Surgery in the time of coronavirus 2020

By: Julie-ann Greenhalgh, BSN, RN, CNOR
September 10, 2020

You can’t see our faces, you can’t see our smiles, you can’t see if we are stressed or scared or that we may be carrying the burden of the world on our shoulders, yet, we give the best care possible to the patients that have literally put their lives in our hands. We’re operating room nurses, and as nurses, we want questions answered quickly and clearly, we want things done right. The need for clear, precise communication is more important now than ever before.

Perioperative nurses are all very much aware of the need for personal protective equipment (PPE). For us, wearing a mask for 12-14 hours in a 24-hour period is nothing new. The dangers of breathing in surgical smoke - approximately 500,000 health care workers are exposed to each year - is well documented.[1] We are also aware of the many particles, viruses and blood borne pathogens we are exposed to each day that go through the filtration system of standard masks. We accept this as part of our jobs.  We know these particles can expose both the staff and patients to harmful byproducts, and we must take all precautions to protect ourselves and our co-workers every day. But now another agent has emerged that is causing us a grave danger along with the fear of the unknown. Its name is COVID-19.

The COVID-19 virus has caused a global pandemic with hundreds of thousands infected in the United States alone.  Despite, the fact that most elective surgeries have been postponed during this difficult time, emergency surgeries from open heart to fractures to exploratory surgeries are still being performed every day.

Given the number of emergency surgeries conducted weekly in operating rooms in the United States, and the incubation time of this virus, thousands of COVID-19 positive patients are likely to need some type of surgical intervention during this outbreak. How do you determine which patient gets surgery and which one gets delayed? Each facility should set the precedents as to what should be considered an emergency procedure.

Speaking with coworkers and nurses from area hospitals, it appears that the patients who are arriving for surgery are more seriously ill and are avoiding coming to hospitals. They are concerned about the cost, don’t want to bother their doctor, or simply the fear of the unknown.

The perioperative team, as always, will provide timely, high-quality surgical care to any patient presented through our operating room doors and work together for the best possible outcome. However, we must adequately protect our surgical teams. A large outbreak of staff with COVID-19 or even exposure could have a devastating effect on a staff that is already anxious about what is going on in the world and the capability of their facility to care for patients.
 
Surgical teams are at high risk for exposure; however, new exposures present themselves every day. Viral particles are often found in nasal passages, pharyngeal mucus, bronchial secretions, and the entire gastrointestinal track from the mouth to the rectum. Blood and stool have also been found positive for harmful particles of tissue and specimens. The virus has been found on flat surfaces in the operating room as well as bottoms of shoe covers.[2]

So how do we, as perioperative professionals, protect our patients, staff, ourselves and other areas of the facility during this difficult time?

The Association of Perioperative Room Nurses (AORN) is the leader for advocating best practices for OR nurses and their evidence-based practices assure that clinical decisions will be up-to-date and help provide clear and consistent expert information during this pandemic outbreak. (AORN tool kit)

As we move forward there are many things that should be considered regarding policies and procedures surrounding daily life in operating rooms. These policies shouldn’t be handled lightly and should be enforced. The safety of our healthcare providers needs to be an ongoing conversation and not a knee-jerk reaction to what we are seeing today. AORN has many powerful recommendations that can help provide safer outcomes.

Read more on how you can advocate during this time here.

Appendix

1 “CDC - NIOSH Research Rounds - Volume 2, Issue 8, February 2017.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 14 Feb. 2017, www.cdc.gov/niosh/research-rounds/resroundsv2n8.html#:~:text=The%20Occupational%20Safety%20and%20Health,the%20smoke%20at%20its%20source.
2 “Study reveals how long COVID-19 remains infectious on cardboard, metal and plastic” ScienceDaily, ScienceDaily, 20 March 2020, https://www.sciencedaily.com/releases/2020/03/200320192755.htm

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