COVID-19 and Occupational Safety and Wellness
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1. Should asymptomatic patients be considered COVID-19+?
- Asymptomatic carriers are less likely to be present in areas with low COVID-19 prevalence. On the other hand, certain regions of the United States are significantly impacted by active COVID-19 disease and one can expect more asymptomatic carriers.
- The prevalence of SARS-CoV-2 is available via your state’s health department. We recommend close coordination with your facility, Infectious Disease and Infectious Prevention specialists, and review of available data regarding COVID-19 prevalence.
2. I put on clean masks and gloves prior to interviewing my patients. I feel that clean gloves and masks in all patient contact areas should be allowed to help in curtailing spread of this highly infectious virus.
- We recommend that health care professionals and patients follow the guidelines specified in the CDC’s “Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic.” The recommendations pertain to all US healthcare settings and stipulate the use of cloth face coverings or facemasks to cover a person’s mouth and nose to prevent spread of respiratory secretions when they are talking, sneezing, or coughing. Because of the potential for asymptomatic and pre-symptomatic transmission, these measures are recommended for everyone in a healthcare facility, even if they do not have symptoms of COVID-19. Hand hygiene remains a cornerstone of good medical practice to prevent the spread of any infectious disease.
3. Does ASA have any specific recommendations on hand hygiene for a patient with COVID-19 for the duration of a surgical case once the airway has been secured?
4. Should the plastic draping on any video laryngoscope used for a suspected or confirmed COVID-19 intubation patient be removed each time or can the draping, if plastic, be wiped down?
- The plastic draping should be removed and discarded after use.
5. Should faculty covering potential COVID-19 cases in two different operating rooms follow OHSA guidelines and change PPE every time they travel back and forth between rooms?
- ASA recommends working closely with your facility and infection control experts to determine the most appropriate strategy for PPE conservation. Prior to the COVID-19 crisis, recommended practice was to completely remove PPE once you leave the immediate care of a patient. A provider would then don completely new PPE to care for the next patient.
- In order to preserve PPE, anesthesia professionals moving between two operating rooms containing patients testing positive for SARS-CoV-2 should remove gloves, practice hand hygiene and don a new pair; change gowns, and clean any visible soil on face shields. Additionally, face masks should be changed if visibly soiled. Shoe covers, hair covering, and face masks that are visibly clean do not need to be changed.
6. Does ASA have a position or recommendation on intubation/aerosols boxes?
- We recommend that hospitals make available the highest level of protective equipment (PPE) for anesthesia team members for care of patient with COVID-19 disease, including those identified on the ASA website. Other techniques or devices aimed to reduce transit of viral load into the room environment do not replace or lessen the need for the most effective PPE. The ASA has no position on the use of mechanical barriers around the patient’s head during intubation and extubation. We recommend that you work closely with infection prevention experts and others on any new or untested devices.
- Several methods have been proposed for partially covering the patient’s head during airway management with plastic covers, covers connected to suction, or plastic boxes with the intention to prevent the spread of aerosolized airway secretions. It is unclear whether such adjuncts might make intubation more difficult or complicate the management of a difficult airway. A simulation study of plastic intubation boxes found that intubation took longer, first attempts were less successful, and provider gown sleeves were frequently breached when boxes were used, raising questions of safety. Another recent simulation study comparing acrylic boxes and plastic sheets as protective barriers reported less contamination in the manikin with the use of the plastic cover. The advantages of a plastic sheet are disposability, lower cost, and less restriction to hand movement. However, improper discarding of the plastic cover sheet can lead to cross-contamination of the clinicians.
- Any device or shield that deflects or contains droplets (e.g. viral particles) might reduce exposure. There is no guidance on whether they are actually effective or if any technique is superior. Some alternatives are using the plastic intubation cubes/boxes, placing a sheet of clear plastic over the patient while intubating, or using clear plastic drape over a Mayo stand covering the patient's head during intubation. Some people have added placing suction under the drape to reduce droplet exposure further. While these might aid in the reduction of airborne particles, some clinicians feel they slow down intubation times.
7. Where can I find physician health and wellness resources?
8. I have COVID-19. When can I return to work?
9. Does the ASA have guidelines or recommendations for physicians who are pregnant? We are concerned about our increased risk for exposure.
- We do not have specific guidance on pregnant anesthesiologists, their risk of contracting COVID-19 or if it will affect their pregnancy. Please review the CDC website and the American College of Obstetricians and Gynecologists for additional information on COVID-19 and pregnancy. Please make sure to regularly check these websites for new information.
10. Is there any data on at-risk caregivers, such as those who are older or are immunosuppressed?
- Data indicate that older individuals and those with co-existing conditions are at increased risk of severe disease and have higher mortality if infected. There is reasonable concern about these anesthesiologists for providing care to COVID-19 patients and suspected COVID-19 patients. There are no national recommendations on mitigating exposure of higher risk physicians, and the ASA likewise does not have specific recommendations. These discussions need to occur on the local level addressing specific issues and concerns and might include deploying those physicians into lower risk clinical situations, if this can be accommodated.
11. At the end of the day, are our loved ones at home safe from infection when we return home?
- We realize this is a sincere and earnest concern among all ASA members. Unfortunately, there is no federal guidance on the risk of possible exposure of physicians’ families. We recommend changing clothes on arriving and before leaving your workplace, showering in the facility if possible before entering your vehicle, and hand hygiene at every step.
Viewers of this material should review these FAQs with appropriate medical and legal counsel and make their own determinations as to relevance to their particular practice setting and compliance with state and federal laws and regulations. The ASA has used its best efforts to provide accurate information. However, this material is provided only for informational purposes and does not constitute medical or legal advice. This response also should not be construed as representing ASA policy (unless otherwise stated), making clinical recommendations, dictating payment policy, or substituting for the judgment of a physician and consultation with independent legal counsel.