Table 4.

Logistical considerations when operating on a COVID-19 positive surgical patient.^a

▪In-transit surgical patients proceeding from the emergency room or an inpatient unit to the operating room must be masked or covered to reduce airborne transmission and carefully transported, with the help of hospital security to clear hallways and elevators.

▪A preselected route should be identified without stopping in an anesthetic bay, preoperative care unit, or any place other than the COVID-dedicated operating room.

▪All transporting personnel should don appropriate PPE, and should doff that PPE (i.e., gowns and glove) and perform robust hand hygiene once they arrive to the operating room and have transferred the patient to the operating table.

▪New, sterile PPE should be used for the procedure, with N95 masks and eye protection recommended throughout the case. Intraoperative gowns/gloves should be doffed and new PPE donned for transport of the patient at the completion of the procedure. Detailed recommendations regarding appropriate operating room protocol and PPE selection are available on the American College of Surgeons website [44].

▪Consider leaving the stretcher that the patient was transported on in the operating room during the case to avoid contamination in an adjacent hallway. Discard stretcher bed linens in biohazard containment bags once the patient is moved to the operating room table and apply fresh linens on the same stretcher prior to transport at the procedure's end.

▪Ideal characteristics of a COVID-dedicated operating suite include negative pressure, the presence of an ante room, and designated nurses and safety officers/health care personnel in attendance to oversee the case from transport in and out of the operating room and from procedure start to finish. ▪There should be a minimum number of personnel involved in both the transfer and intraoperative care of the patient.

▪ Intraoperative and postoperative care planning should be discussed at the beginning of the procedure: o Strict safety protocols should be applied as detailed in this manuscript o Those patients who may safely undergo same day surgical procedures and do not have severe COVID-19 disease should be discharged home, whenever possible, whereas those who require post-operative admission are ideally cared for on a designated COVID-19 unit.

^aAdapted from the Johns Hopkins Hospital COVID-19 Surgical Protocol.