This is a key point: Healthcare professionals are more concerned with catching COVID-19 from you, the patient, than you should be concerned with catching COVID-19 within the healthcare facility. Read on to learn why.
The main questions as to whether a hospital or an ambulatory surgery center can resume elective surgery as of May 2020 are:
- What is the incidence of COVID-19 in your geographic area?
- Is testing for the virus that causes COVID-19 available in your area?
- Is there adequate personal protective equipment (PPE) at the facility?
- If you are having a major surgery in a hospital, will there be an adequate number of ICU and non-ICU beds, ventilators, medications, anesthetics and medical surgical supplies at the facility?
Your state health department will have statistics regarding the incidence of COVID-19 in your area. In Palo Alto, California, where I work at Stanford, the percentage of asymptomatic patients who have a positive COVID posterior nasal swab is quite low at 0.4%, or only 1 out of 250 people. The incidence of positive COVID antibody tests, indicating a prior exposure to the disease, is only 3%. Our county and state health administrations have noted a decline in the incidence of COVID cases, and have authorized a reopening of elective surgery.
The American College of Surgeons, the American Society of Anesthesiologists, the American Association of periOperative Registered Nurses, and the American Hospital Association issued a joint statement on April 17th2020, stating that for reopening to occur, “there should be a sustained reduction in the rate of new COVID-19 cases in the relevant geographic area for at least 14 days and the facility shall have appropriate number of intensive care unit (ICU) and non-ICU beds.”
The joint statement also said that “facilities should use available testing to protect staff and patient safety whenever possible and should implement a policy addressing requirements and frequency for patient and staff testing.” Most facilities are interpreting this to mean that patients should have a negative COVID virus screening test prior to surgery. Most of these swab specimens are taken from the posterior aspect of the nose, although some tests only require an anterior nasal swab or a sputum/saliva sample.
When you enter the healthcare facility, a nurse will question you regarding virus symptoms, and will screen you by taking your temperature. The inside of the healthcare facility will be cleaned prior to any patient care, and will be recleaned after each patient leaves an operating room. Everyone in the healthcare facility will be wearing masks. Everyone will be practicing social distancing of 6 feet unless they need to be closer to you to do their duty. All the precautions you’ve heard about multiple times from TV news reporters over the past weeks are strictly practiced inside healthcare facilities. When I’m at Stanford Hospital or the surgery centers in our area I’m confident the environment is safe.
Changes in the care of surgical patients during the time of COVID are best discussed in terms of preoperative care, intraoperative care, and postoperative care:
Preoperative care: No visitors are allowed into the perioperative region. At Stanford, if you have not had a COVID test prior to elective surgery, a nasal swab is taken on admission, and a rapid COVID test is done with the result available within about 2 hours. Healthcare workers take respiratory precautions with all patients as if that patient was COVID positive, whether the COVID test result has come back yet or not. You will wear a mask in the preoperative room, and that mask will remain on your face until just prior to the induction of anesthesia.
Which surgeries are commonly done as of May 13th, 2020?
Each hospital or ambulatory surgery center is supposed to establish a prioritization policy committee consisting of surgery, anesthesia and nursing leadership, to develop a strategy to screen which surgical cases are appropriate to proceed with or not.
What do you, the patient, do with all this information?
Healthcare professionals will adhere to the high quality standards as outline above, and surgery and anesthesia should be safe for you.
Joint Statement: Roadmap for Resuming Elective Surgery after COVID-19 Pandemic. (The American College of Surgeons, the American Society of Anesthesiologists, the American Association of periOperative Registered Nurses, and the American Hospital Association)
Anesthesia Patient Safety Foundation, COVID-19 and Anesthesia FAQs