OPERATING ROOM

Taufin Warindra
orthopaedic surgeon
PHC Hospital Surabaya
CORONA VIRUS
• SARS (2002)
• MERS-CoV (2012)
• COVID-19 (2019)
TRANSMISSION
Respiratory infections can be transmitted through
- DROPLET TRANSMISSION (respiratory droplets, droplet
particles are>5-10 μm in diameter they are referred to
as respiratory droplets), occurs when a person is in in
close contact (within 1 m) with someone who has
respiratory symptoms
- AIRBORNE TRANSMISSION presence of microbes within
droplet nuclei, which are generally considered to be
particles <5μm in diameter, can remain in the air for
long periods of time
On surface, hours until days
DIAGNOSTIC
• Epidemiological history & clinical manifestation
• Laboratory : CompleteBloodCount, CRP, NLR
• Imaging : ChestXRays , CT Thorax
• Rapid test : Antigen, Antibody IgM & IgG
• Swab : rt-PCR
THERAPY
• No specific treatment ?
• Supportif
• Surgery for other cause
TRIAGE SCENARIO
• EMERGENCY  COVID-19 STATUS ?
• URGENT  COVID-19 STATUS ?
• ELECTIVE  COVID-19 STATUS ?
CASE SELECTION
• COVID-19 CONFIRMED  PPE Level 3, OT negative pressure
( if possible)
• COVID-19 SUSPECTED  PPE Level 3, OT negative pressure
( if possible)
• COVID-19 NEGATIVE  PPE Level 2, OT positive pressure
STANDART KAMAR OPERASI
• Suhu : 19-240C
• Kelembaban : 40-60%
• Kebisingan : 35-45dB
• Kecepatan hembusan : 0,45+0,1m/s
• Kebocoran udara :–
• Tekanan :+
OPERATING ROOM FOR COVID-19
• Avoid/minimalized AGP aerosol generating
procedure (intubation, high speed drilling etc)
• Filter HEPA (High Efficiency Particulate Air)
• Good quality suction apparatus
• Negative pressure (if possible)
• Communication equipment
SURGICAL OPERATIONS FOR
SUSPECTED OR CONFIRMED COVID-19 PATIENTS
Requirements for Operation Rooms and Staff PPE
• negative pressure operating room.;
• disposable surgical items if possible;
• All surgical personnel (including surgeons, anesthesiologists, hand-washing nurses,
and charge nurses in operating room) should put on their PPE in the buffer room
before entering the operating room: Put on double caps, medical protective mask
(N95), medical goggles, medical protective clothing, boot covers, latex gloves, and
powered air-purifying respirator;
• disposable sterile operating clothes and sterile gloves;
• Patients should wear disposable caps and disposable surgical masks;

Handbook of Covid-19 Prevention & Treatment, editor in chief, Tingbo Liang

PERSONNEL
• Surgeon
• Anaesthesist
• Scrub nurse
• Circulating nurse
• Assistant anaesthesist
• Cleaning service
PERSONNEL PROTECTIVE EQUIPMENT
• Cap • Face shield
• Google • Shoe cover
• Mask N-95 • Disposable
gown
• Hazmat
• Glove
• Boot
• glove

Courtesy of Bil
PERSONNEL PROTECTIVE EQUIPMENT

Google N-95 mask elastomeric respirator

PERSONNEL PROTECTIVE EQUIPMENT

cap boot faceshield

 PERSONNEL PROTECTIVE EQUIPMENT

Surgical gown

Shoecover power air puryfing respirator coverall/hazmat

PPE DONNING
Protocol for Donning :
• special work clothes and work shoes
• Wash hands
• disposable surgical cap
• medical protective mask (N95)
• inner disposable nitrite/latex gloves
• goggles and protective clothing (note: if wearing
protective clothing without foot covers, please also put
on separate waterproof boot covers),
• disposable isolation gown and face shield/powered air-
purifying respirator
• outer disposable latex gloves
PREOPERATIVE
• Check PPE, drugs, equipments, instruments,
implants etc
• Check patient & personnel
• Check OT
• Brief all team (type anaesthesia, procedure,
difficulties etc)
INTRAOPERATIVE
• Minimalized AGP aerosole generating procedure
• Personnel outside OT during intubation
• Additional clean nurse outside OT for additional
drugs & equipments
POST OPERATIVE
• Extubation and stabilized patient in OT
• NO recovery room
• Direct to isolation room
• Transfer patient with close apparatus
• Doffing capshield, surgical glove, gown and shoe
cover in OT
• Records and Review all procedure

