Biomedical Engineering Reference
In-Depth Information
Patient selection
•
Elective procedures will not be performed on patients
with smallpox.
•
Emergent procedures that entail life, limb, or eyesight
will be the only surgeries performed on patients with
smallpox.
Patient transport
•
document all information on a dry erase board and
either display the board to the outside circulating
nurse through a core window or relay the information
via telephone.
•
The outside circulating nurse will not enter the OR
and will bring supplies and equipment only to a desig-
nated door.
•
The outside circulating nurse also will wear appro-
priate personal protective equipment (PPE) and an
N95 respirator mask because the positive pressure of
the OR could potentially blow organisms out to him
or her.
Patients will be transported to the OR via the most
direct route in the hospital.
•
The
route
should
bypass
the
preoperative
holding area.
•
Patients will wear a surgical mask and he covered
with a linen sheet during transport because this is
emergency surgery, and the patient will not have
been properly fit tested for an N95 particulate respi-
rator mask.
Staff procedures
•
•
After perioperative staff members enter the OR, they
will not be allowed to leave until the procedure is
concluded.
•
At the conclusion of the procedure, all PPE will be
placed in a biohazard bag as staff members exit
the room.
OR setup
•
The charge nurse will notify perioperative staff
members and the surgical services chief of anesthesia
about the patient with smallpox.
Each OR door will be labeled with airborne and
contact precaution signs.
•
Nonessential equipment will he removed from
the rooms.
•
The central material supplies (CMS) department will
be notified by the charge nurse.
•
To prevent contaminating supplies in cabinets and
drawers that cannot be removed from the OR,
personnel should not open cabinets or drawers after
the patient has entered the room. Cover and seal all
cabinets and drawers with plastic and tape.
•
Facilities managers will be contacted by
the
charge nurse.
•
The facilities department will ensure the proper
number of air exchanges per hour (i.e., a minimum
of 15 air exchanges per hour, at least three of which
must be fresh air) (1).
•
Personal protective equipment will he placed outside
the entrance to the room.
•
Anesthesia personnel will coordinate recovery of the
patient in the OR or intensive care unit with negative-
pressure isolation.
•
The outside circulating nurse will have a designated
door for transport of supplies and equipment. This
door will not be taped, so the outside circulating
nurse will have access. A high-efficiency particulate
arresting (HEPA) tilter machine will be placed in front
of designated door access.
•
All staff members involved in the patient's care and
transportation or cleaning of the OR involved will be
vaccinated and wear an N95 mask, gloves, gown, and
shoe covers.
•
All other doors will be taped shut.
•
All staff members and patients who come in contact
with smallpox should be vaccinated within seven days
if they are not already vaccinated (2).
•
Place tape around the frame of the door and inside of
the OR to prevent or decrease air flowing to the OR
hallway.
•
Non-essential personnel will not be allowed in the OR
at any time.
•
Tape a “do not enter” sign on the outside of the patient
transport door.
•
In addition to the circulating nurse in the OR, an
outside circulating nurse will be assigned strictly for
the procedure.
•
A HEPA filter machine will be placed in the OR in front
of the nontaped door.
•
These machines may expedite air filtration and are an
added precaution to prevent outflow of organisms (3).
•
The outside circulating nurse will assist in bringing
equipment and needed supplies to the room.
•
At a minimum, all personnel will wear an N95 respi-
rator mask, impermeable disposable gown, gloves,
and shoe covers.
•
If the facility does not have computers in the OR for
documentation, the outside circulating nurse will be
responsible for documentation. A paper chart is not
to enter the OR because it may become a vector
if contaminated. The inside circulating nurse will
•
If PPE gets wet or soiled during the procedure,
personnel should change to clean, dry PPE.
Figure 13.4
Guidelines for Handling Patients With High Risk Airborne Diseases (Smallpox) in the OR [2].
