Guidance for Reducing the Impact of COVID-19 During Surgery

As the coronavirus disease 2019 , COVID-19 pandemic continues to unfold, surgical care must be carefully planned and performed to minimize infection risks. Surgical procedures should be based on sound medical judgment, the availability of resources, and the patient’s overall condition. This requires day-by-day, data-driven case triage.

Minimize Aerosolization

Aerosolization of COVID-19 occurs during procedures such as endotracheal intubation, tracheostomy, gastrointestinal endoscopy and during the evacuation of pneumoperitoneum and aspiration of body fluids. These procedures are classified as aerosol-generating medical procedures (AGMPs); therefore, healthcare workers should wear N95 masks and eye protection.

It is also important for anesthesia providers to be diligent about hand washing after each case and follow strict environmental cleaning and disinfection procedures in and around the anesthesia workstation. This should include the disposal of all used airway equipment in a double-zip-locked plastic bag for proper decontamination and disinfection.

In addition, surgeons and other personnel not required for intubation should remain outside the operating room until anesthesia induction and intubation are completed. This will minimize exposure to droplets of COVID-19 by healthcare workers who are not actively involved in intubation.

Minimize Contact with Infected Patients

Surgical site infections (SSIs) are a common cause of hospitalization and contribute significantly to patient morbidity and mortality. These infections occur in approximately 17% of all healthcare-associated infections and are more common than urinary tract infections (UTIs).

Prevention of SSIs requires a comprehensive approach to infection control. This includes preventing infection in the surgical ward, operating room, and recovery.

SSIs are commonly caused by microorganisms in the surgical wound and can be transferred to other patients, staff, or the environment. Effective surgical infection prevention requires redesigning systems and optimizing evidence-based processes of care.

Reduce Exposure to Infected Patients

Infections are a leading cause of illness and death. They can occur in any part of the body and are usually caused by microorganisms like bacteria, viruses or fungi that enter the body.

Surgical site infections (SSIs) are one of healthcare’s most common and important infections. SSIs develop in 2-5% of surgical patients, resulting in 7-11 extra days in the hospital and 2-11 times as high mortality compared to non-surgically infected patients [4, 7, 11].

Infection-control measures before, during and after surgery decrease the incidence of SSIs. They include proper organ function support, skin preparation, antimicrobial prevention and wound care.

Minimize Disposal of Infected Disposables

To minimize the impact of COVID-19 during surgery, it is critical to minimize the disposal of infected disposables. This means that all disposables such as masks, eye protection, and double non-sterile gloves should be properly discarded after use.

In addition, contaminated surfaces should be routinely cleaned and disinfected to minimize the risk of COVID-19 transmission. Additionally, contaminated equipment should be removed from the operating room as soon as possible.

In addition, surgical procedures should be postponed for some time before being performed again if a patient has been diagnosed with COVID-19. This will prevent unnecessary exposure of both patients and healthcare workers.

Reduce Exposure to Infected Patients

Infections during surgery are a major problem and cause patient morbidity, mortality, and prolonged hospital stays. They are a significant healthcare cost to the health system and to the community.

Despite good evidence for the effectiveness of infection-control precautions, many healthcare facilities fail to implement these precautions in routine practice. In addition, knowledge of best practices is often lacking, and there is a great gap between best practice and clinical practice.

CDC guidance encourages healthcare workers to use engineering controls to shield them from infected patients, including physical barriers or partitions in triage areas to guide patients, curtains separating patients in semi-private rooms, and airborne infection isolation rooms (AIIRs) that provide negative pressure ventilation with a minimum of 6 air exchanges per hour. These engineering control precautions reduce the risk of COVID-19 transmission among healthcare workers and prevent exposure to infected patients during surgery.