Table 4 The checklist for the safe management of urgent surgical COVID-19 patients
Urgent surgical patients' management in COVID-19 era check list | Yes | No |
|---|---|---|
Defined in-hospital route for patients with suspected or confirmed COVID-19 | ||
Availability of all necessary PPE including FFP2 mask, eye protection, cap, oversized waterproof long-sleeved gown, knee-high shoe protection and gloves (always a double pair) and trained operating room staff | ||
Availability of a negative-pressure environment to reduce dissemination of the virus beyond the operating theatre or of a standard positive-pressure operating theatre with a high frequency of air renewal (25 times per hour) to reduce the viral load | ||
In the operating theatre | ||
The number of staff involved in any surgical procedure should be limited | ||
The name of all participating staff members should be recorded to facilitate contact tracing | ||
Theatre doors must be closed for the entire duration of the operation | ||
Movement of staff in and out of the operating theatre should also be restricted | ||
Only selected equipment and drugs should be brought into theatre to reduce the number of items that need to be cleaned or discarded following the procedure | ||
A runner, stationed outside the operating theatre, should be available if additional drugs or equipment are needed | ||
Anaesthetic monitors, laptop computers and ultrasonography machine surfaces should be covered with plastic wrap to decrease the risk of contamination and to facilitate cleaning | ||
The patient should be examined, induced and recovered in the operating theatre itself to restrict contamination to just one room | ||
The addition of an expiratory port with a bacterial/viral filter (e.g. HEPA filter) can reduce aerosol emission as well as the use of a closed tracheal suctioning system for aspiration of respiratory secretions | ||
The surgical team will don scrubs following the usual procedure for performing surgery but replacing the surgical mask with a FFP2 (minimum) or FFP3 mask, wearing high shoe protection and a waterproof gown. Eye protection (goggles) or facial protection (face mask) should be always worn | ||
After the surgery | ||
All staff have to shower and change into a clean set of scrubs before resuming their regular duties | ||
The PPE used must be disposed of inside the containers for special waste at risk of infection | ||
The name of all participating staff members is recorded to facilitate contact tracing | ||
The operating room must be sanitized as soon as possible Human coronaviruses can be efficiently inactivated by surface disinfection procedures with 62–71% ethanol, 0.5% hydrogen peroxide or 0.1% sodium hypochlorite within one minute. Other biocidal agents such as 0.05–0.2% benzalkonium chloride or 0.02% chlorhexidine digluconate are less effective | ||