One of the important lessons learned so far during the COVID-19 pandemic is that surgery centers need to stay fluid to survive and thrive.
On top of managing COVID-19 spikes, surgery centers are making preparations for flu season. Since the last flu season, all healthcare facilities have had to take sick leave policies much more seriously, says Lee Anne Blackwell, BSN, CNOR, CAIP, vice president of clinical services for Practice Partners in Healthcare, Inc., in Birmingham, AL.
“Guess what our policies have always been? Don’t come into work sick,” Blackwell says. “People have gone to work sick in the past, but that is going to change.”
The COVID-19 crisis has made everyone gun-shy about being around anyone with flu-like symptoms. But plenty of surgery centers and many other public places now require everyone to wear masks, which could result in an unusually subdued flu season. “We might not have as high of a flu situation because people are going to wear masks and do social distancing,” Blackwell offers. “We may not see flu spikes because people are working from home.”
In July, the World Health Organization’s influenza surveillance update suggested influenza activity was reported at lower levels than expected. In fact, Southern Asia and Southeast Asia reported no influenza detections. Still, surgery centers should prepare for the worst.
In Southern states, the pandemic reached a crisis level in some places over the summer because in May, beaches, restaurants, and bars reopened too soon. This created problems for school districts trying to decide between holding in-person learning or virtual classes this fall.
Surgery center leaders faced similar quandaries. For facilities that cut off elective surgeries in March and later resumed such procedures, administrators may have to press pause again, depending on local circumstances, if they have not already.
Further complicating the issue is the lack of uniform guidance from elected officials. When it comes to allowing elective procedures, orders vary widely. Some hospitals cannot perform these procedures, but perhaps same-day surgery centers can — it all depends on the state, city, and/or county.
Clearly, long-term planning is trickier than ever. Here is how surgery centers can continue to stay safe and open moving into the fall:
• Make COVID-19 policies clear. Practice Partners’ facility welcome signs direct patients to follow strict instructions: wear a mask during the entire visit, wash hands or use a hand hygiene product before entering the facility and throughout the visit, and limit contact with others by remaining six feet apart.
• Keep staff safe and well. Healthcare workers have been hit hard by the pandemic. That is something surgery centers also manage, Blackwell says.
“Society, in some parts of the country, has gotten lax. It’s been a risk that still hasn’t changed,” she says. “We still have risk for the elderly and others who are immunocompromised, and surgical patients are at risk.”
Requiring universal masking helps improve safety. Also, many surgery centers are asking patients’ guests to stay in their cars until it is time to pick up patients. Surgery centers may be taking even more infection prevention precautions in common areas.
Even with all these additional efforts, employees are at risk of acquiring COVID-19 via community spread. Staff must report all possible exposures to the surgery center director.
“I just had a nurse contact me to say her husband works at the hospital in the same city where she’s a surgery center nurse. He came down with COVID-19 symptoms,” Blackwell says. “I said, ‘You need to stay home for 14 days and monitor for symptoms, taking your temperature, documenting it, and take care of your husband from a distance.’” The nurse did stay in a separate room from her husband and disinfected common area surfaces. While she did not experience any symptoms, the situation meant she was out of work for an unplanned two-week period. Administrators must plan for unforeseen, sudden staff shortages.
In another case, an employee, who often experienced sinus infections, developed a particularly bad case. When she visited her primary care provider, the employee was prescribed a steroid dose pack. However, the employee did not get better.
“She had just been to work the day before,” Blackwell recalls. “She called the nurse manager when she had the COVID test, and was told she needed to stay home until she got a negative test.”
Even undergoing the test was a challenge. “She called her doctor and asked for a COVID test, but he said ‘No,’” Blackwell says. “Then, [the doctor] finally tested her for COVID, and she was positive. She had been carrying COVID and transmitting it.”
• Explain policies in pre-op phone calls. “We do a pre-op screening patient phone call, following guidelines from the Centers for Disease Control and Prevention [CDC],” Blackwell says.
These phone call screening questions may include: Have you returned from travel outside this state within the last 14 days? Have you or another person been in close contact with or been near a person known or suspected to have COVID-19? Do you or another person you have been in close contact with currently have a fever of 100.0° F or higher? Are you experiencing cough or shortness of breath?
“We dropped the cruise question because that fell off,” Blackwell notes. “We keep it to 14 days if they’ve been out of state, and we’re monitoring between state travel because there are hot spots, including Florida, parts of Georgia.”
Staff calling patients for pre-op screening give them information about COVID-19 protocols. “We let them know we are wearing masks throughout the day, and they will wear masks while they’re in the center,” Blackwell says. “We will take off the mask when we intubate them, but when we extubate them, we put the mask back on.”
• Take pandemic precautions. During the procedural visit’s first phase, nurses wear face shields and N95 masks. “We take temperatures every day, using a distance thermometer with a gun trigger,” Blackwell explains.
It is becoming more apparent the virus can float in the air, making it especially important to properly train staff to use personal protective equipment (PPE). Even if the virus is airborne, wearing PPE, using hand hygiene, wearing masks, and maintaining social distancing can be effective. “The reason the N95 mask is so effective is because it blocks moisture particles that are a size it is designed to block,” Blackwell notes.
Practice Partners has instituted protocols for PPE reuse and has increased its use of N95 masks. Every staff member wears some kind of mask, according to their organization’s policy and protocol.
“We have general supply chain procedures and contingency plans for seeking alternatives, and now a crisis management plan for reusing PPE,” Blackwell says. “We even have one company that is authorized to disinfect masks for organizations.”
• Follow infection prevention protocols. Practice Partners centers clean with a disinfectant that is approved by the Food and Drug Administration for its efficacy in killing the virus. Ambulatory surgery centers are directed to the Environmental Protection Agency’s website, specifically to List N, which includes updated products effective against coronaviruses.
“This is what has had a big, impactful change,” Blackwell says. “We are cleaning better, more thoroughly, more often now, too.”
• Give patients information about staying free of COVID-19. Surgery center staff tell patients how to monitor for signs and symptoms specific to COVID-19. They also ask them to continue to follow CDC guidelines on maintaining social distancing, wearing masks, and following hand hygiene procedures. Also, staff ask patients to avoid going out in public as much as possible during recovery days, Blackwell says.
“We call them about four to seven days later to screen for COVID symptoms,” she adds. “If they have them, they need to contact their physician.”