Buket ÇELİK, Kübra YASAK, Hale TURHAN DAMAR, Dilek ÇAKIR UMAR, Filiz ÖĞCE

COVID-19 SALGININDA AMELİYATHANE VE VAKA YÖNETİMİ

Koronavirüs hastalığı 2019 (COVID-19), şiddetli akut solunum yolu sendromu koronavirüsü 2'nin (SARS-CoV-2) neden olduğu bulaşıcı bir solunum yolu hastalığıdır. Bu hastalık ilk olarak 2019 yılında Çin'in Vuhan şehrinde ortaya çıkmış, ortaya çıkışından bu yana dünya çapında yayılarak 2019-2020 koronavirüs pandemisine yol açmıştır. Hastaneler COVID-19 salgını açısından yüksek riskli ve iyi yönetilmesi gereken kurumların başında gelmektedir. Hastanelerde de en riskli alanlar yoğun bakımlar ve ameliyathanelerdir. Salgının başlamasıyla birlikte cerrahi müdahale gerekli olan tüm hastalar, olası enfekte kabul edilerek hareket edilmelidir. Ameliyathanelerde cerrahi ekip (cerrah, hemşire, anestezist ve diğer yardımcı sağlık personeli) koordineli biçimde olası/kesin tanılı COVID-19 hastaların yönetiminde bulaş önlemlerini acilen hayata geçirmelidir. Önlemlerin amacı; olası/kesin tanılı COVID-19 hastalarının ameliyat sürecini kolaylaştırmak, sağlık çalışanlarına ve diğer hastalara yönelik viral bulaşma riskini azaltmaktır. Bu makalede, olası/kesin tanılı COVID-19 hastalarının ameliyat sürecinde alınması gereken önlemlere yönelik bir izolasyon ameliyathanesinin tanımlanması, iş akışı ve süreçlerinin belirlenmesi, personelin ve hastanın perioperatif dönem yönetimine ilişkin önlemler açıklanmıştır.

OPERATING ROOM AND CASE MANAGEMENT DURING COVID-19 OUTBREAK

Coronavirus disease 2019 (COVID-19) is an infectious respiratory disease caused by severe acute respiratory tract syndrome coronavirus 2 (SARS-CoV-2). It first appeared in Wuhan, China, in 2019. Since then, it has spread worldwide and led to a coronavirus pandemics. Hospitals are the most important places which have high risk and must be managed well. The riskiest parts of hospitals are intensive care units and operating rooms. After the outbreak, all patients need to surgery should be considered as infected and measures should be taken accordingly. The surgical team (including a surgeon, nurse, anesthetist and other health staff) should urgently implement precautions against the spread of the infection to manage patients diagnosed as or suspected of having COVID-19. The aims of these precautions were to facilitate the surgical process of patients with suspected or confirmed COVID-19 and to reduce the risk of the disease transmission to health professionals and other patients. In this article, an isolation operating theatre for surgeries on patients suspected with or confirmed diagnosis of COVID-19 was described, the work flow and processes were determined and precautions about perioperative management of the surgical team and patients were explained.

Keywords:

