COVID-19 planning

Recently, SIR presented a webinar clarifying what advanced preparation in IR for a pandemic looks like with a panel from Singapore. A critical point is that several countries have been able to utilize their experience in dealing with the SARS outbreak of 2002–2004 and thus have implemented lessons over the years. As many practices in the United States have limited time to implement changes, we have suggested a 10-point plan to implement in preparation of caring for COVID-19 patients. As always, refer to the CDC website for the latest information, and consult your local policy, engineering, infection control and environmental services.

Pre-procedure

Cancel all nonurgent and elective procedures and visits, per SIR COVID-19 Clinical Notification, including eliminating face-to-face visits when possible by utilizing telehealth, video conference and phone appointments; eliminating visitors where possible; and allowing non-essential personnel to work from home. Refer to the NCCN commentary regarding management of cancer patients⁸.
Store all personal protective equipment (PPE) in secure locations with limited access, implement inventory controls, and clearly define PPE to be used based on patient status (non-PUI, PUI/COVID-19 positive) and procedure type with necessary HCP training for each type of PPE.
Identify a dedicated room to perform procedures on PUIs and COVID-19-positive patients, a pathway to the room to minimize exposure to HCPs and patients, and areas to don PPE with appropriate availability of hand hygiene; an air-negative room is strongly recommended if available, and coordination with other services may be needed to share a designated room (e.g., air-negative operating room). Develop clear plans with anesthesia for intubation of patients, when appropriate.
Empty rooms designated for procedures on COVID-19-suspected/confirmed patients of all non-essential equipment and supplies to avoid contamination of equipment
Create a staffing plan that is designed to preserve physician and staff availability in the event that individuals become exposed and sick. Consider backup teams.

Intraprocedure

Minimize staff in the procedure room and implement controls to ensure that all staff who will enter the procedure room and those in the control area have appropriate PPE for the procedure PRIOR to entering the procedure room; consider performing an immediate pre-procedure staff huddle to discuss all aspects of the procedure to minimize unnecessary exposures.
Ensure communication is clear inside and outside of the room. Cover and protect surfaces, eliminate exposures, ensure proper disposal of supplies and waste.

Postprocedure

Develop clear plans for doffing and disposal of contaminated PPE within a designated area clear of other personnel.
Have plans for appropriate cleaning of the procedure room with EPA-approved disinfectants, and determine the minimum amount of time to keep the room unused to allow for air clearance/circulation.
Have a clear exit plan for COVID+ patients that minimizes exposure to staff and HCP; ensure staff are able to exit the doffing area; ensure staff scrubs are changed and lead aprons are cleaned with an EPA-approved disinfectant.

References

1. Lauer, S. A. et al. The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application. Ann. Intern. Med. (2020) doi:10.7326/M20-0504.

2. World Health Organization. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19). (2020).

3. Ng, Y. et al. Evaluation of the Effectiveness of Surveillance and Containment Measures for the First 100 Patients with COVID-19 in Singapore — January 2–February 29, 2020. MMWR Morb. Mortal. Wkly. Rep. 69, (2020).

4. Adams, J. G. & Walls, R. M. Supporting the Health Care Workforce During the COVID-19 Global Epidemic. JAMA (2020) doi:10.1001/jama.2020.3972.

5. Cheng, V. C. C. et al. Escalating infection control response to the rapidly evolving epidemiology of the Coronavirus disease 2019 (COVID-19) due to SARS-CoV-2 in Hong Kong. Infect. Control Hosp. Epidemiol. 1–24 (2020) doi:10.1017/ice.2020.58.

6. Schwartz, J., King, C.-C. & Yen, M.-Y. Protecting Health Care Workers during the COVID-19 Coronavirus Outbreak –Lessons from Taiwan’s SARS response. Clin. Infect. Dis. ciaa255 (2020) doi:10.1093/cid/ciaa255.

COVID-19 planning

Updated March 23, 2020

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