Courtesy of KKP Denpasar

 PPE DOFFING
•Wash hands and remove visible bodily fluids/blood
contaminants on the outer surfaces at both hands
• Wash hands replace outer gloves with new gloves
• Remove powered air-purifying respirator or self-priming
filter-type full-face mask/mask (if used) • Wash hands
• Remove disposable gowns along with outer gloves (if
used)
• Wash hands and put on outer gloves
• Enter Removal Area No. 1
• Wash hands and remove protective clothing along with
outer gloves (for gloves and protective clothing, turn inside
out, while rolling them down) (note: if used, remove the
waterproof boot covers with clothing)
 PPE DOFFING
• Wash hands
• Enter Removal Area No. 2 • Wash hands and remove
goggles
•Wash hands and remove mask • Wash hands and remove
cap
• Wash hands and remove inner disposable latex gloves
• Wash hands and leave Removal Area No.2
• Wast hands, take a shower,put on clean clothes and
enter the clean area
OT CLEANING AND DISINFECTION
• Disinfectant : quartenary ammonium, alcohol, chlorine,
hydrogen peroxide 1,2
• Wet gauze , mopping 1,3,4
• Drymist H202 for 30 minutes and wait for 60 minutes3,4
• Plasma air sterilization or UV for 60 minute 3,4
1. CDC and ICAN. Best Practices for Environmental Cleaning in Healthcare Facilities in Resource-Limited Settings. Atlanta, GA: US Department of Health and Human
Services, CDC; Cape Town, South Africa: Infection Control Africa Network; 2019. Available at: https://www.cdc.gov/hai/prevent/resource-
limited/environmentalcleaning.html and http://www.icanetwork.co.za/icanguideline2019/.

2. List N: Products with Emerging Viral Pathogens AND Human Coronavirus claims for use against SARS-CoV-2 www.epa.gov/pesticide-registration/list-n-disinfectants-use-
against-sars-cov-2

3. Handbook of Covid-19 Prevention & Treatment, editor in chief, Tingbo Liang

4. Permenkes 27/2017
LINEN AND INSTRUMENT
• Use disposable linen and gown ( if possible)
• Clean instrument with recommended cleaning &
disinfectant agent and re-sterilized ( reffered to
instrument manual)
Common low- and intermediate-level disinfectants
which can be used for environmental surfaces in
healthcare settings include:
• quaternary ammonium compounds
• alcohol (ethyl or isopropyl)
• chlorine releasing agents (e.g., bleach)
• improved hydrogen peroxide
1. CDC and ICAN. Best Practices for Environmental Cleaning in Healthcare Facilities in Resource-Limited Settings. Atlanta, GA: US Department
of Health and Human Services, CDC; Cape Town, South Africa: Infection Control Africa Network; 2019. Available at:
https://www.cdc.gov/hai/prevent/resource-limited/environmentalcleaning.html and http://www.icanetwork.co.za/icanguideline2019/.

2. List N: Products with Emerging Viral Pathogens AND Human Coronavirus claims for use against SARS-CoV-2 www.epa.gov/pesticide-
registration/list-n-disinfectants-use-against-sars-cov-2
CDC and ICAN. Best Practices for Environmental Cleaning in Healthcare Facilities in Resource-Limited Settings. Atlanta, GA: US
Department of Health and Human Services, CDC; Cape Town, South Africa: Infection Control Africa Network; 2019. Available at:
https://www.cdc.gov/hai/prevent/resource-limited/environmentalcleaning.html and http://www.icanetwork.co.za/icanguideline2019/.
SUMMARY
• Use adequate PPE
• Know your patient Covid-19 status
• Know your OT resources & spec
• Know your Team strength and weakness
• Know and familiar with procedure
• Record/documented  evaluation !!
SAVE MEDIC
PPE

SAVE PATIENT DX TX + MASK

SAVE PEOPLESD . CTPS, STAY @HOME

SAVE ENVIRONMENT WASTE DISPOSAL

AND YOU
SAVE THE WORLD

THANK YOU