Coronavirus, COVID-19, Operating room, Surgery, Nurse,

PDF

___

1. World Health Organization. "Naming the coronavirus disease (COVID-19) and the virus that causes it." World Health Organization. 2020.https://www.who.int/emergencies/diseases/ novel-coronavirus-2019/technical guidance/naming-the-coronavirus-disease-(covid2019)-and-the-virus-that-causes-it. Erişim tarihi:12.04.2020.
2. Hui DS, I Azhar E, Madani TA, Ntoumi F, Kock R, Dar O, et al. The Continuing 2019-nCoV Epidemic Threat of Novel Coronaviruses to Global Health-The Latest 2019 Novel Coronavirus Outbreak in Wuhan, China. International Journal of Infectious Diseases 2020; 91: 264-6.
3. World Health Organization. WHO DirectorGeneral's opening remarks at the media briefing on COVID-19-11 March 2020. https://www.who.int/dg/speeches/detail/w ho-director-general-s-opening-remarks-at-themedia-briefing-on-covid-19---11-march-2020 Erişim tarihi: 12.04.2020.
4. Coronavirus (COVID-19) Mortality Rate https://www.worldometers.info/coronavirus/coro navirus-death-rate/ Erişim tarihi:12.04.2020.
5. T.C. Sağlık Bakanlığı. Türkiye’deki Güncel Durum. https://covid19.saglik.gov.tr/ Erişim tarihi:12.04.2020.
6. T.C. Sağlık Bakanlığı. COVID-19 Yeni Korona Virüs Hastalığı. https://covid19bilgi.saglik.gov.tr/tr/ Erişim tarihi:12.04.2020.
7. Center of Disease Control and Prevention (CDC). Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19 in Healthcare Settings. 2020. https://www.cdc.gov/coronavirus/2019- ncov/hcp/infection-controlrecommendations. Erişim tarihi:12.04.2020.
8. Lo D. COVID-19: Protecting Health-Care Workers. The Lancet. 2020; 395 (10228): 922.
9. Wong J, Yuan Goh Q, Tan EZ, Lie SA, Tay YC, N SY et al. Preparing for a COVID-19 Pandemic: a Review of Operating Room Outbreak Response Measures in a Large Tertiary Hospital in Singapore. Canadian Journal of Anesthesia 2020;67:732-45.
10. Kamer E, Çolak T. COVID-19 ile Enfekte Bir Hastasının Operasyona İhtiyacı Olduğunda Ne Yapmalıyız: Cerrahi Öncesi, Cerrahi Sırası ve Cerrahi Sonrası Rehberi. Turkish Journal of Colorectal Disease 2020; 30: 1-8.
11. Karaca AS, Özmen MM, Uçar AD, Yastı AÇ, Demirer S. COVID-19’lu Hastalarda Genel Cerrahi Ameliyathane Uygulamaları. Turkish Journal of Surgery 2020;36(1):6-10.
12. Ti LK, Ang LS, Foong TW, Ng BS. What We Do When a COVID-19 Patient Needs an Operation: Operating Room Preparation and Guidance. Canadian Journal of Anesthesia 2020: 1-3.
13. Kampf G, Todt D, Pfaender S. Steinmann E. Persistence of Coronaviruses on Inanimate Surfaces and Their Inactivation with Biocidal Agents. Journal of Hospital Infection 2020; 104: 246-51.
14. Cai H, Chen Y, Chen Z, Fang Q, Han WI. et al. Liang T. (Ed). “Handbook of COVID-19 Prevention and Treatment”, The First Affiliated Hospital, Zhejiang University School of Medicine. 2020.
15. Song X, Vossebein L, Zille A. Efficacy of Disinfectant- Impregnated Wipes Used for Surface Disinfection in Hospitals: a Review. Antimicrobial Resistance and Infection Control. 2019; 8 (136): 1-14.
16. Houghton C, Meskell P, Delaney H, Smalle M, Glenton C, Booth A et al. Barriers and facilitators to healthcare workers’ adherence with infection prevention and control (IPC) guidelines for respiratory infectious diseases: a rapid qualitative evidence synthesis. Cochrane Database of Systematic Reviews. 2020;4:1-57.
17. T.C. Sağlık Bakanlığı. COVID-19 Kişisel Koruyucu Ekipman Giyme Çıkarma Talimatı. https://dosyamerkez.saglik.gov.tr/Eklenti/36977,c ovid-19-kisisel-koruyucu-ekipman-giyme-vecikarma-talimatipdf.pdf?.Erişim tarihi:14.05.2020.
18. Center of Disease Control and Prevention (CDC). Guidance COVID-19 personel protective equipment.2020.https://www.gov.uk/government/ publications/wuhan-novel-coronavirus-infectionprevention-and-control/covid-19-personalprotective-equipment-ppe. Erişim tarihi: 14.05.2020.
19. World Health Organization. Personel protective equipment.2020. https://apps.who.int/iris/bitstream/handle/10665/3 31498/WHO-2019-nCoV-IPCPPE_use-2020.2- eng.pdf Erişim tarihi: 14.05.2020.
20. Wax RS, Christian MD. Practical recommendations for critical care and anesthesiology teams caring for novel coronavirus (2019-nCoV) patients. Canadian Journal of Anesthesia 2020;12:1-9.
21. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and Clinical Characteristics of 99 Cases of 2019 Novel Corona Virus Pneumonia in Wuhan, China: A Descriptive Study. Lancet 2020;395:507-513.
22. Yu GY, Lou Z, Zhang W. Several suggestion of operation for colorectal cancer under the outbreak of Corona Virus Disease 19 in China. Zhonghua Wei Chang Wai Ke Za Zhi. 2020;23:9-11.
23. Luo Y, Zhong M. Standardized diagnosis and treatment of colorectal cancer during the outbreak of novel coronavirus pneumonia in Renji Hospital. Zhonghua Wei Chang Wai Ke Za Zhi. 2020;23 (3): 1-6.
24. Halvachizadeh S, Teuber H, Cinelli P, F Allemann, Pape HC, Neuhaus V. Does the time of day in orthopedic trauma surgery affect mortality and complication rates? Patient Safety in Surgery. 2019; 13(8): 1-8.
25. Peng PW, Ho PL, Hota SS. Outbreak of a new coronavirus: what anaesthetists should know. British Journal of Anaesthesia. 2020; 124 (5): 497- 501.
26. Kampf G, Todt D, Pfaender S, Steinmann E. Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents. Journal of Hospital Infection 2020; DOI: https://doi.org/10.1016/ j.jhin.2020.01.022.
27. Emergency Care Research Institute (ECRI). Safety of Extended Use and Reuse of N95 Respirators. Clinical Evidence Assessment. 2020. Erişim Adresi: https://www.elsevier.com/__data/assets/pdf_file/ 0006/997863/COVID-ECRI-N95 Respirators_2020-03.pdf. Erişim tarihi:20.04.2020.
28. Filtering out Confusion: Frequently Asked Questions about Respiratory Protection, Respirator. https://www.cdc.gov/niosh/docs/2018- 130/pdfs/2018- 130.pdf?id=10.26616/NIOSHPUB2018130. Erişim tarihi:20.04.2020.