Access Now: AORN COVID-19 Clinical Support

Archive June 2020 XXI, No. 6

Infection Prevention: Limit the Risks of COVID-19

Focus on the fundamentals to protect patients and staff from exposure.

Franklin Dexter

Franklin Dexter, MD, PhD


COVID HANGOUTS Bacterial and viral pathogens tend to accumulate in areas away from the surgical field, and the novel coronavirus is no exception.

Elective procedures are beginning again in areas of the country where the curve of the new coronavirus is flattening. If you already have strong infection prevention protocols in place, adjust them in response to novel COVID-19 challenges. If you don’t, this is a great time to establish them. Safely caring for patients and protecting your staff from exposure to dangerous bacteria and viruses has always required vigilance in following best practices. COVID-19 simply raises the stakes. Your “new normal” of infection prevention should include a renewed focus on environmental cleaning, rethinking anesthesia delivery and a deliberate ramp-up to a full case volume.

Surveil patients and surfaces. Obviously, your ability to test patients for COVID-19 before they enter your facility is critical. Testing patients is an excellent start in keeping the coronavirus out of your facility, but it’s also not enough to limit risks. If you’re using day-before RT-PCR oropharyngeal or nasopharyngeal screenings, false negatives can occur about 19% of the time. In communities with 1% of individuals testing positive, only about 0.24% would have COVID-19. That’s good news, but the bad news is facilities averaging fewer than 60 cases a day would then have a false negative most weeks. So, perform good hand hygiene, decontaminate patients with oral antisepsis and nasal decolonization, and clean and monitor reservoirs where the virus accumulates and persists.

Protect your staff and patients from COVID-19 by monitoring your ORs for locations where pathogens tend to be detected and, if present, address them. Closely monitor the environment in your ORs for pathogenic transmissions and increase your focus on cleaning the reservoirs you find. If you’re already surveilling for reservoirs of Enterococcus, Staphylococcus aureus, Klebsiella, Acinetobacter, Pseudomonas and Enterobacter spp. (ESKAPE) contamination, you’ll likely have a line on where COVID-19 would collect.

Alter anesthesia practices. Establish “clean” and “dirty” areas around anesthesia workstations. Put alcohol-based hand rubs on the IV pole to the provider’s left, and a wire basket lined with a zip-closure plastic bag for deposit of contaminated instruments on the IV pole to the provider’s right. Anesthesia providers should double-glove before touching the patient’s nose and mouth, and remove the outer gloves following contact. After patient positioning, wipe down equipment and high-touch surfaces with disinfecting wipes that contain a quaternary ammonium compound and alcohol.

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