Nama : Samsul Maarif

Tgl Lahir : Gresik 06 Mei 1972

NIRA : 35730240004
Email : samsulmaarifmlg@yahoo.com

Pandidikan : SPK Soetomo Surabaya lulus tahun 1991

D-3 Keperawatan Universitas Muhammadiyah Malang lulus tahun
2003
Sarjana Keperawatan & Ners Universitas Brawijaya lulus tahun 2008
Magister Keperawatan Universitas Brawijaya lulus tahun 2020

Pekerjaan : Staf Perawat Kamar Bedah RS Aisyiyah Malang

Kepala Sub Bidang Sumber Daya Manusia RS Aisyiyah Malang
Dosen D-IV Keperawatan Perioperatif POLTEKKES Kemenkes Malang

Organisasi : Ketua Pengurus Daerah HIPKABI Malang Raya 2017-2022

Anggota Bidang Diklat Pengurus Wilayah HIPKABI JATIM 2016-2021
Anggota Bidang Diklat Pengurus Pusat HIPKABI 2018-2023
Preventing SARS Cov-2 Transmission
in the Operating Room
SAMSUL
MAARIF

“Asuhan Keperawatan Perioperatif

Di Masa Pandemi Covid-19”
Nursing care of patients with Covid 19
is focussed on mitigating the spread
of infection to staff, other patients,
and the community.
Nursing Care Must be Based on
Curren Scientific Evidence
 SARS Cov-2 Pathogenesis

Investigations into SARS-CoV-2

suggest that it uses tissue
angiotensin converting enzyme-2
(ACE-2) as its receptor

COVID-19 is not just a

respiratory disease but an
illness that can affect multiple
organs

https://pubs.asahq.org/anesthesiology/article/132/6/1346/109039/
Surface Distribution of SARS Cov-2

Half of the samples from the soles of the shoes of

medical staff is tested positive.

The rate of positivity was relatively high for the surface of

the objects that were frequently touched by medical staff

On the basis of the positive detection, the maximum

transmission distance of SARS-CoV-2 aerosol might be 4 m

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7323510/
SARS-CoV-2 was more stable on plastic and stainless
steel than on copper and cardboard, viable virus was
detected up to 72 hours on plastic and stainless steel

On copper, no viable SARS-CoV-2 was measured after 4

hours. On cardboard, no viable SARS-CoV-2 was
measured after 24 hours

SARS-CoV-2 remained viable in aerosols

throughout the duration of 3 hours

https://www.nejm.org/doi/10.1056/NEJMc2004973#article_citing_articles
Virus RNA in Stool Sample

In a meta-analysis of 60 studies comprising

4243 patients, it is found that 17.6% of patients
with COVID-19 had gastrointestinal symptoms.

Virus RNA was detected in stool samples from

48.1% patients and could persist for up to ≥33
days from illness onset even after viral RNA
negativity in respiratory specimens

https://www.gastrojournal.org/article/S0016-5085(20)30448-0/fulltext
Virus RNA in Plasma Sample

Plasma samples from blood donation

was detected positive for viral RNA from
4 asymptomatic donors.

https://wwwnc.cdc.gov/eid/article/26/7/20-0839_article

Children with covid 19 was detected 8%

had viral RNA in plasma, and positivity
in saliva samples was 80% in the first
week but dropped sharply to 33%
second week
https://wwwnc.cdc.gov/eid/article/26/10/20-2449_article
SARS Cov2 Decolonization

Four products antiseptic solution (PVP-I 10%), skin cleanser

(PVP-I 7.5%), gargle and mouth wash (PVP-I 1%) and
throat spray (PVP-I 0.45%)] achieved C 99.99% virucidal
activity against SARS-CoV-2 within 30 s of contact.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7341475//

Povidone-iodine preparations reduce viral loads of

the patient skin, oropharynx, and nasopharynx

https://journals.lww.com/anesthesia analgesia/Fulltext/2020/07000/
Mode Of Transmission

1. Droplets generated through coughing, sneezing or

breathing
2. Direct contact with patient and its body fluids
including faeces
3. Indirect contact with surfaces
4. Airborne transmission (virus can survive in droplet
particle in air up-to 3-hours and was found 4-meter
distance from patient)
5. Faecal-oral route of transmission is also suspected
Nursing Assessment

1. Airway : Assess the patency of airway

2. Breathing : Assess respiration rate, dyspnea, abnormal
breathing and oxygen saturation
3. Circulation : Assess blood pressure, pulse rate, capilary
refill, cyanosis
4. Disability : Assess the level of conciousness using AVPU,
co-morbidity
5. Expossure : contact with probable or confirmed case more
than 15 minute, direct care for a patient with probable or
confirmed case without using proper PPE
Diagnosis

1. Nasopharyngeal, oropharyngeal swab for

PCR to detect RNA of coronavirus
(nasopharyngeal swab is reliable in first
week of illness)
2. Chest X-ray has very little diagnostic value
3. CT Scan: ground glass opacities, subpleural
dominance, crazy paving and consolidation.
4. Serology tests to identify IgM and IgG
antibody (test is reliable after 14 days of
infection
Case Definition Based on Assessment

Confirmed Case : A person with laboratory

confirmation of COVID-19 infection, irrespective
of clinical signs and symptoms.

