OR Manager - May 2020 - 11

COVID-19
sure anterooms, and some may not
have negative pressure rooms.
Precautions should be taken when
performing aerosol-generating procedures,
such as intubation, extubation,
and bronchoscopy inspection of airways.
The CDC states that these airflow-generating
procedures should ideally take
place in an airborne infection isolation
room (ie, negative pressure). However,
this negative pressure can put surgical
patients at risk for surgical site infections
(SSIs). An interdisciplinary team should
perform a risk assessment to determine
if surgery on a patient with suspected or
confirmed COVID-19 can be postponed
until the person is no longer infectious.
If it is determined that a negative
pressure room will be used for a surgical
procedure,
it's important to keep
the doors to the room closed to minimize
traffic in and out of the room,
and, if possible, perform the procedure
with as few people as possible. After
the procedure, leave the room vacant
while the OR air exchanges clear any
airborne contaminants that may have
remained in the room. These air exchanges
should occur before anyone
who is not wearing respiratory protection
enters the room and before environmental
cleaning is done.
Before converting an OR to negative
pressure, consult with engineering
and maintenance teams. They will help
evaluate whether altering the pressure
to negative might affect the air balancing
in adjacent areas.
Can surgery on a COVID-19
patient be done in a positive
pressure OR?
Link: Yes, a team may decide to use a
positive pressure OR for a COVID-19 patient
when there is an increased risk for
an SSI or when converting an OR to negative
pressure is not feasible or possible.
If possible, it is important that these
procedures be performed with the least
amount of people. In other words, this
is a risk vs benefit decision that is spewww.ormanager.com
cific
to the situation, patient needs, and
proximity of other patients in the OR.
Only essential personnel wearing respiratory
protection, such as an N95
respirator or a powered air-purifying respirator
(PAPR), should be in the OR during
intubation and extubation, including
the RN circulator. A time should then be
established for when it is safe for other
team members without respiratory protection
to enter the room after intubation
or extubation. This time should be
determined in conjunction with facilities
engineering personnel who know the air
handling systems very well and who can
provide information on the number of air
exchanges for the room.
If a runner is used outside the OR
to secure supplies, that person may
wear a surgical mask but should not
enter the OR. An anteroom or substerile
room can be used as a drop-off point.
Make sure one door is closed before
the other is opened.
Other options include a portable
high-efficiency particulate air (HEPA)
filtration unit positioned near the patient's
breathing zone. The facilities
engineering personnel can help with
this placement. In addition, this portable
unit can be turned off during the
surgical procedure. A PAS [portable air
scrubber]-HEPA combination unit also
may be used in the anteroom.
After the procedure, adequate air
exchanges should occur before environmental
services staff enter the room for
cleaning.
What is the recommended
time lapse in an OR for
proper reduction of airborne
contaminants?
Burlingame: The amount of time it
takes to clear the airborne contaminants
is dependent on the number of
air changes per hour.
According to the CDC, most ORs
have either 15 or 20 air changes per
hour, but some have more. Contact the
facility's maintenance or plant operaUse
cloth
masks only as
a last resort.
tions department to find out the number
of air changes if not known.
The time it takes to achieve 99% efficiency
at 15 air changes per hour is
18 minutes, and for 99.9% efficiency,
it's 28 minutes. If the air changes per
hour are set at 20, the time required for
99% efficiency is 14 minutes, and for
99.9% efficiency, it is 21 minutes. More
air changes per hour equals less time.
Another way to say this is the time it
takes before personnel may enter the
room without wearing respiratory protection.
Cleaning should not occur while
waiting for the air to be cleaned.
What doors should be opened for
supplies?
Burlingame: It is key to keep door
openings to a very minimum in both
positive and negative pressure rooms.
During the intubation and extubation
process and for the number of minutes
it takes to remove contaminants after
intubation and after extubation, the
door should remain closed at all times.
If the OR has two doors, one leading
to the core and one leading to the
hallway, either door may be opened, but
think about it from this aspect: Which
door would provide the least amount
of airflow disruption? In some facilities,
the door to the outer hallway is
much larger than the one to the core,
or it may be automated, which leaves
it open longer than it takes to manually
close the door to the core. In either
case, the door to the core should be
used except when it is necessary to
move the patient through the door. The
door should be opened only as far as
necessary to bring in supplies.
Continued on page 12
OR Manager | May 2020
11
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