should include a renewed focus on environmental cleaning, rethinking
anesthesia delivery and a deliberate ramp-up to a full case volume.
Surveil patients and surfaces. Obviously, your ability to test patients
for COVID-19 before they enter your facility is critical. Testing patients is
an excellent start in keeping the coronavirus out of your facility, but it's
also not enough to limit risks. If you're using day-before RT-PCR oropha-
ryngeal or nasopharyngeal screenings, false negatives can occur about
19% of the time. In communities with 1% of individuals testing positive,
only about 0.24% would have COVID-19. That's good news, but the bad
news is facilities averaging fewer than 60 cases a day would then have a
false negative most weeks. So, perform good hand hygiene, decontami-
nate patients with oral antisepsis and nasal decolonization, and clean
and monitor reservoirs where the virus accumulates and persists.
Protect your staff and patients from COVID-19 by monitoring your
ORs for locations where pathogens tend to be detected and, if pres-
ent, address them.
Closely monitor the environment in your ORs for pathogenic trans-
missions and increase your focus on cleaning the reservoirs you find. If
you're already surveilling for reservoirs of Enterococcus,
Staphylococcus aureus, Klebsiella, Acinetobacter, Pseudomonas and
Enterobacter spp. (ESKAPE) contamination, you'll likely have a line on
where COVID-19 would collect.
Alter anesthesia practices. Establish "clean" and "dirty" areas
around anesthesia workstations. Put alcohol-based hand rubs on the
IV pole to the provider's left, and a wire basket lined with a zip-clo-
sure plastic bag for deposit of contaminated instruments on the IV
pole to the provider's right. Anesthesia providers should double-glove
before touching the patient's nose and mouth, and remove the outer
gloves following contact. After patient positioning, wipe down equip-
ment and high-touch surfaces with disinfecting wipes that contain a
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