Surgical Staff (Kaitlyn Stout)
Fact-Checked Source: Aurora Pryor, "SAGES and EAES Recommendations Regarding Surgical Response To COVID-19 CRISIS"
On March 30th, 2020, the Society of American Gastrointestinal and Endoscopic Surgeons released a statement with several recommendations considering safety precautions and procedural considerations for surgery, along with the rationing of services regarding surgical staffs.A Deeper Perspective: Five Facts Checked
The recommendations stated in SAGES press release were based on professional opinions from the global surgical community. I looked deeper into these sources to better understand SAGES's recommendations for their surgeons.
All elective surgical and endoscopic cases should be postponed at the current time.
I was interested in looking further into this recommendation because I was curious about how the surgical staff would make the transition to resume performing elective surgical procedures, knowing that many patients are now anxious to hear when they can have surgery. The American College of Surgeons' statement, Local Resumption of Elective Surgery Guidance, claims that elective surgeries need to be postponed for surgical staff to be well prepared for the peak of COVID-19 cases. The article states that for elective procedures to resume, specific protocols need to be implemented locally for tracking community's COVID-19 numbers, diagnostic testing, available personal protective equipment, facility capacity, medical supplies, surgical staff, patient communication, and surgery prioritization.
There may be enhanced risk of viral exposure to proceduralists/endoscopists from endoscopy and airway procedure.
I chose to look further into this fact because I was curious if the protocol for wearing personal protective equipment changes as the risk of exposure increases. Xiangdong Chen's review article in Translational Perioperative and Pain Medicine, Perioperative Care Provider's Considerations in Managing Patients with the COVID-19 Infections, verifies that the risk of exposure is heightened during endoscopy and airway procedures and describes the protective equipment necessary based on the procedure's risk level.
Surgical equipment used during procedures with COVID-19 positive or suspected COVID-19 patients should be cleaned separately from other surgical equipment.
I was interested in this fact because it seemed that there would likely be large consequences if the contaminated equipment was mixed in with other surgical equipment. The Occupational Safety and Health Administration's COVID-19 Control and Prevention website describes the risk of exposure when touching contaminated objects and then touching one's face, and verifies that the contaminated equipment should be cleaned separately with EPA-registered disinfectants.
Consent discussion with patients must cover the risk of COVID-19 exposure and the potential consequences.
This recommendation was interesting to me because of the large amount of information that is unknown regarding the coronavirus. The Annals of Surgery's Surgical Consent During The COVID-19 Pandemic confirms that there must be informed consent and that patients should be aware of the risks and potential consequences of COVID-19 exposure. The article also mentioned that the discussion must have "transparency about potential but unknown risks and an honest admission of how little we currently understand about the surgical outcomes of COVID-19 positive patients and patients with unknown COVID-19 status" (Annals of Surgery, 2020).
All members of the operating room staff should use PPE as recommended by national or international organizations including the WHO or CDC. Appropriate gowns and face shields should be utilized.
I wanted to dive deeper into this recommendation to learn more about the effectiveness of the face shield. Xiangdong Chen's review article in Translational Perioperative and Pain Medicine, Perioperative Care Provider's Considerations in Managing Patients with the COVID-19 Infections, describes specific details of the personal protective equipment necessary. Chen states that the face shields have some protective effects against airborne transmission, however does not offer as much protection as the N95 masks that filter 95% of air particles.
Analytic Essay
Protecting Surgical Staff While Treating Patients
In this time of uncertainty, many people are making adjustments: some may be working remotely or “desperately” needing a haircut, while others may be losing their jobs. Perioperative workers are adjusting to new changes too, at the risk of their health and patients’ lives. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), a large, national organization of specialty surgeons that focuses on innovating surgical practices, collaborating internationally, and educating surgeons to improve patient care, has stepped in to guide surgical teams to mitigate risks of COVID-19 to both patients and surgical staff. On March 29, SAGES released a statement of recommendations to protect the health of patients and practitioners. As the SAGES statement highlights, surgical staff are greatly affected by the coronavirus, as to meet their goal of improved patient care, they now must navigate important safety precautions, difficulties communicating during procedures, challenges with patient-doctor communication, and postponed non-urgent surgeries.
To limit the risk of perioperative workers transmitting the coronavirus between patients or other health care workers, the SAGES press release strongly recommends expanded personal protective equipment (PPE) — far beyond standard operating procedure — as well as additional surgical, cleaning, and patient flow procedures. In support, Xiangdong Chen’s review article in Translational Perioperative and Pain Medicine, Perioperative Care Provider’s Considerations in Managing Patients with the COVID-19 Infections, elaborates on the importance of perioperative care workers consistently wearing PPE. The specific types of equipment vary based on the severity of procedure risk as the PPE becomes more extreme when the risk of exposure is higher (Chen, 2019). However, the PPE may also create other challenges for the perioperative workers in the operating room.
Chen acknowledges that PPE is useful in limiting transmission, however, it does result in numerous difficulties for surgical personnel. For example, a coverall gown may limit visibility due to the hood of the gown, which may interfere with a medical support person’s ability to read critical information such as medication details. Additionally, when multiple layers of heavy equipment are necessary, the increased temperature may be very uncomfortable and make their jobs more difficult (Chen, 2019). The impact of the PPE on communication between the surgical staff can cause many issues as well, as it may be significantly more difficult to hear your team’s instructions that may be critical to your patient’s safety. It is also important to consider the coverall gown’s impact on individual identification, which is why Chen recommends writing names on gowns so that perioperative workers are recognizable to members of the surgical team and patients (Chen, 2019).
The PPE can also act as a barrier between the patients and their surgical team as it decreases their ability to communicate and understand each other well. SAGES stated that it is mandatory that patients fully understand the risk of COVID-19 exposure and the potential consequences of undergoing surgery (SAGES, 2020), however, the surgical staff’s face masks and eye equipment along with the patient’s recommended face mask can negatively impact the patient’s ability to obtain informed consent as they can barely see their physician’s face or emotional gestures (Chen, 2019). The disconnect between the patient and surgical staff, unfortunately, makes the informed consent process more difficult and less effective and does not allow the surgical staff to create the relationship with the patients that they would before COVID-19.
Additionally, the priority to care for COVID-19 patients has had an impact on patients who have necessary, but not urgent, surgical needs. SAGES recommends prioritizing certain patients’ needs due to all “elective” surgeries being postponed (SAGES, 2020). This is necessary for surgical staffs to be fully prepared for the peak of COVID-19 cases and ensure that there is a reliable supply of PPE, hospital beds, and ventilators, and that there are many safety precautions to be put in place before allowing elective procedures to be performed (American College of Surgeons, 2020). However, patients whose elective procedures are postponed may have heightened anxiety as they may “feel they have a ticking time bomb inside them”, which may contribute to the patient’s distrust towards their surgical team (Zhang, 2020). Distrust between the patient and their surgeon can be very detrimental to the surgical team’s ability to achieve their goal of providing the best care for their patient.
The SAGES recommendations, written by national surgical leaders, aim to ensure patient and surgical staff safety during COVID-19 while following their mission of improving patient care. However, the recommendations result in challenges for surgical teams such as the ability to communicate during surgery and physical discomfort, and also the ability to build trust with the patient. These challenges that result from the SAGES recommendations impact the entirety of the surgical team and damages their ability to provide improved patient care. Still, surgical staff in this specialty must follow SAGES recommendations, because as the premier organization for gastrointestinal surgeons, they hold a position of authority to guide policy.