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Pushing For Change - July 2020 - Subscribe to Outpatient Surgery Magazine

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rience as an epidemic intelligence officer for the CDC to help guide the algorithm's development. For practical reasons, it's easy to apply; the team's goal was to have the guidelines created by the PPE task- force, ratified by hospital leadership and implemented within 72 hours. He says leadership from all service lines must be involved in implementing the algorithm's steps. To determine the level of PPE needed for a particular case, refer to the flow chart (opposite page). The first step is to decide the surgery's level of risk, which depends on the anticipated viral bur- den at the surgical site and the likelihood that a procedure would aerosolize the virus. High-risk cases include any involving the open aerodigestive tract such as nasopharyngeal and oropharyngeal pro- cedures; bronchoscopy; endoscopy of the GI tract; and surgery of the bowel with gross contamination. Next, consider the results of the patient's screening for symptoms of COVID-19 (fever, cough, sore throat). Surgical teams can wear stan- dard surgical attire during surgery performed on patients who do not present for surgery with symptoms, according to the algorithm. If the patient does screen positive for symptoms, consider delaying the case or proceeding with staff wearing the highest level of barrier protec- tion. Patients who screen positive for symptoms at Stanford Health are subjected to in-house reverse transcription polymerase chain reaction (RT-PCR) testing, which detects presence of the coronavirus. Dr. Forrester concedes many facilities don't have immediate access to such resources. "Much of the PPE triage is based on COVID-19 test- ing," says Dr. Forrester. "Facilities that don't have access to effective testing must operate with more stringent PPE protocols in place." PPE availability, anticipated burn rates and supply chain disruptions may require modification of the algorithm, according to Dr. Forrester. J U L Y 2 0 2 0 • O U T P A T I E N T S U R G E R Y . N E T • 1 9

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