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Personal Protective Equipment (PPE) in the Operating Room - Recommendations

March 24, 2020 10:40 PM | Anonymous

An important point for surgeons is the use of PPEs in the operating room. Because there seems to be a variable understanding of the recommendations, we have provided some basic recommendations. The CDC has the following information and recommendations for PPE use for COVID-19 patients, or persons under investigation (PUI).

While in the operating room (OR), N95 respirators are recommended, particularly when operating on confirmed or suspected COVID-19 patients; however, the American College of Surgeons recognizes that many health care facilities have limited access to N95s at this time. Recent recommendations have been developed by the ASA and others for projected shortages of N95 masks. These include: implementing leadership controls to minimize who needs respiratory protection, use of alternatives to N95 masks, practices allowing extended use and or limited reuse of N95 masks, prioritization of N95 masks for health care personnel at highest risk of COVID-19 and consider use of masks approved by the National Institute of Occupational Safety and Health typically used in manufacturing and construction. For individuals at highest risk of exposure at institutions that are unable to provide N95 masks to all members of the OR team, we recommend that all surgeons and other personnel who are not wearing N95s evacuate the OR during intubation, extubation, and other procedures that may generate aerosolized small particles. The Centers for Disease Control and Prevention and the American Society of Anesthesiologists have recommendations to help prioritize.

Ensuring a proper fit of the N95 mask is paramount, so FIT TESTING is needed. The CDC also has delineated some key factors for using the N95 mask effectively, as well as checking for an appropriate mask “seal”.

Finally, shortages of masks increasingly are being reported, so strategies for optimizing facemasks/PPEs from the CDC are provided in this link.

Proper Donning and Doffing of PPE to Treat COVID-19 Patients

A similar donning and doffing technique can be used as the Centers for Disease Control and Prevention (CDC) recommended for physicians on the front lines during the Ebola crisis. Informational materials are available that demonstrate the procedures described in CDC guidance for putting on and removing PPE.

PPE for Office Visits

The same recommendations made for hospital care should be applied to outpatient office visits. The safety of patients and health care professionals is best served by allowing patients to stay home whenever possible to avoid bringing together large numbers of people. Although much of the focus has been on surgery and procedure areas, outpatient office areas experience a much higher volume of traffic with more providers in a smaller area without routine PPE during patient interactions. In addition to trying to discourage social interaction in these settings, additional preservation of PPE is a priority, which is undermined by continuing to see patients without urgent problems in outpatient offices. Thus, whenever possible outpatient evaluation should be by permissible remote connectivity. Patients who the provider deems in need of urgent personal evaluation may still be offered in-person office visits.

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