key: cord-279534-klqg8wnh authors: Mari, Giulio M.; Crippa, Jacopo; Casciaro, Franco; Maggioni, Dario title: A 10-step guide to convert a surgical unit into a COVID-19 unit during the COVID-19 pandemic date: 2020-04-27 journal: Int J Surg DOI: 10.1016/j.ijsu.2020.04.052 sha: doc_id: 279534 cord_uid: klqg8wnh nan The following additional information is required for submission. Please note that failure to respond to these questions/statements will mean your submission will be returned. If you have nothing to declare in any of these categories, then this should be stated. Please enter the name of the registry, the hyperlink to the registration and the unique identifying number of the study. You can register your research at http://www.researchregistry.com to obtain your UIN if you have not already registered your study. This is mandatory for human studies only. 1. Name of the registry: 2. Unique Identifying number or registration ID: 3. Hyperlink to your specific registration (must be publicly accessible and will be checked): Please specify the contribution of each author to the paper, e.g. study design, data collections, data analysis, writing. Others, who have contributed in other ways should be listed as contributors. Giulio M Mari, Franco Casciaro and Dario Maggioni conceived the study Giulio M Mari and Jacopo Crippa wrote the paper. The Guarantor is the one or more people who accept full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish. Please note that providing a guarantor is compulsory. We present a 10-step guide meant to implement a COVID-19 unit starting from a General Surgery Division, as reported from our experience from a medium volume hospital in Northern Italy during the COVID-19 outbreak. 1. All the devices for personal protection must be present in the unit. Everyone who has to enter a COVID-19 unit must know how to properly protect themselves. Entrances in the COVID-19 unit must be planned in order to have only the essential personnel exposed to the virus. Protection devices must be administrated by the dedicated staff not to waste any material. 2. Approximately 90% of COVID-19-19 patients requires oxygen therapy (6) . A careful analysis of the oxygen flows that can be delivered in a single unit has to be performed. 4. Part of the surgical personnel will inevitable face a relocation. The surgical team must be then divided in two sub-teams: a dedicated COVID-19 team working in the COVID-19 units, and a surgical "clean" team dedicated to the surgical procedures working in COVID-19 free surgical units (7) . A tailored reorganization of the surgical staff according to the hospital size must be performed to ensure that emergency surgical capabilities are maintained. 5. The COVID-19 team needs constant training throughout the whole emergency. Surgeons and surgical nurses have to be rapidly trained to the invasive and noninvasive ventilation. Dedicated blood gas analysis machine has to be placed in the unit. 6. To ensure the connection with the nursing staff, a surgeon must always be present in medical shifts, together with an internal doctor, expert in the field of respiratory diseases and ventilation. 7. Dedicated technical staff had to create a clean-dirty path for medical and nursing staff and for the COVID-19 patients within the unit. 8. A dedicated clean path must be guaranteed for food, drugs and devices supply as well. A 24-hour direct connection with an anesthesiologist and an intensivist dedicated to the COVID-19 unit has to be instituted. 10. A daily service connecting isolated patients to their close ones has to be implemented. Especially for patients utilizing a C-PAP hood, the communications with their relatives are extremely difficult. Doctors or dedicated nurses must closely keep in touch with the relatives in order to update them about the clinical conditions of their beloved ones. This outbreak not only provokes us to go back to the origin of our job, taking care of patients, but also forces us to completely change what we were doing and the way we were doing it. We are facing something that, for the moment, remains out of our control. The treatment we provide for these patients is substantially supportive and its outcome largely depends on the condition of each patient. Every single medical practitioner is involved. Provenance and peer review Not Commissioned, internally reviewed The outbreak of COVID-19: An overview Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72314 Cases From the Chinese Center for Disease Control and Prevention Coronavirus Disease 2019 (COVID-19) in Italy Defining the Epidemiology of Covid-19 -Studies Needed Facing Covid-19 in Italy -Ethics, Logistics, and Therapeutics on the Epidemic's Front Line The Italian coronavirus disease 2019 outbreak: recommendations from clinical practice Unexpected Fatality in Perioperative Period