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Protocols for elective surgeries during COVID-19

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Dr Upendra Bhalerao, cardiovascular and thoracic surgeon, Wockhardt Hospital reviews the various protocols put into place to ensure that resuming elective surgeries during the pandemic is safe for both patients and healthcare workers

 The healthcare system is already burdened owing to the spike in COVID-19 cases. Now, the challenge is also to clear the backlog of elective and non-urgent surgeries that were postponed during these unprecedented times. The surgeries will have to be carried out safely making sure patient has good outcome and does not catch up perioperative COVID-19 infection.

Today, the entire world is under the grip of coronavirus. Owing to the pandemic, the number of elective surgeries has been postponed in order to ensure the safety of the patients. Steps should be taken to protect the patients and even healthcare workers.

Resuming elective surgeries during pandemic

  • Elective procedures were not carried out during the initial period of the lockdown, from March to June. Only emergency surgeries were being done. Till that time, the understanding about patient care during COVID-19 time was evolving. From the month of May -June, elective surgeries resumed slowly. Some patients’ condition was serious, and they could not wait any further. Now, the elective surgeries have been continually carried out for the last 4-5 months.
  • The patients who came for elective surgeries were screened whether he/she is suffering from anything similar to COVID-19. The patient’s family and travel history are being checked whether he/she has fever cough or any other ailment in his/her family members or any other relatives. After the patient is thoroughly screened then only, he/she is admitted to the hospital. The patient will undergo a rapid antigen test. If the test is positive then the patient is COVID-19 positive. Once, the patient is COVID-19 positive then he/she is treated for the same first. If the test is negative then the patient is admitted to the hospital and his/her RT-PCR which is a real-time reverse transcription polymerase chain reaction (RT -PCR) test is done. If the test is positive then the patient’s elective surgery is postponed, and will only be done after the patient is back on track after COVID-19.
  • Along with RT-PCR, even a CT scan of the chest is done. If the CT scan indicates something suspicious then the surgery will be again postponed and the patient will be sent back home, and then again asked to come for surgery after two weeks. There were incidents when the patients were admitted, his/her RT-PCR was positive, then the surgery was delayed. The risk of mortality complications and lung dysfunction is high in COVID-19 cases hence to minimise risk patient’s surgery is delayed till he is cured of COVID-19 status. But remember, the surgery is not postponed forever. The patient must become infection-free and should be negative for at least 10 days, and then only the patient will be operated on.
  • The patient will be isolated once they are negative. Only one family member of the patient will be allowed in the hospital, and that person will also have to isolate himself and minimise his/her contact with the other people. The family member should be free from any disease.
  • The doctors and the other staff wear PPE during the procedures to minimise the risk of transmission of infections.
  • It is ensured that everyone washes their hands from time to time and uses masks. In case, the patients get fever after the procedure then it is taken as ‘high-risk,’ and the RT PCR test is carried out to rule out any possibilities of COVID-19.
  • Even the staff is screened for any symptoms of COVID-19 and the ones who have any symptoms are isolated and treated accordingly.
  • The cleaning and disinfection of the floors, equipment, door knobs, and surfaces is done on a regular basis.

Take-home message

People should avoid delaying elective procedures due to the fear of getting infected with COVID-19. This will increase mortality and morbidity. Be assured that enough measures are being taken to take care of the infection. Doctors, nurses, hospital management and staff would make everything in their capacity to ensure patients are treated in segregated and safe environment to achieve the best possible outcome of surgery.

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