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Procedural Guidance for Suspected or Positive COVID-19 Patients

SCHEDULING PROCEDURES

Procedures that are performed on a patient that is suspected or has tested positive for COVID-19 should be scheduled in a single room.  If more than one case is scheduled, they should be scheduled in sequential order if possible.  A minimum of 30 minutes should be scheduled between each procedure to ensure proper cleaning is performed.

CLEANING THE ROOM

How should the operating rooms be decontaminated following surgery on a COVID-19 patient?

Answer: The current CDC guidance states that routine cleaning and disinfection procedures using an EPA-registered, hospital-grade disinfectant, are appropriate for SARS-CoV-2 in healthcare settings. Upon patient leaving the room, entry should be delayed until sufficient time has elapsed for enough air changes to remove aerosolized infectious particles. The AORN Guideline for Environmental Cleaning outlines recommended cleaning procedures that should be monitored for quality and consistency.  Linen and medical waste should follow the routine established practices as outlined by local, state and federal regulations.

What PPE should individuals don when cleaning the OR after surgery on a COVID-19 patient?

Answer: Once sufficient time has elapsed to remove infectious particles, individuals performing cleaning should perform hand hygiene and don a gown, gloves, facemask, and eye protection. Shoe covers are not necessary as part of PPE.

Are there special considerations for cleaning, decontaminating, and sterilization of surgical instruments that have been used for a patient with suspected or confirmed COVID-19?

Answer:  Instruments and devices that have been used in procedures for patients with known or suspected COVID-19 should be handled the same as other instruments.  Reprocessing should follow manufacturer’s instructions for use (IFU) and be consistent with recommendations in the AORN Guidelines for Cleaning and Care of Surgical Instruments, Sterilization Packaging Systems, and Sterilization. 

Operating or Procedure Room Cleaning Checklist

Terminal clean the procedure room after every suspected or positive COVID-19 patient:

  1. All floors-wet vacuum or a single-use mop
  2. Anesthesia carts and equipment
  3. Anesthesia machines
  4. Patient monitors
  5. OR beds
  6. Reusable table straps
  7. OR bed attachments
  8. Positioning devices
  9. Patient transfer devices
  10. Overhead procedure lights
  11. Tables and Mayo stands
  12. Mobile and fixed equipment
  13. Storage cabinets, supply carts, and furniture
  14. Light switches
  15. Door handles and push plates
  16. Telephones and mobile communication devices
  17. Computer accessories
  18. Chairs, stools, and step stools
  19. Trash and linen receptacles

If the Bioquell System is available at your facility:

  • After the final terminal clean of the day has been performed, the Bioquell Hydrogen Peroxide Vapor Decontamination process should be performed in the procedure room of a suspected or positive COVID-19 patient. 

CLEANING THE ANESTHESIA MACHINE

Does the anesthesia machine need to be decontaminated after use on a COVID-19 patient? We have HEPA filters in the circuit and the gas sampling line.

Please refer to the ASA Guidance that states, “After the case, clean and disinfect high-touch surfaces on the anesthesia machine and anesthesia work area with an EPA-approved hospital disinfectant.” The internal components of the anesthesia machine and breathing system do not need “terminal cleaning” if breathing circuit filters have been used as directed. (https://www.asahq.org/about-asa/governance-and-committees/asa-committees/committee-on-occupational-health/coronavirus/clinical-faqs)

March 28, 2020