Preparing your operating room for a COVID-19 patient

ACS released guidelines this week for measures to prepare the operating room for a suspected or confirmed COVID-19 patient. The biggest key is planning, and dedication of materials and resources ahead of time.

Resources to allocate for COVID-19-dedication

1. Dedicated operating room for COVID-19 cases. Designate and prepare the room(s) in advance

2. Separate OR airway cart; specific airway guidelines for COVID-19 PUI/confirmed patients

3. Separate OR equipment cart

4. Separate OR medication cart

5. Dedicated transport ventilator for any patient on mechanical ventilation (or dedicated ambulatory bag with viral filter, if ventilator unavailable)

OR room concerns

1. Empty the OR of all nonessential materials prior to case

2. Use anteroom for donning/doffing of PPE

3. Consider a negative pressure anteroom with separate access if possible

4. Minimize the number of times the room is exited/entered

5. Minimize the number of people in the room at any given time

Staffing concerns

1. Establish clear, specific roles and responsibilities of all OR team members, with a common goal of minimizing the spread of infection to health care workers

2. Have a runner outside OR for drugs, devices, equipment

3. Consider dedicated COVID-19 OR teams, will need to be educated in COVID-19 guidelines

PPE guidelines

1. Special PPE for OR: N95 or PAPR, goggles or face shield, gown, boot covers

2. PPE education: see CDC Sequence for Putting On and Removing PPE, and post in anteroom

Anesthesia preparation

1. Have an additional heat and moisture exchange (HME) filter and viral filter on the expiratory limb of anesthesia machine circuit

2. Minimize airway circuit disconnection, endotracheal tube (ETT) must be clamped if any circuit disconnection planned

3. Extubate in a negative pressure ICU/ward room if possible

4. Recover patient in the negative pressure ICU/ward room, or if unavailable, in the dedicated COVID-19 OR room

5. See Anesthesia Patient Safety Foundation (APSF) recommendations:

-Perioperative Considerations for the 2019 Novel Coronavirus (COVID-19)

-Recommendations for Airway Management in a Patient with Suspected Coronavirus (2019-nCoV) Infection

-FAQ on Anesthesia Machine Use, Protection, and Decontamination during the COVID-19 Pandemic

6. See the CDC Guidelines for droplet/aerosol room environments with # air exchanges.

Figure from: Lian Kah Ti et al. What we do when a COVID-19 patient needs an operation: operating room preparation and guidance. Canadian Journal of Anesthesia (2020) https://link.springer.com/article/10.1007/s12630-020-01617-4