Protecting Surgical Teams During the COVID-19 Outbreak: A Narrative Review and Clinical Considerations - Annals of Surgery

In press; https://journals.lww.com/annalsofsurgery/Documents/COVID%20Surgery_VF.pdf
By: Gabriel Brat, et al. 

Aims: Review available literature and clinical experience to highlight key considerations for surgical teams operating on patients with suspected or known COVID-19. 

Keys:

• Perform as little surgery as possible
• Proper personal protective equipment is essential

Summary:

• Given the current infection rates, thousands of emergency surgical procedures will be conducted in contaminated patients. Protection of surgical staff is key to maintain continuity of surgical care. 
• Surgical teams are at uniquely high risk for SARS-CoV-2 exposure. Viral load has been identified in essentially all tissues and fluids tested and even surgical smoke from the use of electrocautery. In addition; aerosols can last for 3 hours and the virus can survive on surfaces for days.
• Key protection measures for surgical staff:
  • Structure frequent communication before essential events. E.g. plan safe patient transport with huddles with surgeons, pulmonologists, intensivists, nurses etc. 
  • Assume the entire OR is contaminated. The virus can survive for days on surfaces. OR’s use pressure airflow therefore there is also risk adjacent OR’s and hallways are contaminated. 
    • OR’s with negative pressure are recommended. If not available; 30 minutes between cases waiting time for complete room air exchange.
    • Leave all items outside OR (pagers, cell phones, etc)
    • Place a dedicated runner outside the OR to provide the necessary supplies so the circulating nurse does not have to leave the OR.
    • Throw away all single-use equipment after surgery (even unopened!)
  • Choose personal protective equipment (ppe) effective against aerosols
    • Normal ppe for surgical staff: face shield, mask (preferably N95), waterproof gown, double gloves and shoe covers. 
  • Adapt surgical technique to reduce exposure risks
    • Use smoke evacuation devices
  • Use a buddy system to put on and remove PPE correctly.
    • Chances of contamination when removing ppe incorrectly are high.