COVID-19 Surgical Patient Checklist*

To minimize healthcare provider exposure when operating on COVID+ or suspected patient

PREOPERATIVE INTRAOPERATIVE POSTOPERATIVE

Team Briefing
 At All Times Recovery

Surgeon, Nurse, Anesthesia Provider & OR Runner All staff in OR wearing N95/FFP mask Anesthesia Provider & Nurse
Anesthesia & Surgical plan If extubated, recover patient in OR
Plan for outside OR Runner to deliver supplies if Induction Low flow oxygen
needed Essential personnel only Dispose of unused medications or wipe
Minimize traffic, keep patient chart & staff belongings Minimize aerosol generation vial with 70% alcohol**
outside OR OR documents placed in plastic sleeve
If no airway intervention, patient wears surgical
Recovery plan Surgical/Oxygen mask on patient during transport
mask throughout case
Remove PPE after patient transferred
Setup
 During Operation
WAIT ONE HOUR AFTER EXTUBATION TO CLEAN
Nurse Runner remains outside OR OPERATING ROOM***
COVID notification sign on door Perform WHO Surgical Safety Checklist
PPE available Time Out* before incision AFTER PATIENT LEAVES OR
Viricidal cleaning supplies available Surgeon to minimize duration and aerosolization
Remove non-essential equipment Specimen Handling
End of Case All specimens double bagged
Anesthesia Provider Perform WHO Surgical Safety Checklist Sign Out* Porter wears gloves for transport
Prepare drugs & equipment If patient to remain intubated, notify ICU
Viral filter between patient & circuit If extubation, ONLY essential personnel Operating Room Disinfection
Dedicated tray for contaminated items remain inside OR Clean all surfaces (OR table, anesthesia machine,
Runner remain outside OR until patient transported equipment, stools) - 0.5% chlorine or 70% alcohol
Patient Transport to OR Clean floor with 0.5% chlorine
Nurse, Anesthesia Provider & OR Runner
Anesthesia Provider and Nurse don PPE for transport Waste Management
Surgical mask on patient during transport All materials from OR double bagged in plastic bag
OR Runner to clean stretcher after patient transfer for disposal
Perform WHO Surgical Safety Checklist Sign In* Spray waste bags with viricidal
Transport wears gloves

*To be used in conjunction with WHO Surgical Safety Checklist. This checklist is not intended to be comprehensive. Additions and modifications to fit local practice are encouraged.
**Cleaning and reuse of disposables during COVID-19 pandemic is not recommended if resources are adequate; these recommendations are for critical resource limitations only.
*** This refers to standard unventilated room. Time may vary depending on OR ventilation system .
V1. 7 May 2020 (Eng.)
 COVID-19 Surgical Patient Checklist*
To minimize healthcare provider exposure when operating on COVID+ or suspected patient

1. AEROSOL GENERATING PROCEDURES 2. PPE FOR PERIOPERATIVE STAFF 3. DECONTAMINATING, CLEANING &
REUSING EQUIPMENT
• Intubation & Extubation
• Positive pressure ventilation DONNING PPE FOR COVID+ OR ANESTHESIA EQUIPMENT DECONTAMINATION
• Manual Ventilation with Bag-Valve-Mask − Coach should be present to observe
Do not reuse oxygen facemask or circuit between
• Open suctioning of respiratory tract
1. Perform hand hygiene patients without decontamination**
• High-flow oxygen administration
2. Don head covering
• Non-invasive ventilation
3. Don N95 mask, place upper strap first, Reprocessing oxygen facemask, ETT, suction & circuit
• Nebulized medications
perform seal check tubing**
4. Cover N95 mask with surgical mask 1. Brush under soap & water, clean internal and
• Venting CO2 in laparoscopy
5. Don eye protection/face shield external portions thoroughly
• Smoke generated by cautery
6. Don gown 2. Dip in 70% alcohol solution or 0.5% chlorine
• Use of high speed surgical devices
7. Don gloves 3. Rinse with clean water
• Upper GI endoscopy, Bronchoscopy,
8. Confirm PPE properly placed with coach 4. Dry completely before next use
Tracheostomy, upper airway endoscopy
• Dental procedures
DOFFING PPE FOR COVID+ OR • Patient trolley & all OR surfaces wiped with 0.5%
TO MINIMIZE AEROSOL GENERATION − Coach should be present to observe chlorine or 70% alcohol solution
− Perform hand hygiene if contaminated at any
Consider: step
• Alternative anesthesia techniques depending • Filters may be transferred with patient, but cannot
− Hand hygiene can be performed over gloves to
on patient condition and situation conserve supply be reprocessed or reused for a new patient

If general anaesthesia required: 1. Remove gown, pull to side & untie in front WHEN N95/FFP SUPPLY LIMITED
• Cover patient with clear plastic box or sheet 2. Remove gloves
3. Remove eye protection/face shield • Prioritize N95 for staff performing Aerosol Generating
during aerosolizing procedures
4. Remove surgical mask, untie lower ties first Procedures
• Preoxygenate, low flows, minimize manual
5. Remove N95, remove lower strap first • Consider alternative anesthesia (regional, sedation)
ventilation, use rapid sequence induction
6. Remove head covering • Reprocess N95 for reuse (N95decon.org)**
• Cuffed ETT preferred, minimize leaks
7. Perform hand hygiene, change scrubs • Wear surgical mask over N95 mask to
• Inline suction if available
minimize surface contamination
• Viral filter between patient & circuit elbow
WHY SHOULD STAFF IN OR WEAR N95? • Utilize protocols for extended use or reuse of
• Essential airway personnel only. Others enter
N95 (www.cdc.gov)
only after intubation complete • High risk of aerosol generation, may take 1 hour or • Train staff on PPE use & conservation
• Leave viral filter on ETT when disconnecting more for aerosols to clear
• Must be viral (HEPA, HMEF or equivalent) • Potential for ongoing aerosolization in OR during
filter to protect against COVID exposure (HME surgical procedure
filter not protective) • Potential lack of anesthesia scavenging system,
or lack of viral filter on circuit

**Cleaning and reuse of disposables during COVID-19 pandemic is not recommended if resources are adequate; these recommendations are for critical resource limitations only.
V1. 7 May 2020 (Eng.)