Inform Promote Sustain
Coronavirus (COVID-19)Infection Prevention and Control The Operating Department
Version 1.2 14th April 2020
What is Coronavirus and COVID-19
Inform Promote Sustain
Coronaviruses are a large family of viruses - they cause infections ranging from the common cold to Severe Acute Respiratory Syndrome (SARS)
Coronaviruses circulate between animals and humans; sometimes new variants of the coronavirus emerge - such as COVID-19
COVID-19 has the potential to spread widely as lack of immunity means everyone in the population is susceptible
What are the symptoms of COVID-19? Symptoms start 5 -11 days
after exposure Similar to seasonal flu Majority have fever and dry
cough (rapid onset) Symptoms last 5 - 6 days Severe illness starts day 7 Shortness of breath Lung inflammation Pneumonia
Symptom Proportion of cases
Fever >37.8oC 88%Dry cough 68%Fatigue 38%Sputum 33%Shortness of breath 19%Muscle/joint pain 15%Sore throat 14%Headache 14%
Inform Promote Sustain
Severity of COVID-19 illness Most people have no obvious
symptoms (30-40%) Most children get mild disease More severe disease in:
Older people Diabetics Heart disease Chronic respiratory disease Immune compromised
Less than 2% of cases fatal Highest in high risk groups
Inform Promote Sustain
Undetected
CriticalRespiratory/muli-
organ failure
SevereShortness of breath; Respiration; O2 sats
MildFever, cough
How is COVID-19 transmitted? Exposure to large respiratory droplets Coughing/sneezing droplets onto mucous membranes
mouth, nose, eyes Need close contact for this to occur (within two meters)
Contact with respiratory secretions Directly or via contaminated surfaces Tissues contaminated with respiratory secretions Transferred by touching mucous membranes
Not transmitted in air except during a procedure involving the respiratory tract that generates aerosols
Inform Promote Sustain
Infection Prevention & Control Strategies
1. Cough etiquette
2. Standard precautions
3. Isolation precautions
Inform Promote Sustain
Personal hygiene to prevent spread Cough etiquette Cover mouth and nose with a tissue or your sleeve
(not your hands) Dispose of tissues directly into bin Hand hygiene after contact coughing/sneezing
Inform Promote Sustain
Ensure patients have hand wipes
or alcohol gel available
Standard Precautions Essential to minimize risk of transmission
between staff and patients Will reduce the risk of transferring the virus from
patients not recognized to have COVID-19
Inform Promote Sustain
Hand hygiene Protective clothing for contact with body fluid Safe disposal of waste Clean equipment & environment
Hand Hygiene
Immediately before touching a patient
Before a clean/aseptic procedure
Immediately after touching a patient or their surroundings
After removing gloves
Inform Promote Sustain
Alcohol gel is effective against COVID-19Soap and water should be used if hands are soiled
Patient hand hygiene
Encourage patients to clean their hands After coughing/sneezing Before eating After toilet
Make hand wipes or alcohol gel available at bedside for patients to use
Inform Promote Sustain
Standard precautions: Gloves For procedures involving DIRECT contact with blood
or body fluid Risk assess procedure if gloves are indicated put on immediately before
commencing procedure Remove and decontaminate hands immediately after
the procedure
Inform Promote Sustain
Take gloves off promptly!Virus (and other pathogens) are transferred between patients,
surfaces and your own mucous membranes on your gloved hands
Standard Precautions: Aprons
For procedures where there is a risk that the clothing may become soiled
Risk assess procedure If indicated put on immediately before commencing
procedure Remove if contaminated or on leaving the
patient and decontaminate hands
Inform Promote Sustain
Droplet precautions Operating theatres
Patient with possible or confirmed COVID-19 where no Aerosol Generating Procedures (AGP)
Patient transfers Patient with possible or
confirmed COVID-19
Airborne precautions Operating theatres
Surgery involving AGP on patient with possible or confirmed COVID-19
Inform Promote Sustain
Transmission-based Precautions
Aerosol Generating Procedures Associated with high
velocity air passing over respiratory mucosa Generates tiny (<5µm)
respiratory particles which remain airborne
Only perform AGP on COVID19 patients if essential
Only essential staff present Airborne precautions required
(FFP3 mask/gown)
Aerosol Generating Procedures (AGP)
Inform Promote Sustain
Intubation & extubationManual ventilation/open suctioning Surgery - high speed devices Dental - high speed drilling Tracheostomy Upper GI endoscopy + open
suction of respiratory tract Bronchoscopy & ENT with suction High flow nasal oxygen Non-invasive ventilation (BiPAP,
CPAP) & HFOV Sputum induction
FFP3 Respirator Masks Filters out very small particles Protects from inhalation of fine airborne particles
(droplet nuclei) Filtration effective only if sealed to contour of face
Fit testing required to ensure effective protection Fit check before each use
Required for procedures which generate aerosols of respiratory secretions (AGP)
Not necessary for close contact without AGP Must be worn with long-sleeved waterproof gown
Inform Promote Sustain
Droplet Precautionsknown or suspected COVID-19 patients
