key: cord-277564-x5qfxag3 authors: Kim, Si-Hyun; Jeong, Yeon Jeong; Kim, Youn Jeong; An, Ye Rin; Kwak, Eunji; Seo, Yeseul; Ahn, Joong Hyun title: Infection prevention and control practices for emergency surgery during the COVID-19 pandemic in a tertiary care hospital in South Korea date: 2020-10-24 journal: nan DOI: 10.1016/j.ijso.2020.10.007 sha: doc_id: 277564 cord_uid: x5qfxag3 • Proper risk assessment for COVID-19 should be implemented. • Appropriate infection prevention practices for perioperative management are important. -Hospitals should organize dedicated protocols considering its facilities and human resources. The World Health Organization declared coronavirus disease (COVID-19) as a pandemic in March 2020. COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has posed a serious health threat worldwide [1] . When implementing infection prevention and control measures in healthcare settings, several important characteristics of COVID-19 should be considered. Recent data suggest the possibility of transmission of SARS-CoV-2 from asymptomatic carriers or pre-symptomatic patients [2, 3] . SARS-CoV-2 is primarily transmitted from person to person through respiratory droplets, but it can also be transmitted by an airborne route, particularly under aerosol-generating procedures including endotracheal intubation and extubation [4, 5] . Based on these findings, we established infection prevention and control practices for emergency surgery in the hospital. There are recommendations for emergency surgery preparation during times of COVID-19 [6, 7] . However, each healthcare institution should optimize these recommendations in consideration of its facilities, human resources, and equipment. Herein, we present our experience of risk assessment and perioperative management for emergency surgery in this study. The hospital is an 846-bed tertiary care teaching hospital located in Incheon, Republic of Korea. Incheon's population is 2.95 million, and the number of confirmed cases of COVID-19 was 718 (2429 per 100 000) as of 31 August 2020 [8]. In the hospital, there are 17 operating rooms (ORs), two of which are negative-pressure ORs, and there are 5, 9, and 14 negative-pressure isolation rooms in the emergency department (ED), general wards, and intensive care units, respectively. Real-time reverse transcription polymerase chain reaction (rRT-PCR) testing for SARS-CoV-2 is conducted 5 times a day in the hospital with a turnaround time of approximately 4 h. During the COVID-19 pandemic, all patients are screened for clinical signs or symptoms compatible with those of COVID-19 and epidemiological risk factors of COVID-19 in the triage prior to entry into the hospital, as previously reported [9] . Patients with findings suggestive of COVID-19 should be placed in a negative-pressure isolation room in the ED until the results of the rRT-PCR test for SARS-CoV-2 are confirmed as negative. Since 13 April 2020, to identify patients with asymptomatic or pre-J o u r n a l P r e -p r o o f 2 symptomatic infection, all patients requiring hospitalization should undergo at least one rRT-PCR test for SARS-CoV-2 and chest radiography before admission. However, patients requiring emergency surgery before confirmed negative SARS-CoV-2 rRT-PCR test results are evaluated for the risk of transmission by infectious disease specialists and the infection control team based on 3 criteria: clinical signs or symptoms, epidemiological risk, and chest radiological findings (Fig. 1 ). All patients should wear a medical face mask whenever they are transported within the hospital, regardless of the risk, and non-essential contacts between patients and other individuals should be minimized. When transporting high-risk intubated patients, a negative-pressure isolation stretcher is used. Patients are transported directly to the OR by personnel wearing appropriate personal protective equipment. When transporting intermediate-or high-risk patients to and from the OR, the transport route is controlled, and environmental disinfection of the route is performed thereafter. In principle, the number of personnel participating in emergency surgeries is minimized, and only necessary equipment should be left in the OR. The anesthesia machine and other equipment in the OR are covered with plastic sheets. When performing emergency surgery in high-risk patients, a negative-pressure OR should be used. If a negative-pressure OR is not available, then a general OR set to neutral pressure with proper ventilation is considered for intermediate-risk patients. For anesthesia, rapid sequence induction and intubation is performed by an experienced anesthesiologist, and video laryngoscopy is used whenever possible. After the surgery, patients should recover in the OR and be transported directly to the room, bypassing the post-anesthesia care unit. Patients who still have unconfirmed SARS-CoV-2 rRT-PCR test at the end of the surgery are transferred to the cohort ward, a single room, or a negative-pressure isolation room according to their risk. The anesthesia machine and other reusable equipment require meticulous routine cleaning, and disposables should be bagged as contaminated waste. After the patient has left the OR, the room should remain closed along with adequate ventilation, and then subjected to enhanced environmental cleaning and disinfection using hydrogen peroxide vapor. Perioperative infection prevention and control measures according to risk are summarized in Table 1 . Authors must obtain written and signed consent to publish a case report from the patient (or, where applicable, the patient's guardian or next of kin) prior to submission. We ask Authors to confirm as part of the submission process that such consent has been obtained, and the manuscript must include a statement to this effect in a consent section at the end of the manuscript, as follows: "Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request". Patients have a right to privacy. Patients' and volunteers' names, initials, or hospital numbers should not be used. Images of patients or volunteers should not be used unless the information is essential for scientific purposes and explicit permission has been given as part of the consent. If such consent is made subject to any conditions, the Editor in Chief must be made aware of all such conditions. Even where consent has been given, identifying details should be omitted if they are not essential. If identifying characteristics are altered to protect anonymity, such as in genetic pedigrees, authors should provide assurance that alterations do not distort scientific meaning and editors should so note. Not applicable. Please specify the contribution of each author to the paper, e.g. study concept or design, data collection, data analysis or interpretation, writing the paper, others, who have contributed in other ways, should be listed as contributors. World Health Organization. WHO Coronavirus Disease (COVID-19) Dashboard Transmission of 2019-nCoV infection from an asymptomatic contact in Germany COVID-19 transmission within a family cluster by presymptomatic carriers in China Aerodynamic analysis of SARS-CoV-2 in two Wuhan hospitals Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review European Society of Trauma and Emergency Surgery (ESTES) recommendations for trauma and emergency surgery preparation during times of COVID-19 infection Korea COVID-19 Infection Control Guideline Working group Korea Medical Association Task Force Expert Committee. Guidelines for Surgery of Confirmed or Suspected COVID-19 Patients Preparedness for COVID-19 infection prevention in Korea: a single-centre experience In accordance with the Declaration of Helsinki 2013, all research involving human participants has to be registered in a publicly accessible database. Please enter the name of the registry and the unique identifying number (UIN) of your study.You can register any type of research at http://www.researchregistry.com to obtain your UIN if you have not already registered. This is mandatory for human studies only. Trials and certain observational research can also be registered elsewhere such as: ClinicalTrials.gov or ISRCTN or numerous other registries.Not applicable. 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 Not applicable.