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Surgical Challenges During a Pandemic
We are at sea in the midst of unprecedented challenges for global health care brought on by Coronavirus disease 2019 (COVID-19). The pandemic was officially declared by the World Health Organization on 11 March 11, 2020. A tsunami has ensued.
In “normal” times, surgical procedures include mandatory, urgent care procedures or elective treatments performed in clinics and hospitals. Since the earliest days of surgery, the field has always required highly skilled teams and specialized tools. Today’s surgical procedures utilize conventional manual tools that haven’t changed much over the years. The surgeon’s toolbox also includes cutting-edge technology such as sophisticated medical-device micro cameras, lasers, robotic guidance and specialized software. Some devices include visualization to perform diagnostics followed by immediate surgical treatment, e.g., incision and cauterization.
Recent advances in miniaturization and imaging has fueled several trends before the pandemic. More surgical procedures are now performed minimally invasively. Additionally, once devices such as bronchoscopes, endoscopes required extensive sterilization protocols before each procedure / reuse. Now they are also being developed in a single-use form or with key disposable components. Such advances save valuable time and staff resources for sterilization and surgical protocols.
Surgical procedures in “normal” times are usually scheduled according to urgency, facility and staff availability, and also considerations such as medical insurance coverage or out-of-pocket possibilities. Surgical equipment needs are handled according to facility protocols and budgets.
The COVID-19 pandemic has had a tremendous impact on surgical care. A worldwide emergency situation with unique challenges in different regions rapidly unfolded during 2020 like a Hollywood drama, yet more surreal. New safety precautions were established with standards of care revised as more data is available.
Special isolation wards were setup within hospitals, replacing existing wards and operating rooms. Special military-style field hospitals were mobilized in underground parking, parks and vacant lots. Surgical procedures need to be performed under extreme isolation conditions, sometimes in make-shift operating rooms. Triage protocols were revised to reduce risk of contamination, isolate “regular” non-COVID-19 patients from coronavirus patients, in the ER and main facility wards.
Medical devices such as endoscopes are evolving to minimize infections. In April 2020, the FDA recognized the importance of single-use endoscopes to prevent cross-contamination, enhance safety. The agency noted that it “believes the best solution to reducing the risk of disease transmission by duodenoscopes is through innovative device designs that make reprocessing easier, more effective, or unnecessary.”
Health care needs continue to be volatile, with surges according to regional outbreak waves and government policies. Globally, this is the “new normal” rollercoaster for the near future.
How to Protect Health Care Professionals & Patients
To reduce contamination, demand skyrocketed worldwide for personal protection equipment (PPE), sterilization modalities as well as the increased need for various single-use devices. As the virus spread during the first wave, non-essential surgical procedures were initially cancelled/delayed. As the world adjusts to the “new normal”, these can now rescheduled with extra precautions for health care professions and patients. The Center for Disease Control and Prevention (CDC) provides important guidance for risk assessment and work restrictions for health care personnel with potential exposure to COVID-19.
To reduce risk, the article “Surgery in Times of COVID-19” advises that surgical teams should consider waiting for COVID-19 test results of patients who may be suspected of being infected.
“In case of anticipated [operating theater] staff shortage, emergency surgical procedures specially in the night should be considered only after ascertaining suitable availability of staff and equipment. Aerosol is generated during procedures such as intubation, electrocautery of blood, catheter insertion etc. This increases the risk of healthcare workers acquiring infection from patients who test COVID-19 positive or patients who are on high suspicion of having infections. If these procedures are unavoidable, surgical staff should wear personal protection equipment including disposable surgical caps, medical protective mask (N95), work uniform, disposable medical protective uniform, disposable latex gloves, full-face respiratory protective devices or powered air-purifying respirator.”
The Right Tools – More Important Now Than Ever
As the pandemic continues, health care organizations must balance the need to provide necessary services also while minimizing risk to patients and health care staff. Now is time to be efficient in selecting the right tools.
In Ten Ways Healthcare Systems Can Operate Effectively During the COVID-19 Pandemic, the CDC provides practical approaches to protect health care personnel, patients and communities: for worker safety and support, patient service delivery, facility practices such as “surge plans” for risk analysis-based scenarios, from alternative care sites to emergency field hospitals and optimal equipment planning. The PPE burn rate calculator tool can help maintain critical surgical supply levels.
On the technology side, COVID-19 has propelled innovation across the healthcare industry. Surgeons in today’s pandemic scenarios turn to single-use devices that are clinically proven to perform under extreme operating conditions, yet with superior cost/value. Microcams with integrated illumination from 1mm in diameter are being custom-integrated into a variety of surgical devices. Video platforms have become vital for delivering communications and telemedicine follow-up.
With the ebb and flow of cases according to COVID-19 waves, best-care practices and the right tools are more important than ever – for surgical teams to protect themselves, their patients and their families.
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