Philippine Journal of Surgical Specialties Vol. 75, No. 1, January-June 2020, pp 7-8

Precautionary Measures for Emergency Surgery During COVID-19 Pandemic

Author(s): Philippine College of Surgeons

This PCS Advisory, dated March 22, 2020, focuses on recommendations for emergency surgery performed on COVID (+) patients and those at risk of having COVID 19 infection. A PCS Advisory dated March 14, 2020 recommended to cancel or minimize all elective and urgent operations during this time of community quarantine and lockdown. However, it is inevitable that life-saving emergency surgeries will need to be performed. As the surgeon leader, it is your responsibility to protect and ensure the safety of all the members of the team and to assure high quality surgery.

  1. During this rapid spread of the COVID 19 pandemic, it is prudent to assume all patients for surgery are COVID-19 infected unless proven otherwise. Hence, appropriate PPE should be worn when inside the Operating Room and strictly by all members of the surgical team.
  2. A comprehensive COVID-19 infection control workflow must be practiced. Surgeons must ensure that there is proper planning, preparation, simulation, execution, and continuous evaluation of these workflows. These containment measures are imperative to optimize quality of care, while reducing the risk of viral transmission to operating room personnel and patients.
  3. Operating Room Management
    1. Safety and protection of all health care workers is of primary importance:
    2. An operating room with negative pressure environment is ideal to reduce spreading the virus beyond the OR.
    3. Preferably the operating rooms have their own ventilation system with an integrated high efficiency particulate air (HEPA) filter. If possible, designate an operating room with its own contained access and a COVID-designated surgical team for patients confirmed to have COVID-19 to reduce in-hospital transmission.
    4. Limit the number of staffs involved in the surgery. Movement of staff in and out of the OR should also, be restricted. Secure all doors to the OR during surgery to minimize traffic and flow of contaminated air.
    5. Design new work flows for the designated COVID-19 OR focusing on

Key words: Safety and protection of all health care workers, PAPR, PPE