Suspected case : Patient with acute respiratory illness

and having been in contact with a confirmed or probable
COVID-19 case in the last 14 days prior to symptom
onset
Preventing Transmission
of SARS Cov-2 in the OR
 Pre Operative

Advise patients to shower or have a bath (or help patients

to shower, bath or bed bath) using antiseptic soap, either
the day before, or on the day of surgery

Pre operative Oral decolonization (before the patients are

transfered to the OR, using 1 % povidone iodine)

Give the patients specific theatre wear before they

are transferred to the OR

Provide patient with surgical mask and ask them

to follow coughing and sneezing etiquettes.
 Intra Operative

Change the Air Pressure in the Operating Room from

Positive to Negative Pressure

Deploy minimum required personel in the OR to

reduce the need of PPEs and risk of infections

Additional Circulating Nurse is Needed Outside the

OR for Additional Equipment and Drug

All surgical personnel should put on their PPE in the

buffer room before entering the operating room

Surgical Team Outside the OR During Intubation

Minimized Aerosole Generating Procedure

Use closed endotracheal

suctioning system with low
suction pressure to prevent
risk of aerosol exposure

Endotracheal intubation is done after five

minutes oxygenation, HME filter is used between
the mask and the circuit of ventilation
Suction System

Use central suction system

with dispossable suction bag
 Post Operative

The patient should NOT be brought to PACU or

Recovery Room, they should be recovered in the OR
and direct transferred to negative pressure room.

Transfer the patient with close breathing

System if possible

Regularly provide oral care (every 6-hourly

using 1 % povidone iodine) and bed bath
daily (with disposal wet sponges)
Doffing Protective Equipment

Doffing capshield, surgical glove, gown

and shoe cover in operating room

After removing protective equipment,

remember to avoid touching your face
before washing hands.
Instruments Reprocessing

instrument should be cleaned and disinfected with 0,5%

NaOCl by submerging for 5 minutes.

Seal all used airway equipment immediately in a

double zip-locked plastic bag, it must then be removed
for decontamination and disinfection.

Linen should be wrapped in a leak-proof

plastic bag and soaked in 0.05% NaOCl
solution for 10 minutes before washing
Environment Cleaning
All surfaces in the OR should be cleaned with 0,5%
NaOCl solution.

Blood or body fluid spillage should be treated with

1% NaOCl solution for 3 minutes before wiping
Floors should be cleaned by first mopping with 5%
phenolic solution followed by 0.5% sodium
hypochlorite solution (NaOCl).

Biomedical waste should be treated with 1% NaOCl

solution and discarded in color- coded bins as per
local or national management policy
 Referrences
1. Anderson DE, Sivalingam V, Eng A, Kang Z, Ananthanarayanan A, Arumugam H, et al. Povidone-Iodine Demonstrates Rapid In
Vitro Virucidal Activity Against SARS-CoV-2 , The Virus Causing COVID-19 Disease. Infect Dis Ther. 2020;9(3):669–75. Available
from: https://doi.org/10.1007/s40121-020-00316-3
2. Cui Y, Fu R, Dong Y, Chi X, Zhang M, Liu K, et al. Aerosol and Surface Distribution of Severe Acute Respiratory Syndrome
Coronavirus 2 in Hospital. Emerg Infect Dis. 2020;26(7). Available from: https://pubmed.ncbi.nlm.nih.gov/32275497/
3. Cheung KS, Hung IFN, Chan PPY, Lung KC, Tso E, Liu R, et al. Gastrointestinal Manifestations of SARS-CoV-2 Infection and Virus
Load in Fecal Samples From a Hong Kong Cohort: Systematic Review and Meta-analysis. J Gastroenterol. 2020;81–95.
Available from: https://www.gastrojournal.org/article/S0016-5085(20)30448-0/fulltext
4. Doremalen N, Bushmaker T. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. N Engl J Med. 2020;
Available from: https://www.nejm.org/doi/10.1056/NEJMc2004973#article_citing_articles
6. Eggers M. Infectious Disease Management and Control with Povidone Iodine. Infect Dis Ther. 2019;8(4):581–93. Available
from: https://doi.org/10.1007/s40121-019-00260-x
7. Greenland JR, Michelow MD, Wang L, London MJ. COVID-19 Infection: Implications for Perioperative and Critical Care
Physicians. Anesthesiology. 2020 Jun 1;132(6):1346–61. Available from: https://doi.org/10.1097/ALN.0000000000003303
7. Loftus RW, Dexter F, Parra MC, Brown JR. In Response: “Perioperative COVID-19 Defense: An Evidence-Based Approach for
Optimization of Infection Control and Operating Room Management.” Anesth Analg. 2020;131(1). Available from:
https://journals.lww.com/anesthesia-analgesia/Fulltext/2020/07000/In_Response___Perioperative_COVID_19_Defense__A
n.69.aspx