Considering specifics of work, the surgical personnel have rather high risks of infection with a koronavirusny infection. In this article we will consider made and recommendations concerning protection of personnel in the operational room, and on minimization of risks of infection with COVID-19 infection in other premises of surgical clinic.
In the beginning we will consider work in the operating room. Use of individual protection equipment is recommended for each operation which is carried out on the patient with the confirmed infection of COVID-19 or on the patient with suspicion of an infection.
Respirators of N95 type or respirators with higher level of protection have to be used by personnel which carry out itself manipulation or are present on aerosol - the generating procedure (for example, the patient's intubation at the operating room) at the patient with COVID-19 or with suspicion of this infection.
Disposable respirators and front masks have to be removed and utilized properly according to the approaches accepted in concrete clinic.
It is necessary to execute hygienic processing of hands after utilization of a respirator or a mask. Individual test selection is very important for providing a due prileganiye of a respirator. There is a probability that individual protection equipment, including suitable respirators and masks of N95 type can be in deficiency. Healthcare institutions are recommended to draft protocols for preservation of stocks of masks and other protective equipment.
During the work with patients without suspicions on COVID-19 which is carried out in the conditions of policlinic, office of acute management, intensive care unit and an intensive care or the operating room use of a surgical mask with an ear loop is recommended.
For work with patients with suspicion or with a positive take on COVID-19 when the patient has symptoms of COVID-19 or results on COVID-19 are expected, or the positive take, in the conditions of policlinic, office of acute management, intensive care unit and an intensive care or the operating room is already received, necessary SIZ are: eye protections (front guard), N95 mask (respirator similar or more high-class protection), dressing gown and gloves.
At implementation of aerozoleobrazuyushchy procedures at patients with suspicion or with a positive take on COVID-19 and manipulations on respiratory tracts at all patients in the conditions of policlinic, offices of acute management, intensive care unit and an intensive care or the operating room, necessary SIZ are: The filtering respirator with compulsory air supply or N95 mask (or a respirator similar or more high-class protection) + a front guard (eye protections), a dressing gown and gloves. To aerozoleobrazuyushchy procedures the laringoskopiya and an intubation, noninvasive IVL, cardiopulmonary resuscitation, a bronkhoskopiya, sanitation of an oral cavity or a tracheobronchial tree treat without use of the closed systems for sanitation, use of the nebulizer or an inhaler.
In all the cases stated above the hygiene of hands is required at an entrance and an exit to a workroom, regardless of whether there is a patient on isolation and whether SIZ are put on.
In separate group mark out the risks connected with carrying out an intubation.
It is known that the aerozolization and transfer in the airborne way of COVID-19 virus are serious risks for surgical personnel as it leads to increase of virus loading. The risk of an aerozolization and transfer increases in the airborne way with such procedures as an endotracheal intubation, a tracheostomy, endoscopic researches, during removal of a pneumoperitoneum and aspiration of biological liquids during laparoscopic interventions. Surgeons and personnel whose presence is not required at an intubation have to remain outside the operating room before completion of induction in anesthesia and intubations of patients with suspicion or existence of an infection of COVID-19.
Are recommended at an opportunity operational and preoperative with negative pressure.
Among other recommendations there is a restriction to minimum the number of personnel in the operating room, including an intubation and also during all stages of operation. Operations are performed without visitors and observers. Also use of the tow truck of smoke when carrying out electrothermic coagulation is recommended.
After carrying out operation if transportation of the patient with a positive take or with suspicion of COVID-19 infection in external chamber of awakening or in intensive care unit is required, then transfer of such patient has to be carried out to the minimum number of personnel for transportation which wait outside of the operating room. These personnel have to put on the recommended SIZ.