COVID 19 AND SURGERY

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DERRICK OBIERO  - KRPON,KRCHN

                          KUTRRH

PERI-OP CONSIDERATIONS IN COVID-19 

The covid-19 pandemic has put a strain on healthcare systems and therefore a need to adapt a new normal in perioperative practice

Hospitals should develop strategic steps and practices for interventions on covid positive patients undergoing surgery

IMPACT ON SURGERY

CANCELLATION OF ELECTIVE SURGERIES

This was necessary during the surge of the pandemic in order to increase and focus the healthcare manpower on the care of covid19 patients.

This was also to reduce the exposure of such patients to the virus in the hospital setup

POST OP SURGICAL CARE

Covid19 respiratory complications might occur postop. Some patients would therefore require mechanical ventilation after surgery

COVID SURGICAL PATHWAY

The need to set up specific surgical areas to correctly cohort suspected covid19 patients, from the isolation wards, critical care areas and a dedicated OR for such patients

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• SHORTAGE OF BLOOD COMPONENTS

A sharp decline in blood donation drives brought about by the containment measures set up and the fear to get infected

The restriction of blood drives in schools has also caused the shortage experienced

Most major surgeries would necessitate the availability of blood and its components

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Cont..

• REDEPLOYMENT OF SURGICAL STAFF

Surge capacity needs and the consequent decrease of surgical activity led to redeployment of perioperative nurses to critical care areas

The main initial challenge for this was keeping up with the changing protocols considering there was little to no time for adequate training on this

Flexibility of perioperative nurses is necessary to ensure fitment into such new environment with unique challenges

Pre-operative considerations

• Operating room preparation

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•  Negative pressure ORs would be ideal to minimize infection risk. 
•  However, ORs are normally designed to have positive pressure air circulation. A high air exchange cycle rate (≥ 25 cycles/h) contributes to effectively reduce the viral load within ORs.
• Equipment kept in each OR must be minimized to what is strictly necessary on a case to case basis. Once the operation starts, all efforts must be made to use what is available in the room and minimize staff transiting in and out the OR, in order to minimize infection risk.
• Standard anaesthetic trolleys should be replaced with dedicated pre-prepared ones with minimal but adequate stock. All required surgical material (i.e., stitches, scalpel blades) must be pre-emptively prepared in a sterilizable steel wire basket. 
• Alcoholic solution for hand hygiene must always be available. Avoiding non-strictly necessary commonly used non-disposable devices is recommended. 
•  Disposable material in general should be preferred, including linen. All operators (i.e., surgeon, anaesthetist, nurses, technicians) should enter the OR timely, aiming to minimize time spent within the OR itself. Once in the OR, they should not leave until the operation is completed, and once out they should not re-enter

INTRA-OP CONSIDERATIONS

• Only essential team members allowed in the OR-in full PPE
• If electrocautery is used, the lowest power setting should be used with a smoke evacuator to minimise the exposure to surgical smoke and any potential aerosolised virus particles
• Patient anaesthesized and recovered in the OR rather than an anaesthetic room-
• Single use instruments wherever possible
• Surgical instruments decontaminated in the normal method
• Place operations on confirmed or suspected covid-19 patients at the end of the list where possible

POST OP CONSIDERATIONS

• Recovered in the OR  to minimise spread. Given ondansetron or metoclopromide to minimise post op nausea and vomiting which could further lead to spread
• Surgical specimen labelled as suspected covid 19 and sealed in the OR in addition to all body fluids, disposable equipment, tubing, gowns and PPE double bagged and labelled
• OR disinfected, including high-touch surfaces such as the operating table and anaesthetic machine with a minimum of 75% alcohol or chlorine-based disinfectant
• Other surfaces cleaned with a neutral detergent followed by a chlorine-based solution with minimum strength no less than 1000ppm of chlorine
• Patient to wear respirator or surgical mask during transport

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IMPACT ON PERI-OP EDUCATION AND TRAINING

                                            THANK YOU