Personal protective equipment and evidence‐based advice for surgical departments during COVID‐19

Abstract

Background Inconsistencies regarding the use of appropriate personal protective equipment (PPE) have raised concerns for the safety of surgical staff during the coronavirus disease 2019 (COVID‐19) pandemic. This rapid review synthesizes the literature and includes input from clinical experts to provide evidence‐based guidance for surgical services. Methods The rapid review comprised of targeted searches in PubMed and grey literature. Pertinent findings were discussed by a working group of clinical experts, and consensus recommendations, consistent with Australian and New Zealand Government guidelines, were formulated. Results There was a paucity of high‐quality primary studies specifically investigating appropriate surgical PPE for healthcare workers treating patients possibly infected with COVID‐19. SARS‐CoV‐2 is capable of aerosol, droplet and fomite transmission, making it essential to augment standard infection control measures with appropriate PPE, especially during surgical emergencies and aerosol‐generating procedures. All biological material should be treated a potential source of SARS‐COV‐2. Staff must have formal training in the use of PPE and should be supervised by a colleague during donning and doffing. Patients with suspected or confirmed COVID‐19 should wear a surgical mask during transfer to and from theatre. Potential solutions exist in the literature to extend the use of surgical P2/N95 respirators in situations of limited supply. Conclusion PPE is advised for all high‐risk procedures and when a patient's COVID‐19 status is unknown. Surgical departments should facilitate staggered rostering, remote meeting attendance, and self‐isolation of symptomatic staff. Vulnerable surgical staff should be identified and excluded from operations with a high risk of COVID‐19 infection.

Surgery triage during the COVID‐19 pandemic

“…There were concerns in the Australian and New Zealand media that PPE was in short supply. To address this concern a rapid review was conducted on Personal Protective Equipment for Coronavirus Disease 2019 (COVID‐19): Evidence‐Based Guidance from the Royal Australasian College of Surgeons 55 and a subsequent manuscript published in this issue 63 . It was concluded that adequate PPE was available in accordance with the COVID‐19 status in Australia and New Zealand, however this situation could have changed rapidly if a second wave of infection occurred after containment measures were relaxed.…”

Screening and testing for COVID‐19 before surgery

“…21 As SARS-CoV-2 can spread rapidly even when clinically undetectable, patient history must be screened for potential sources of exposure to the virus (Table 1). Surgical patients from population groups at high risk of contracting COVID-19 21,26 should be treated with appropriate perioperative precautions, 7,10,12 and if it is unlikely to worsen postoperative outcomes, surgery should be delayed for preoperative RT-PCR testing ( Table 2). Patients from 'essential' professions that are at high risk of exposure to COVID-19 (e.g.…”

“…1,17,18,28,31,39, The literature also suggests that olfactory or gustatory dysfunction, particularly of sudden onset, No preoperative investigation for SARS-CoV-2 infection † †Proceed to surgery with surgical staff wearing full PPE and taking appropriate intraoperative precautions, especially for potential aerosol-generating procedures. 7,10,12 Isolate patient postoperatively and test for SARS-CoV-2 infection when possible.…”

Spatiotemporal characteristics and factor analysis of SARS-CoV-2 infections among healthcare workers in Wuhan, China

“…Studies have shown that the infection rate of HCWs is significantly higher than that of non-HCWs [11]. In order to deal with HCW infections, researchers in China and elsewhere have explored the causes of HCW infections [12], revealed the transmission routes leading to HCW infections [13], and formulated allocation schemes to address resource limitations [14] and protective measures [15,16].…”