Guidelines for the management of surgical departments in non-uniform hospitals during the COVID-19 pandemic

Abstract

In the last several weeks we have been witnessing the exponentially progressing pandemic SARS-CoV-2 coronavirus. As the number of people infected with SARS-CoV2 escalates, the problem of surgical management of patients requiring urgent surgery is increasing. Patients infected with SARS-CoV2 virus but with negative test results will appear in general hospitals and may pose a risk to other patients and hospital staff. Health care workers constitutes nearly 17% of infected population in Poland, therefore early identification of infected people becomes a priority to protect human resources and to ensure continuity of the access to a surgical care. Both surgical operations, and endoscopic procedures are considered as interventions with an increased risk of infection. Therefore, determining the algorithm becomes crucial for qualifying patients for surgical treatment, but also to stratify the risk of personnel being infected during surgery and to adequately protect staff. Each hospital should be logistically prepared for the need to perform urgent surgery on a patient with suspected or confirmed infection, including personal protective equipment. Limited availability of the equipment, working under pressure and staff shortages in addition to a highly contagious pathogen necessitate a pragmatic management of human resources in health care. Instant synchronized action is needed, and clear uniform guidelines are essential for the healthcare system to provide citizens with the necessary surgical care while protecting both patients, and staff. This document presents current recommendations regarding surgery during the COVID-19 pandemic in Poland.

Influence of COVID ‐19 pandemic on hospitalizations at the tertiary dermatology department in south‐west Poland

“…We compared hospitalization profile of two corresponding 9‐week periods of 2019 and 2020 (18 March 2019 to 19 May 2019 and 14 March 2020 to 15 May 2020, respectively). The start point of 14 March 2020 was taken into consideration as this was the begging of the introduced specific restrictions 4 . On 12 March 2020, the hospital authorities strongly suggested to discharge the possible patients and limit the planned admissions to the necessary minimum.…”

“…At the same time, special hospitals were appointed to admit only infected patients. Moreover, all hospitals were ordered to limit their planned activity 4 . Such restrictions resulted in an unprecedented low number of hospitalized patients 5 …”

In pursuit of COVID-19 surgical risk stratification to manage a limited workforce and supplies in minimally invasive surgery.

“…Taking into account the RT-PCR SARS-CoV-2 result and the presence of disease symptoms, we divided patients into four risk groups with regard to the infection of others while performing surgery in this patient group (Table I) [26].…”

“…intubation, local anaesthesia, and intravenous access insertion. It should be noted that an increased risk of SARS-CoV-2 infection is also present during endoscopic examinations and procedures, especially in the upper gastrointestinal tract [26,27]. A surgical mask is designed to reduce the emission of aerosol exhaled from the airways containing virus particles.…”

Face to Face with COVID-19: Highlights of Challenges Encountered in Various ENT Practices Across the Czech Republic (A National Survey)

“…In ENT clinical settings, this brought about an enormous in ux of unexpected problems. These included inexperience and shortage of time in handling the ferocity of the disease across various health institutes, rede ning and revising safety protocols for staff and patients [5][6][7][8][9][10][11][12][13], de cit in personal protective equipment (PPE) [14], shortage of sterilization and disinfections products, reorganizing departments with provision of isolation for COVID-19 suspected and positive patients, replacement of unavailable staff as well as support of medical personnel vulnerable who were contaminated or in personal contact with infected patients [15][16][17]. And nally a certain extent of economical and nancial instability due to reduction in clinical times and operating lists, physical exhaustion and psychological burden from workplace [18] and including quarantine acquired stress amongst staff were also observed.…”