surgical instruments )
• Ensure adequate availability of inpatient hospital beds and intensive care beds and ventilators for the expected post-operative care
Pathogen Transmission in the OR : Lessons Learned
As we have seen , the world is still learning all there is to know about SARS-CoV-2 , and in the earliest stages of the pandemic , data was incomplete . A year and a half later , In its Update on the Perioperative Considerations for COVID-19 Severe Acute Respiratory Syndrome Coronavirus-2 , the Anesthesia Patient Safety Foundation ( APSF ) confirms , “ The period immediately prior to symptom onset is associated with SARS-CoV-2 viral shedding and represents a considerable transmission potential , further implicating all ( asymptomatic ) patients as an additional risk . To protect and ensure the safety of HCWs , and by extension , patients , preventing nosocomial transmission of SARS-CoV-2 requires a coordinated effort and complete organizational support . Due to the rapid spread of COVID-19 , the ability of healthcare organizations to prepare for increasing admissions and implement risk mitigation strategies has been time-pressured . Anxiety and fear placed additional pressure on providers , due to concerns of inadequate supplies of personal protective equipment ( PPE ) and a lack of clarity of information or unified thinking amongst leaders . We ’ ve learned that discordant messages cause confusion , create tension , and slow protocol implementation . Furthermore ,