Additional advice about Personal Protective Equipment (PPE) in Emergency Surgery has been developed.
A new COVID-19 screening process and corresponding PPE requirements have been developed to support the delivery of timely and efficient care to emergency surgical patients.
Where relevant, these documents replace existing PPE information for emergency surgery and should be treated as a package, encompassing:
- Patient groups
- Testing groups
- Management groups
- Room Rest Times and in-theatre PPE
Please take time to review these documents and make sure you always refer back to this page for the latest versions.
Background
Overarching principles
- To deliver timely and efficient care to emergency surgical patients
- Staff protection through the reduction in risk exposure and appropriate PPE
- Preservation of operating capacity through efficient utilisation of resources and preservation of infrastructure and employee capacity.
Caveats
- Not all clinical decisions are able to be addressed by a single, rigid and unchanging flow chart
- Many decisions are driven by non-patient factors
- Acceptance that not all scenarios can be addressed by this single protocol
Explanatory statement
In response to challenges managing the changes to swabbing and screening, the following structure facilitates safe emergency surgery.
Contained in the below documents are a unifying system for managing potential and confirmed COVID-19 patients throughout the surgical process, with transitions from ED to the ward, to theatre, and post-operative disposition. This harmonises the process across most facets of Monash Health – ED, OR, Labour Wards, ICU, General Wards.
There is now a new patient group, COVID Low Risk, where the Screening Questionnaire is negative, but the COVID-19 test is pending. This will enable different areas to enhance the existing guidance for this subsection of emergency patients and further reduce employee risk when appropriate.
The model recognises that the risk to patients and employees is not only dependent upon patient factors, but also what procedures are performed. For example, airway management in theatre is regarded as an aerosol-generating procedure (AGP) and requires a higher level of PPE than routine ward management. We suggest that in this “low risk” group that the level of PPE is transiently elevated around a time of potentially elevated risk. Once the risk has abated (outside of AGPs in theatre and Room Rest Time (RRT)), the level of PPE is adjusted accordingly. This provides recommended protections for all employees through the perioperative process and enhances them in situations where there are unknown variables such as an incomplete COVID-19 test result, or incomplete Screening Questionnaire.
The aim remains to pursue surgery in a manner that is safest for the patient and employees. In an ideal world, we would have a completed Screening Questionnaire and a known COVID-19 test result for all patients prior to surgery. With emergency procedures, this is not the case. This method offers solutions to proceed to surgery without delay, recognising that many results are likely to be available prior to surgical intervention. In addition, it offers solutions to the common questions of who is to be managed as COVID-negative (COVID-NEG), COVID-low risk (COVID-LR), COVID-suspect (SCOVID), or COVID-positive.
Thanks go to Andrew Silvers, Alan Saunders, Al Ford, and Jon Au from Monash Anaesthesia for their work developing and proposing this structure to support safe emergency surgery.
