OPERATING ROOM PREPAREDNESS

CHECKLIST
COVID NON REMARKS
NEED RATING : Dependency of the resumption of the service COVID
M must be in place for partial resumption
R recommended, must be in place for full resumption
P recommended, must be planned for a target future date
N not applicable

  HOSPITAL DIRECTIVES / ACTIONS

  * Scope/extent of services to be restarted is defined.
  * Date of resumption of service is declared.
  * Approval of recommended ORMAT Policies / Process
  * Announcement of resumption of services to public is made
* Clear guidance regarding manpower deployment is in place(i.e.
  separate COVID / Non-COVID teams, duty rota of HCWs, etc)
* Decision on how many rooms will be made available for each
  service area is made.
  * Decision on where the OPD operations will be done is made
  * Surgical residents not required to support COVID operations
* Physical and clear separation of COVID and non-COVID areas of the
  hospital
  * Standard protocol for admission of cases in place
* Revised consent forms to reflect increased risk of mortality and
morbidity for COVID-infected patients and possibility of acquiring
  COVID in the hospital setting
  * Consider longer OR operating hours
   
  COVID TESTING
  * Clear guidance on COVID-testing for patients and HCWs
* COVID testing capability within hospital with results out within 72
  hours
  * Mandatory testing of patients and HCWs
  * Mass mandatory testing of community in PGH catchment area
  * Clear policy on pre-operative COVID swab testing of patients
   
  GENERAL HOSPITAL OPERATIONS
  * Emergency room in full operation
  * outpatient services running for at least 2 weeks
  * No increase / expansion of COVID work/operations
   
  MANPOWER (OPERATING ROOM)
  1. Operating Room Nurses
* Sufficient manpower deployment to man target number of
  operational Ors
  * Pulled out staff returned to OR post
   
  2. ORSA Staff
  * Sufficient manpower deployment for the 3 shifts
   
  3. PACU Staff
* sufficient manpower deployment for a 13-bed PACU with 3 close-
  monitoring beds
   
   
  4. Radiology Technician
  * A radiology technician is in the OR during its operating hours
   
  5. Biomedical Engineer / Technician
* A biomedical engineer/technician is in the OR during its operating
  hours
   
  6. PhilCare
* Provision of hazard pay for Philcare staff handling the waste
  disposal of the OR
   
  SUPPLIES (except drugs and pharmacy)
  1. PPE
* Ensure all PPEs are medical grade (goggles and faceshields currently
  provided fogs/glares)
  * Par-level of hazmats determined
* Par-level of hazmats consistently achieved and available for at least
  4 weeks
  * Par-level of surgical gowns determined
* Par-level of surgical gowns consistently achieved and available for
  at least 4 weeks
  * Par-level of scrub suits determined
* Par-level of scrub suits consistently achieved and available for at
  least 4 weeks
  * Par-level of goggles determined
* Par-level of goggles consistently achieved and available for at least
  4 weeks
  * Par-level of face shields determined
* Par-level of face shields consistently achieved and available for at
  least 4 weeks
  * Par-level of N95 masks determined
* Par-level of N95 masks consistently achieved and available for at
  least 4 weeks
  * PAPRs provided to nurses
  * PAPRs provided to ORSA staff
  * PAPRs provided to anesthesia staff
  * PAPRs provided to surgeons
   
  2. Sterilization / Disinfection
* Sufficient alcohol-based handscrubs available in the scrub areas,
  consistently
* Sufficient materials available at ORSA for sterilization (MATET,
  please provide more details here)
  * UV light available for use for the service area
   
  3. Waste Disposal
 * Par-level of yellow-bin liners consistently achieved and available for
  at least 4 weeks
  * sufficient number of covered bins available at the garbage room
   
  EQUIPMENT
  1. Anesthesia Machine / Monitors
  * Machines are equiped with a closed filtering system
   
  2. Suction
  * A closed-system suction is available in all operating rooms
   
  3. Electrocautery machine
  * Must be equiped with smoke-capturing attachments
   
  4. Surgical instruments
  * Secure missing/lacking basic surgical instruments
  * remove/condemn defective instruments in sets
   
  5. C-arm
  * A dedicated C-arm is available at the COVID OR
  * At least 2 C-arms are available at the Inpatient OR
   
  6. Operating microscope
  * A dedicated operating microscope is available at the COVID OR
   
  7. Laparoscopy towers
  * A closed-suction filter mechanism is available
   
  8. Portable xray machine
  * A dedicated portable xray machine is available at the COVID OR
  * A working portable xray machine is available at the Inpatient OR
  * Lead gowns are available at the COVID OR
   
  9. Computer workstations
  * Required number of workstations per service area determined
  * required number of workstations installed
  * Sufficient supplies (paper, ink) provided
   
  INFRASTRUCTURE
  1. Operating Rooms
  * Airconditioning units of the rooms are functioning
  * Exhaust system in place
  * Negative pressure / proper airflow in place
  * Hepa filters in place for each room in use
  * PACS system in place in all Ors
   
