Throughout the COVID-19 pandemic Texas Children’s has remained focused on caring for our patients and their families while preserving their safety and the safety of our workforce. One area where this is especially important is in the operating room where the risks of contagion could be higher than the average hospital setting.
“The operating room is a high-risk environment because of the potential to need to intubate and extubate patients,” said Children’s Surgery Program Manager Joyce Enochs. “Both of these procedures generate aerosolized particles, which can put medical workers at a greater risk of contracting COVID-19 from an infected patient.”
To protect the perioperative staff from any undo exposure or risk, the Departments of Surgery and Anesthesiology, Perioperative and Pain Medicine have taken a two-phased approach in protecting families and staff alike. The first phase entailed creating a training program for a new care paradigm for potential COVID patients. Dr. Chris Glover, medical director of Perioperative Services, in conjunction with Department of Anesthesiology and Perioperative and Pain Medicine Simulation Committee Members – Dr. David Young, Dr. Lisa Caplan, and Dr. Kathleen Chen – created the program from the ground up to reinforce this new workflow.
The program includes an information session where team members learned about COVID-19 and how Texas Children’s employees are protecting themselves from the disease; a simulation where team members learn how to don and doff PPE appropriately and confidently; and a simulation where team members transport a mock patient from an intensive care setting into the operating room, intubate them, return to the intensive care unit.
In addition, the training covers additional precautions to limit transmission risk in the operating room. These precautions include modifications during intubation and extubation, such as the use of N95 masks and goggles, as well as the incorporation of High Efficiency Particle Air or HEPA filters on the anesthesia circuits to filter out particles and ensure that none are emitted into the air. Another effort to mitigate aerosolization in the operating room is modifying induction techniques by using plastic barriers for patients.
The second phase of this new care approach is the incorporation of expanded testing so that every patient presenting for surgery receives COVID-19 testing prior to arrival. This further answers concerns on potential exposures of our perioperative staff as well as taking a judicious approach to appropriately utilize PPE.
“This is an overarching effort to ensure our health care workers, our folks who are on the frontlines, are protected as we’re dealing with this unprecedented event,” Gover said “For us to proceed along this pathway, we’ve had a lot of support and guidance throughout the organization.”
Anesthesiologist-in-Chief Dr. Dean Andropoulos agreed and said the efforts and countless hours from the anesthesiologists who led this simulation training should be commended. “Not only are they leading at Texas Children’s Hospital, but they are setting standards for potential future outbreaks at all Children’s hospitals,” Andropoulos said.
The training positions the team well as it continues to prepare to care for those diagnosed with COVID-19 and as the team begins to take on elective surgeries again. In light of Gov. Abbott’s decision to loosen restrictions put in place for elective surgeries, the Department of Surgery is prioritizing cases that initially may not have been urgent, but are now more important due to the several week delay.
“Through a phased approach, our surgical team is working through the large number of cases that are pressing, primarily outpatient cases, and prioritizing them appropriately based on a variety of factors,” said Surgeon-in-Chief Dr. Larry Hollier. “During the previous order, Texas Children’s continued to serve patients who needed us while remaining mindful of the impact elective surgeries may have had on critical supplies and resources. We remain prepared to care for those diagnosed with COVID-19 and cognizant of our supply levels while providing the best care possible to all patients, as we are here for them during this time and beyond.”