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.
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