Infection is transmitted by respiratory droplets and contact with respiratory secretions therefore: Place patient at end of list Admit directly to operating theatre Anaesthetise & recover in operating theatre Protective clothing for contact (within 2 metres)
Fluid resistant surgical mask, eye protection, gloves, plastic apron Theatre ventilation must be left on Dedicated patient equipment where possible Clean surfaces as for infected patients
Inform Promote Sustain
Surgical masks protect mucous membrane from contamination by large respiratory droplets (and are as effective as FFP3 for this)
Protective clothing Known or suspected COVID-19
(no aerosol generating procedures)Direct care (in operating room) Fluid Resistant Surgical mask (Type IIR) Eye protection Gloves
MUST be changed after each task (as per 5MHH) to protect patient from infection
Apron (or sterile gown if scrubbed) change if soiled
Inform Promote SustainRemember to avoid touching your mouth, nose and eyes
Discard all protective clothing and clean hands on leaving room and when patient discharged
Airborne PrecautionsAGP on known/suspected COVID-19 patient Ventilation (ultraclean air or conventional) MUST
be on during the AGP procedure Rapid dilution of aerosols will protect theatre staff
Only staff required to perform procedure to be present
Staff to wear: FFP3 respirator mask Eye protection (visor) Long-sleeved waterproof gown Gloves
Inform Promote Sustain
Inform Promote Sustain
Inform Promote Sustain
Public Health England
Removal of protective clothing(Doffing)
Discard mask when moist or damaged Remove PPE in this order:
1. Gloves (then decontaminate hands)2. Apron/gown (avoid touching contaminated front surface)3. Mask/eye protection
Decontaminate hands after all PPE has been removed
Inform Promote Sustain
Inform Promote Sustain
Remember!Don’t touch your mouth, nose or
eyes.
Decontaminate your hands
thoroughly on leaving the area/room.
Summary of precautions for known/suspected COVID-19 patients
In-patient areas Operating Department
PPE Patient contact(within 2m)
AGP (in room)& high risk
areas
No AGP AGP
Plastic apron Surgical mask - fluid-resistant (IIR/EN14683)
Long sleeved disposable gown Risk assess
FFP3 respirator Eye protection Risk assess Disposable gloves
Inform Promote SustainAGP = aerosol generating procedures
Additional precautions may be applied in in-patient areas where there is sustained transmission of COVID-19
Environmental contamination Surfaces may become contaminated with respiratory
secretions Directly from coughing/sneezing Indirectly by touching with contaminated hands Contamination greatest where AGP performed
COVID-19 unlikely to survive in significant numbers on surfaces for longer than a few days Studies often recover virus RNA but many do not test if viable
and able to cause infection
Easily removed by cleaning Detergent & water followed by disinfectant Chlorine at 1000ppm effective
Inform Promote Sustain
Medical EquipmentFor known/suspected COVID-19 patient Protect ventilators with high efficiency filter Use closed system suction Use single-use equipment where possible Laryngoscope –disposable or processed by sterile services Video laryngoscope –decontaminate handle as per
manufacturers instructions
Near-patient medical equipment Decontaminate after the patient has left the operating theatre Use detergent & water followed by disinfectant
Select disinfectant using protocol for infected cases or manufacturers instructions
Inform Promote Sustain
Surgical Instruments Used on known/suspected COVID-19 patient
Apply standard infection control precautions to handle instruments after the procedure Wrap surgical instruments and tray in the usual way Return wrapped trays directly to sterile services Clean trolleys using detergent & water followed by
disinfectant (chlorine 1000ppm)
Inform Promote Sustain
Cleaning after procedure on known/suspected COVID-19 patient
Aerosols will be rapidly removed by air changes airborne contamination will eliminated after five mins
Clean surfaces according to infected patient protocol Commence after patient has left operating theatre Use detergent followed by chlorine 1000ppm Decontaminate cleaning equipment immediately after use
Waste - treat as clinical waste Linen - place directly into water-soluble bag
Inform Promote Sustain
Staff with COVID-19
If you develop symptoms of a flu-like illness then DO NOT come into work: Acute onset fever >37.8oC and new persistent cough
Inform your manager Self-isolate at home for seven days from onset of
symptoms If your symptoms worsen contact NHS 111
Staff at high risk of complications from COVID-19 risk-assessment to manage their deployment
Inform Promote Sustain
Useful resourcesPublic Health England Campaign Resourceshttps://campaignresources.phe.gov.uk/resources/campaigns/101-coronavirus-
Public Health England Coronavirus (COVID-19) infection control guidance https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control
NHS Englandhttps://www.england.nhs.uk/ourwork/eprr/coronavirus/
NHS websitehttps://www.nhs.uk/conditions/coronavirus-covid-19/
Healthcare Infection Societyhttps://his.org.uk/resources-guidelines/novel-coronavirus-resources/
World Health Organizationhttps://www.who.int/emergencies/diseases/novel-coronavirus-2019
Inform Promote Sustain