Table E2.

Take-home message

What we learned: • Testing both patients and health care workers for the new coronavirus with NP swabs it is at the heart of COVID-19 screening and prevention • Cardiac surgery patients and health care workers can be highly exposed to SARS-CoV-2 infection • COVID-19 infection at any stage of the cardiac surgery journey, from preoperative to postoperative course, remains a dreadful condition • Diagnosis may be more difficult after cardiac surgery; the inflammatory state that follows the CPB may mask laboratory findings

What we changed: • A dedicated area (“gray area” or “bubble area”) was created. The “bubble” is a specific environment in which elective or semielective patients are kept isolated until NP swabs are processed; when the patient is cleared, they then are allowed to enter clinical area (see also Video 1) • Urgent cases transferred from other hospital or A&E are accepted into the clinical area only if the NP swab is negative. The “bubble” has a “red room” with a mechanical ventilator • Hospital resources such as echo, ECG, portable CX, and other equipment are specifically allocated to the “bubble” • Dedicated health care workers must wear FFP2/3/N95 mask, gowns, gloves, and face shield in the bubble area • Education at all level is promoted with seminars (webinar) on COVID-19 • Strict “bare below elbow policy” in the clinical area • Every 2 wk health care workers must undergo surveillance NP swab • Low threshold for CT scan of the chest and NP swab in case of postoperative respiratory failure

NP, Nasopharyngeal; COVID-19, coronavirus disease 2019; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; CPB, cardiopulmonary bypass; A&E, accident/emergency; ECG, electrocardiogram; CX, chest x-ray; FFP, Filtering Face Piece; CT, computed tomography.