Operative team checklist for aerosol generating procedures to minimise exposure of healthcare workers to SARS-CoV-2

Abstract

Objectives: In many countries around the world, the COVID-19 pandemic has resulted in health services being diverted to manage patients with the condition. There are situations however that still require the undertaking of aerosol generating procedures (AGP) with potentially high exposure of healthcare workers to SARS-CoV-2 transmission through droplet, contact and possibly airborne routes. The objective of this paper is to explore a structured way for the operative team to approach AGP to reduce aerosolisation of secretions, decrease open airway time and minimise staff exposure.

Methods: The authors (otolaryngologists, anaesthetists and nursing staff) created a unified operative team checklist based on collation of national and international specialty society statements, local state government recommendations, hospital policies and literature review. Simulation was undertaken and the checklist was refined after performing AGP on patients with unknown (presumed positive) COVID-19 status.

Results: An 8 step operative team checklist is provided describing details for the immediate pre-operative, intra-operative and post-operative journey of the patient to encourage healthcare workers to reflect upon and modify usual practice during AGP to mitigate exposure to SARS-CoV-2. The example of paediatric laryngo-bronchoscopy for diagnostic purposes or retrieval of an inhaled airway foreign body is used to illustrate the steps however the checklist structure is modifiable for other AGP and adaptable for local needs.

Conclusions: At a time of overwhelming and changing information and recommendations, an operative team checklist may provide some structure to healthcare workers undertaking AGP to reduce anxiety, maintain focus, prompt consideration of alternatives and potentially reduce risk.

Keywords: Aerosol generating procedure; Aerosolisation; Anaesthesia; Bronchoscopy; COVID-19; Coronavirus.

Fig. 1

Clinical photograph during airway foreign body removal in a 16-month old child. The surgical team were wearing PAPR however the anaesthetic team had elected not to as the child was COVID-19 negative and they had not completed training in PAPR use prior to the emergency procedure.

Fig. 2

Summary of 8 step operative team checklist used for high-risk aerosol generating procedures (AGP).

Fig. 3

The general principles of approach for high-risk aerosol generating procedures (AGP) used to develop the operative team checklist.

Fig. 4

The ENT checklist used at Sydney Children's Hospital for aerosol generating procedures is provided as an example detailing site-specific nomenclature, equipment and preferences. Numbered point form was used, and the font and margins of the layout were adjusted to allow printing on only 2 sheets of paper to be less overwhelming at a time of information overload.

Fig. 4

The ENT checklist used at Sydney Children's Hospital for aerosol generating procedures is provided as an example detailing site-specific nomenclature, equipment and preferences. Numbered point form was used, and the font and margins of the layout were adjusted to allow printing on only 2 sheets of paper to be less overwhelming at a time of information overload.