Myongji shares know-how about operating on Covid-19 patient
A) View of the entire negative-pressure operating room. The surgical team is wearing enhanced personal protective equipment, and a negative-pressure cart is shown (yellow arrow). Airflow was maintained from the ceiling perforated supply diffuser (red arrow) to the exhaust grille (blue arrow) installed at the bottom of the operating room's four corners. B) Surgical suit, an isolation gown, and enhanced personal protective equipment. C) Negative-pressure status display panel and intercom installed outside the entrance of the negative-pressure operating room.
A Korean hospital published a case report of safely operating on a Covid-19 patient in an international journal.
Myongji Hospital reported the case in the International Journal of Surgery Case Reports, published by the Netherlands’ Elsevier, of a Covid-19 patient who had to undergo an urgent appendectomy due to acute appendicitis.
The case report shared how to design a manual and train a surgical team for surgery in a Covid-19 patient in a negative-pressure operating room (OR).
On May 27, Myongji Hospital performed an appendectomy on a Covid-19 patient safely in a negative-pressure OR, and the case report presented the details.
Before surgery, Myongji’s medical team confirmed the patient had peritonitis through the CT scan and decided to perform an emergency laparoscopic appendectomy. After laboratory exams, the patient entered the OR on a negative-pressure cart. An anesthesiologist wearing a Level 4 protective suit performed general anesthesia.
The surgical team wore personal protective equipment, including an isolation gown, surgical gown, head cover, face shield, two pairs of surgical gloves, shoe covers, and an N95 mask. Surgeons did not use electrocautery during surgery and used disposable devices whenever possible.
The team applied anesthesia for 60 minutes, and the operation lasted 45 minutes. The surgeons and the patient stayed in the OR for 90 minutes.
After the operation, the medical staff exiting the OR disposed of their protective gear immediately under the supervision and took a shower. The hospital placed waste in dedicated containers.
The hospital maintained the OR under the negative-pressure air conditioning for two hours after the patient left the OR. The hospital then fumigated disinfectant for three hours and wiped the surface with diluted chlorine bleach (500ppm).
The hospital could re-use the OR five hours after the surgery on the Covid-19 patient.
An infection specialist nurse recorded the entire process of patient transfer, the OR's preparation, the surgical procedure, and postoperative disinfection, the case report said. Also, the hospital actively monitored all members of the surgical team for two weeks.
Before this case, Myongji Hospital had performed emergency appendectomies for eight patients who were suspected of Covid-19. The hospital developed an instruction manual for emergency surgery for Covid-19 patients and improved it through several simulations.
“One of the concerns in laparoscopic surgery for Covid-19-confirmed patients is the proper care of aerosols containing viruses that could be produced by these patients,” the research team said. “The negative pressure inside the OR was maintained at a negative pressure of 4.7 Pa or greater, and the air introduced from the perforated supply diffuser from the ceiling was discharged through an exhaust grill located at the height of 110 cm from the floor at all four corners of the OR.”
The research team noted that although the surgical team is exposed to an infection risk, the risk can rise if they remove protective gear after surgery.
“In particular, it is essential to supervise and monitor the entire operation process, exiting of the surgical team, and the postoperative disinfection tasks by the infection specialist nurse,” the case report said.
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