The plan of execution for a COVID-19 patient requiring an operation must incorporate three essential elements : limit foot traffic and OR personnel ; locate the designated OR and supplies to minimize risk to staff ; and communicate the plan to personnel .” keeping up with rapidly changing guidelines and communicating them clearly to an entire organization is challenging . We recommend a unified approach to supporting and communicating with members of staff within your organization .”
Regarding pathogen transmission in the OR and around the anesthesia work environment , APSF observes further , “ Within the OR , the anesthesia work environment allows for numerous surfaces that can harbor droplets , thus serving as reservoirs for the virus if proper droplet precautions or proper decontamination processes are not followed … processes that favor aerosolization of sputum by an infected individual in the perioperative setting represents a potential source of exposure to HCWs . For the anesthesia professional and intensivist , attention should be given to the time periods during intubation and extubation , as these represent the highest risk of exposure and involve direct contact with respiratory droplets during airway management . Areas immediately outside the OR and around the operating department complex represent low-risk areas with regards to aerosol generation but may still be potential sources for transmission . Irrespective of location , inadequate PPE , improper use of PPE , and poor hand hygiene are potential factors that can lead to transmission to the bedside HCW .”
Much has been learned during the pandemic about the importance of operating room flow . As Heffernan , et al . ( 2020 ) emphasize , “ The plan of execution for a COVID-19 patient requiring an operation must incorporate three essential elements : limit foot traffic and OR personnel ; locate the designated OR and supplies to minimize risk to staff ; and communicate the plan to personnel .” The authors recommend these key principles :
• Limit unnecessary personnel within and throughout the OR
• Restrict movement ( ambulation , intra-hospital transport ) of non-COVID-19 patients to minimize potential contact with COVID-19 patients
• Separate ORs geographically ; OR supplies and PPE should be designated for COVID-19 patient care only
• Assign a dedicated infection control person trained to supervise appropriate donning and doffing of PPE for any OR personnel who will be in the room of the COVID-19 patient
• Assign an area for containment and disposal of OR attire including scrubs after an operation on a COVID-19 patient
• Clearly display the plan and map for personnel to reference
Other perioperative considerations from Heffernan , et al . ( 2020 ) include :
• All personnel involved must have appropriate PPE including N95 masks or PAPR . Have extra PPE equipment readily available
• Use a dedicated negative-pressure OR if possible
• Limit the number of people in the OR to essential personnel only
• Pre-operative “ time out ” must include COVID-19-specific information in the checklist
• Use telephonic or other electronic tools to facilitate communication from inside to outside the OR to minimize door opening and foot traffic .
• Consider using a topical local anesthetic to minimize aerosolization from coughing during airway manipulation .
• For extubated patients , consider recovering the patient fully in the OR for up to one hour prior to transport to the next level of care .
• For patients remaining intubated , a dedicated COVID-19 transport ventilator should be used .
• When switching between anesthesia and transport ventilators the endotracheal tube should be temporarily occluded to minimize risk of aerosolization .
The Future
The pandemic affects people in different ways , but it can be especially frightening to frontline medical staff because of the greater risk of infection . While this is understandable , it is important to learn more about COVID-19 to prevent panic . “ Fear and panic are wasted energy ,” AORN ’ s Kyle says . “ We , as healthcare professionals , should spend our energy seeking out reliable information and focusing on what we can do to protect ourselves , our communities , and our patients from the detrimental effects of this pandemic .”
Advice from AORN to perioperative nurses is a simple yet powerful message : “ Do what we do best : Remain calm , and take care of the problem ,” Kyle adds .
References :
Alvino RT and Caughell CM . COVID-19 in the Perioperative Setting : Applying a Hierarchy of Controls to Prevent Transmission . AORN J . Vol . 113 , Issue 2 . Pages 147-164 . February 2021 .
https :// doi . org / 10.1002 / aorn . 13301
American College of Surgeons . Joint Statement : Roadmap for Resuming Elective Surgery After COVID-19 Pandemic . https :// www . facs . org / covid-19 / clinical-guidance / roadmap-elective-surgery . April 17 , 2020 .
Heffernan DS , Evans HL , et al . Surgical Infection Society Guidance for Operative and Peri-Operative Care of Adult Patients Infected by the Severe Acute Respiratory Syndrome Coronavirus-2 ( SARS-CoV-2 ). Surgical Infections . Vol . 21 , No . 4 . April 30 , 2020 . https :// doi . org / 10.1089 / sur . 2020.101
Joint Commission Position Statement : Preventing Nosocomial COVID-19 Infections as Organizations Resume Regular Care Delivery . Revised June 22 , 2020 .
Zucco L , et al . An Update on the Perioperative Considerations for COVID-19 Severe Acute Respiratory Syndrome Coronavirus-2 ( SARS-CoV-2 ). APSF Newsletter . https :// www . apsf . org / article / an-update-on-the-perioperative-considerations-for-covid-19-severeacute-respiratory-syndrome-coronavirus-2-sars-cov-2 /