THEATRE SAF E T Y
What COVID has taught us about theatre safety
With COVID-19 lockdown measures beginning to ease, Gemma Rower discusses how hospitals can maintain a safe operating theatre during the global pandemic – protecting the perioperative team and patients.
Clinicians and healthcare workers are arguably among the most at-risk of COVID-19 infection. Ensuring their safety is essential, not just because of the work they do, but because if they do contract COVID-19, they represent a ‘triple threat’ to pandemic control, becoming patients themselves in a healthcare system already under intense pressure.
The use of and access to PPE has been a topic of intense discussion during the pandemic. It has been widely accepted that clinicians and other hospital staff must be able to access PPE during the course of their work, and it is a crucial first barrier of protection. Yet few studies exist on how else clinicians can be protected in the course of their duties.
One study that does exist, published by the (US) Nature Public Health Committee1 makes the case that physical distancing within an operating theatre is “challenging but necessary” if hospitals are to maintain safety. The study also raises the importance of cultural and behavioural shifts which should
be adopted for this to be made possible. Clear communication, along with managing work patterns, is one such measure which can keep the number of staff present within a facility to a minimum. Verbal communication is another possible route of transmitting COVID-19, so utilising email and phone communication before and after the procedure wherever possible will help limit COVID-19 transmission.1
Assessing the landscape The layout of an operating theatre should always centre on minimising the risk of a patient acquiring infection during a procedure.2
instance, ensuring as few people as possible are admitted to the wards, sanitising gels, and taking the patient directly through to theatre to reduce the time they are exposed to air potentially containing the COVID-19 virus protects both them, the surgical team and by extension, the wider hospital environment.
Now, however, even more focus should also be on what happens inside the theatre doors. To use the field of laparoscopy, which has continued to operate throughout the pandemic – albeit with some debate3
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as an example, steps have been taken to ensure patients are safely transported through a network of ‘clean zones’, with restrictions on human contact in place. For
Despite these efforts, laparoscopic clinicians are still somewhat vulnerable. In the cases where operating theatre rooms are confined due to its dimensions or the size of the equipment deployed for the operation, it is not possible to maintain physical distancing, either between surgical teams or the patient. This can present a high risk, which can be minimised through sterilising equipment and adopting different processes, including single-person equipment. The Royal College of Obstetricians and Gynaecologists (RCOG) and British Society for Gynaecology Endoscopy (BSGE) state that “there is no evidence of an increased risk of COVID-19 transmission during gynaecological laparoscopic surgery when Personal Protective Equipment (PPE) is used”.4 However, the joint statement also issues the following advice: “There is a high risk of explosive dispersion of body fluid when the uterus is removed from the vagina at total laparoscopic hysterectomy. Swabs, suction and retrieval devices should be used to minimise droplet transmission and consideration should be given to performing an open hysterectomy, on a case by case basis.”4
One of the main concerns associated with laparoscopy is the potential infection risk associated with aerosol production. It is feasible that particles in the aerosol may contain viruses, which are then transmitted through the nose, mouth, hands, and other forms of transmission.
The RCOG / BSGE statement also addresses the issue of ventilation and the removal of laparoscopic smoke commonly expelled during the procedure. By limiting the quantity of incisions made for a
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