EXECUTIVE SUMMARY

Some best practices included in COVID-19 pandemic safety guidance issued by federal and professional organizations are likely to continue even after the worst of the emergency is over.

  • Expect to continue presurgery COVID-19 testing on all patients.
  • Surgery professionals will continue to use personal protective equipment and take all additional infection prevention precautions.
  • Leaders will need to monitor and address staff stress and burnout through the rest of 2021 and beyond.

As surgery centers coped with the changing landscape of the COVID-19 pandemic, federal and professional organizations tried to produce the most up-to-date, relevant information.

It was not easy, as evidence-based data takes time to emerge. As surgery centers waited for professional guidance, most organizations built general recommendations based on CDC guidelines.

For example, the American Society of Anesthesiologists (ASA) and the Anesthesia Patient Safety Foundation recently issued a joint statement, referring to the CDC’s guidance for physicians to use when deciding whether to discontinue transmission-based precautions for hospitalized patients recovering from COVID-19, or home isolation for outpatients.1

For questions about COVID-19 vaccines, the Association of periOperative Registered Nurses (AORN) provides links to the CDC website, as well as to AORN’s own COVID-19 toolkit.2

The American Hospital Association, along with the ASA, AORN, and the American College of Surgeons, issued a joint statement in late 2020 about how healthcare organizations could continue to provide surgery during the pandemic, referring to CDC recommendations on PPE, COVID-19 testing, and other regulatory and operational issues.3

What happens if and when the pandemic ends? What, if any, precautions will surgery professionals continue to take even after the worst is over? Will testing continue even after most Americans have received a vaccine? The short answer is, “Yes.”

“For now and in the foreseeable future, we’re going to continue to need COVID testing before surgery,” says Beverly Philip, MD, FACA, FASA, president of the ASA. “The virus still is in the population, and our patients need to be protected all the time. On the provider side, physicians, anesthesiologists, and all others [in surgery centers] will need to continue to take precautions and wear personal protective equipment.”

At press time, not every patient may have been vaccinated, but by now, surgery center staff should have had access to at least one dose, if not both doses, of the vaccine. “The vaccine is highly effective in preventing bad disease by anyone who gets any of the shots. It’s an amazing thing,” Philip says.

Still, COVID-19 testing should continue, regardless of patients’ vaccine status. The CDC’s Advisory Committee on Immunization Practices provides recommendations for vaccination prioritization. As more people are vaccinated, the CDC’s priorities for COVID-19 testing likely will evolve.4

Researchers who have studied surgeons’ response to the pandemic also say the next few years will see a continuation of infection prevention precautions as SARS-CoV-2 mutates and causes surges, even in vaccinated regions.

Thus, surgery professionals should continue to take all infection prevention precautions until further recommendations come out, according to Christopher G. Larsen, MD, an orthopedic surgery resident at Northwell Health.

“Wear full personal protective equipment, even with people who are vaccinated,” he says. “Nothing has come out saying that if you’re vaccinated, there is no way you could transmit COVID.”

The COVID-19 vaccine prevents serious illness, but if someone who was vaccinated becomes even mildly sick with the virus, it’s possible they could be a vector to spread the disease. “Everyone needs to maintain proper precautions with full PPE when dealing with COVID-positive patients. That’s our policy,” Larsen says of Northwell Health. “When we take COVID patients to the operating room, everyone is wearing N95 respirator masks, gloves, face masks and shields, and eye protection.”

Before these heightened infection prevention practices change, more data are needed about how the world responds to vaccination, says Jessica M. Intravia, MD, an orthopedic surgeon at the North Shore-Long Island Jewish Medical Center in New York. “There are very few tests that every surgery patient gets, and the COVID-19 test is one of the few,” she notes.

Early data indicate the three COVID-19 vaccines in circulation in the United States are safe and efficacious. There is widespread enthusiasm among healthcare professionals and the general public about receiving the vaccine, although there are plenty of reports about skepticism among ordinary citizens and health professionals alike. Anecdotally, it does not appear mandates are widespread, but Philip believes there could be a time “down the road” when many are required to take the COVID-19 vaccine.

Until then, surgery leaders should emphasize to staff that continuation of PPE and additional disinfection processes should continue through the vaccination period.

“The issue of why we continually test and use PPE is that it’s for patients’ safety,” Philip explains. “There are enough reports that some patients who have surgery while they have COVID do not do well afterward.”

Follow the CDC’s and ASA’s guidance on how long patients with COVID-19 should wait to undergo elective surgery. “In general, if it’s uncomplicated COVID-19, wait a month before having truly elective surgery,” Philip offers. “If you have had more serious COVID-19, then it might be several months.”

Patients should discuss this with their surgeon and primary care physician to determine when it would be safe for them to undergo a procedure after COVID-19 illness. “If surgery needs to be done now, it needs to be done. That’s fine,” Philip adds.

Other pandemic-era changes in surgery likely will continue indefinitely, such as limiting the number of family members who accompany the patient and stay in waiting rooms. At some facilities, depending on size, families may continue to be asked to drop off patients and wait until they are called to pick up the patient. There may be beeper systems like restaurants use. This tactic prevents visitors from transmitting infections.

Some may like these new techniques because they are more efficient. Rather than waiting in the surgery center for an hour or longer, a person could run an errand and return when he or she receives a notification that the patient is ready for pickup. “The need for distancing and more limited family in the surgery center will continue for a while, and it’s for the patient’s family’s safety,” Philip says.

Using telemedicine to communicate with patients and family exploded in popularity during the pandemic. The tool might have improved overall care and made patient-physician meetings a little more efficient, according to Philip.

“Physicians and anesthesiologists are responsible for patients being well enough to have surgery beforehand and for after medical care,” she says. “Now, we have telemedicine to check in on patients, and that wasn’t there before. I think these precautions will persist. I think the days of the entire family coming in and staying around and cheering on their family member is not coming back any time soon.”

Mask-wearing and strict hand hygiene also will persist. “We’re all aware that the number of people who get sick from influenza this year has been very small because the same thing that protects us from COVID-19 protects us from all these other diseases,” Philip says. “One of my colleagues reminds us that when HIV came on the scene, we learned how to deal with that, and it changed our practices. Now, I think what COVID-19 will do is give us a background level of protection from airborne illnesses, and a lot of that is good.”

Another change that surgery leaders will need to acknowledge over the next year and possibly longer involves staff’s stress and wellness.

“How do you keep everybody at work feeling they can work with the physical stresses there are?” Philip asks. “Fortunately, now we have what appears to be a light at the end of the tunnel. Getting the vaccine takes off stress. It’s a real comfort that my odds of getting sick from COVID-19 are now [near] zero.”

But leaders still should watch for mental health issues, signs of burnout, and support their colleagues by offering time for stress reduction and providing information on techniques to reduce stress.

“COVID-19 now is part of our environment,” Philip explains. “It will become a less bothersome part of our environment, but to expect it to vanish is not a realistic expectation.”

REFERENCES

  1. American Society of Anesthesiologists, Anesthesia Patient Safety Foundation. ASA and APSF joint statement on elective surgery and anesthesia for patients after COVID-19 infection. March 9, 2021.
  2. American periOperative Registered Nurses. COVID-19 (coronavirus) AORN tool kit. Updated March 24, 2021.
  3. American College of Surgeons, American Society of Anesthesiologists, Association of periOperative Registered Nurses, American Hospital Association. Joint statement: Roadmap for maintaining essential surgery during COVID-19 pandemic. Nov. 23, 2020.
  4. Centers for Disease Control and Prevention. Overview of testing for SARS-CoV-2 (COVID-19). Updated March 17, 2021.