Infection Prevention and Control in Perioperative Patients during the COVID-19 Pandemic: Protocol from a Tertiary General Hospital

To the Editor:

“Even though we are in the midst of a crisis, essential health services must continue,” said Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, on March 30, 2020 [1]. In the current coronavirus disease 2019 pandemic situation, most Chinese hospitals are cautious in screening patients for admission. The severe acute respiratory syndrome coronavirus 2 is transmitted by not only patients with symptoms but also by asymptomatic individuals [2], which undoubtedly increases the difficulty in preventing and controlling hospital transmission. For patients requiring surgery, especially emergency patients, on the one hand, strict screening can reduce the incidence of nosocomial infection and medical staff infection; on the other hand, tedious screening methods may delay the operation. Thus, finding a balance is the challenge. We offer the following protocol (Fig. 1 ) and recommendations for infection prevention and control in patients awaiting emergency operations.

Fig 1.

Algorithm for screening patients awaiting operation. ICT = infection control team; BSL-3 = biosafety level 3.

Adopt the principle of saving people first and ensuring maximum protection [3]. We recommend computed tomography and antibody testing as the preferred screening methods, which are faster and more effective than an etiologic examination. The hospital must establish a control team, which includes experts from the infection, respiratory, surgery, and anesthesiology departments. In case of any difficulty in decision-making, one must report to the infection control team to confirm the results. A negative-pressure operating room must be established to meet the operation requirements of suspected or confirmed cases. A negative-pressure isolation transfer cabin can be used by staff wearing biosafety level 3 protective medical equipment to transport patients. Biosafety level 3 protective gear, including N95 masks, goggles, protective suits, face shields, caps, shoe covers, and gloves, is required while performing operations on patients confirmed with coronavirus disease 2019 or patients suspected with severe acute respiratory syndrome coronavirus 2 infection. For the care of patients receiving general anesthesia and endotracheal intubation, the anesthesiologist should use a powered air-purifying respirator [4]. All protective gear should be disposed of properly. The next operation must be performed 2 hours after the disinfection of the operation theater (a chlorine-containing detergent and ultraviolet irradiation are recommended).

In general, we believe that correct triage and mindful practice of protection measures can effectively resolve the contradiction between high operation demand and the threat of hospital infections.