  2. Scrub areas
  * All scrub sinks / taps functioning well, hands-free
  * Drains all working
  * Proper handscrub guide posted
  * Handscrub handsfree dispensers installed and working
  * Timers in place
   
  3. Waiting Area
  ??? What do we do with this area in the RCB???
  * layout fitted for proper distancing (for Outpatient)
   
  4. Corridors
  Positive pressure airflow
   
  5. Prep/ Packing Area
  * Appropriate place identified
  * Layout reviewed and optimized
   
  6. Pneumatic tube system
  * Existing system checked and functioning
  * System inslalled in all OR complexes
   
  7. Dressing Rooms
  * All piumbing inspected, fixed and working well
  * Install more shower areas at COVID OR shower room
* Ensure provision of locker rooms for EVERYONE for storage of
personal items (keys, cellphones, wallets) so these are not brought in
  the OR
   
  8. PACU
  * Physical layout of PACU beds mapped out
  * Ports checked and functioning
* Route for PACU patients from the OR and to the Unit must be laid
  out, taking into account the shared path with the COVID patients
* Plan for relocation of the PACU to one of the RCB-ORs studied. If
  considered, proper retrofitting of the OR is completed
   
  8. ORSA (Main OR and OPD)
  * Physical layout inspected and approved by HICU and OETS
  * Required builds for infection control completed
* Physical separation of disinfection and sterilization areas for COVID
  and non COVID supplies/equipment
   
  9. Elevators
  * At least 2 elevators functioning at Central Block
  * OPD OR elevator functioning
  * separate elevator for COVID / Non-COVID patients
* Process/ policy regarding use of elevators during elective OR hours
  prepared and implemented
   
  10. RCB OR Radiology Developing Room
  * Developer functioning
  * Sufficient supply of cassettes and films available
  * Sufficient supply of solutions available
   
  11. Communication systems
  * All rooms with internet/LAN ports
  * All rooms and corridors with sufficient wifi signal
  * All rooms and corridors with sufficient celfone signal
  * All rooms, stations with extension phone lines
  * Intercom system in place between ORs,nurses' station, office
  * PACS system / workstations in the OR complexes
   
  SUPPORT SYSTEMS
  1. Pharmacy (OR, Central, Main, OPD)
  * Par-level of basic anesthesia needs/drugs determined
* Par-level of basic anesthesia needs/drugs consistently achieved and
  available for at least 4 weeks
  * Par-level of basic OR needs determined
* Par-level of basic OR needs consistently achieved and available for
  at least 4 weeks
  * OR pharmacy open 24/7
   
  2. Emergency room

* The emergency room has resumed functioning, with sufficient

infrastructure, beds, equipment, PPEs, manpower, and supplies to
  accept and manage surgical emergencies, as in pre-ECQ status
* The ER has the necessary equipment and manpower to transport
  patients to the operating room
   
  3. Laboratory
  * Same day scheduling / extraction for OPD patients
  * Consistent delivery of results to clinic
  * Consistent / more reliable openMRS
   
   
  4. Radiology
  * Separate CT scans for COVID and non-COVID patients
  * Separate xray machines/rooms for COVID and non-COVID patients
* Efficient, reliable, transparent scheduling remote (online or by
  phone) scheduling system
  * Reliable, efficient results releasing process
   
  5. Blood bank
* Sufficient stocks of blood products to support resumption of
  services (BB + ORMAT to make projections)
  * Easy, efficient process for COVID testing of blood donors
* System of securing blood for the OR in place which does NOT rely
  on residents going to the blood bank
   
  6. Intensive Care Unit
* Surgical ICUs reestablished -- sufficient beds with appropriate
  manpower and equipment provided for
  * ICU bed to OR capacity ratio established and achieved
   
  7. Telemetry Unit
* Telemetry unit reestablished-- sufficient beds with appropriate
  manpower and equipment provided for
* If to be relocated , site identified, necessary builds made,
  manpower and equipment provided for
   
  ORMAT POLICIES
  * Surgical Triage/Review Committee established
  * Surgical Triage/Review Committee functioning
  * Priority list of each department approved
  * Operating room hours established
  * OR policies and proceses for each area in place and disseminated
  * Scheduling process in place
* Equipment maintenance schedule and process in place and
  implemented
  * Waste management process in place and implemented
* HICU-approved reuse and resterilization process of PPE in place and
  implemented
  * Room disinfection schedule and process in place and implemented
  * Clear guidance on PPE level for each OR
* Allow outpatient/day surgeries to be performed at the Major
  /Inpatient OR (to allow use of equipment available at Major OR)
   
  DEPARTMENT POLICIES
  * Participation in the Surgical Triage/Review Committee committed
  * Prioritization scheme for operations in place
  * Prioritiy list of cases/operation made
  * All staff members fit-tested for N95 respirators
  * All staff members trained on donning and doffing
  * All staff members oriented on OR processes and policies