Source : Anesthesia & Analgesia Journal Publish – Ahead of Print
Auteur : Franklin Dexter et al.
We describe an evidence-based approach for optimization of infection control and operating room management during the COVID-19 pandemic. Confirmed modes of viral transmission are primarily but not exclusively contact with contaminated environmental surfaces and aerosolization. Evidence-based improvement strategies for attenuation of residual environmental contamination involve a combination of deep cleaning with surface disinfectants and ultraviolet light (UV-C). (1) Place alcohol-based hand rubs on the IV pole to the left of the provider. Double glove during induction. (2) Place a wire basket lined with a zip closure plastic bag, on the IV pole to the right of the provider. Place all contaminated instruments in the bag (i.e. laryngoscope blades and handles) and close. Designate and maintain clean and dirty areas. After induction of anesthesia, wipe down all equipment and surfaces with disinfection wipes that contain a quaternary ammonium compound and alcohol. Use a top down cleaning sequence adequate to reduce bioburden. Treat operating rooms using UV-C. (3) Decolonize patients using preprocedural chlorhexidine wipes, 2 doses of nasal povidone iodine within one hour of incision, and chlorhexidine mouth rinse. (4) Create a closed lumen IV system and use hub disinfection. (5) Provide data feedback by surveillance of ESKAPE transmission. (6) To reduce the use of surgical masks and to reduce potential COVID-19 exposure, use relatively long (e.g., 12-hour) staff shifts. If there are 8 essential cases to be done (each lasting 1-2 hours), the ideal solution is to have 2 teams complete the 8 cases, not 8 first case starts. (7) Do 1 case in each operating room daily, with terminal cleaning after each case including UV-C or equivalent. (8) Do not have patients go into a large, pooled phase I post-anesthesia care unit, because of the risk of contaminating facility at large along with many staff. Instead, have most patients recover in the room where they had surgery, like done routinely in Japan. These 8 programmatic ACCEPTED Copyright © 2020 International Anesthesia Research Society. Unauthorized reproduction of this article is prohibited. 4 recommendations stand on a substantial body of empirical evidence characterizing the epidemiology of perioperative transmission and infection development made possible by support from the Anesthesia Patient Safety Foundation (APSF).