新型冠状病毒肺炎流行期间围术期感染的防控策略

doi:10.24920/003739

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Based on recently published articles, this review provides detailed and feasible recommendations for the primary anesthesiologists on infection prevention in operating room during COVID-19 disease outbreak.

Abstract

A novel coronavirus that emerged in late 2019 rapidly spread around the world. Most severe cases need endotracheal intubation and mechanical ventilation, and some mild cases may need emergent surgery under general anesthesia. The novel coronavirus was reported to transmit via droplets, contact and natural aerosols from human to human. Therefore, aerosol-producing procedures such as endotracheal intubation and airway suction may put the healthcare providers at high risk of nosocomial infection. Based on recently published articles, this review provides detailed feasible recommendations for primary anesthesiologists on infection prevention in operating room during COVID-19 outbreak.

Key words: COVID-19, SARS-CoV-2, infection control precaution, perioperative management, anesthesia machine, disinfection

Tian Yi, Gong Yahong, Liu Peiyu, Wang Sheng, Xu Xiaohan, Wang Xiaoyue, Huang Yuguang. Infection Prevention Strategy in Operating Room during Coronavirus Disease 2019 (COVID-19) Outbreak[J].Chinese Medical Sciences Journal, 2020, 35(2): 114-120.

Figures/Tables 3

Table 1

Table 2

Suggestions on disinfection methods of different areas"

Risk levels	Areas	Cleaning/disinfection objectives	Methods	Frequency
Low risk area	Administrative department, library, conference room, medical record room, etc	Object surface, ground	Wipe with clean water	Once a day
Low risk area		Walls/ceilings, vents	Wipe with clean water	Once a season
Medium risk area	General ward, outpatient department, functional examination rooms	Low-frequency contact surfaces	Wipe with 75% alcohol or 0.5‰ chlorine-containing disinfectant	Ground twice a day, walls/ceilings once a month
		Medical devices surfaces	Wipe or clean with alcohol-containing disinfectant wipes, and then wipe with 75% alcohol or 0.5‰ chlorine-containing disinfectant	After used; once or twice a week
		High-frequency contact surfaces		Twice a day; bedsides, bed railings and bedstands once a day; vents once a month
High risk area	Emergency department, operating room, delivery room, NICU, ICU, catheterization room, hemodialysis center, CSSD, labs	Low-frequency contact surfaces, ventilation system	Wipe with 75% alcohol or 0.5‰ chlorine-containing disinfectant after cleaning	Ground twice a day; walls/ceilings once a week; air cleaning system once a week; air conditions once a month
		Medical devices surfaces	Clean with alcohol-containing disinfectant wipes, and then wipe with 75% alcohol or 0.5‰ chlorine-containing disinfectant	After used; once or twice a week
		High-frequency contact surfaces		Three times a day
Extremely high risk area	Fever clinic, isolation ward, nucleic acid testing laboratory, elevators and stairs in these places	Low-frequency contact surfaces	Wipe with 1‰ chlorine-containing disinfectant after cleaning	Ground four times a day; walls/ceilings twice a week
		Medical devices surfaces	Clean with alcohol-containing disinfectant wipes, and then wipe with 75% alcohol or 1‰ chlorine-containing disinfectant	After used; twice a week
		High-frequency contact surfaces		Six times a day
		Ventilation system		Air cleaning system once a week; air conditions twice a month

Table 2

Table 3

Suggestions on disinfection methods of anesthetic devices"

Devices	Disinfection methods	Remarks
Internal respiratory circuit of anesthesia machine	Compound alcohol disinfectant machine (recommendation)	Ozone disinfectant machine has certain corrosive effect on metal; the devices should be left for one week to remove drug residue after ethylene oxide disinfection; both sterilization and immersion disinfection require the removal of the inner circuit. Select sterilization or immersion disinfectant according to the characteristics of each component
	Ozone disinfectant machine (caution)
	Ethylene oxide or autoclave sterilization
	Soak in chlorine-containing disinfectant (1:1000) for 30 min
Surface of anesthesia machine, monitors, pumps and computers	Wipe with 500-1000 mg/L active chlorine, 500 mg/L chlorine dioxide or 2000 mg/L peroxyacetic acid disinfectant	Protect with a disposable transparent cover before used. The surfaces should be in contact with disinfectant at last 30 min after used
Handles of video laryngoscopes	Wipe with 75% alcohol, 3% hydrogen peroxide solution or 500-1000 mg/L active chlorine disinfectant	Protect the handle and display screen with disposable protective sheath
Ultrasonic machines	Wipe with 3% hydrogen peroxide, 0.55% sodium hypochlorite, 2% glutaraldehyde, or 0.55% ortho-phthalaldehyde	Mainframe:	cover with a disposable film. Remove protective film and disinfect machine after use.
Ultrasonic machines		Probe:	use the disposable sterile protective sheath and sterile couplant on probe surface; wipe with disinfectant after use
Non-invasive blood pressure cuff	Wipe with 75% alcohol, 3% hydrogen peroxide solution, or chlorine-containing disinfectant	Make sure that no disinfectant enters the valve when cleaning cuffs and pressure pip
SPO₂ sensors	Wipe with 75% alcohol	/
Temperature probes	Wipe with 75% ethanol	Use protection covers. The temperature probe can not tolerate higher than 100°C

Table 3

References 16.

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Personal protective equipment	Levels of protection
Personal protective equipment	First level	Second level	Third level
Applicable facilities	General clinics and ward	Fever clinics	Isolation ward, isolation area in fever clinic, operating room for patients confirmed and suspected infection
Applicable procedures	General diagnosis and treatment	Diagnosis and treatment	Perform sputum aspiration; lower respiratory tract sampling; endotracheal intubation tracheotomy; works that may cause secretion of respiratory tract and internal substance spillage; relevant laboratory work
Working clothes	√	√	√
Disposable hair cover	√	√	√
Surgical masks	√
Latex globes	If need	√	√
Medical protective masks		√	√ (double)
Fluid-resistant gown		√
Protective coverall		If need	√
Goggles/Face shield		√	√
Disposable shoe covers		√	√
Positive pressure breathing headgears			Recommended

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