OR use during COVID-19

The Issue
COVID-19 positive patients undergoing aerosol generating procedures (AGPs) increase the risk of transmission of the SARS-CoV-2 virus. CDC recommendation is to ideally perform all AGPs in Airborne Infection Isolation Rooms (AIIRs) which are negative pressure rooms. This recommendation leads individuals to consider performing surgeries and other procedures that are normally performed in positive pressure rooms in negative pressure rooms due to the possibility of aspiration generation.

ASHE Position
ASHE recommends that health care organizations perform surgeries and other procedures on COVID-19 positive patients following the same guidelines for active TB patients:

• Only medically necessary surgeries or procedures should be scheduled and performed “after hours” or when there are no other non-COVID-19 positive patients within the suite.
• Develop a dedicated COVID-19 operating room and procedure room.
• Minimizing the amount of equipment and supplies in room is one proven action to prevent transmission.
• Minimize staff within the operating or procedure room and all staff involved should wear N95 respirators.
• All doors to the operating or procedure room should be kept closed as much as possible. Assigning a runner outside of the room who will retrieve medications, instrumentation and other supplies to minimize opening of doors should be considered. 
• If possible intubation and extubation should be performed in an Airborne Infection Isolation Room.
• Terminal Cleaning should be performed only after the necessary number of air changes has occurred to remove potentially infections particles. See the CDC table B.1 for appropriate time frames.

If it is determined to provide negative pressure for these services leaving the room ventilation in a positive pressure status and utilizing a negative pressure anteroom with separate entrance between operating or procedure room and main hallway is recommended. This anteroom can also be used for donning and doffing PPE and the placing of supplies that are needed after case begins.