CURRENT RECOMMENDATIONS
We do not have any curative treatment or effective prevention with vaccination. Therefore, the healthcare provider’s most important task is while attending patient care, protection from Coronavirus transmission is critically essential. IOM staff is not a frontline care provider for ICU patients, but COVID -19 patients may undergo surgery, which necessitates IOM support.
In these conditions, diagnostic tests for COVID -19 are essential information for IOM personnel to know the results.
During monitoring COVID -19 positive patients’ surgery, it is imperative to protect ourselves and use appropriate Personal protective equipment (PPE) if available. Any IOM team member loss has a severe impact on service supply since IOM specialty experts (IOMP or IOMT) are always in short supply.
We should also implement necessary IOM equipment and electrode cleaning methods according to evolving and updated WHO or respective country health service guidelines.
As a society, we are going to advise you on current knowledge and information about Covid-19 patients and IOM practice, according to the World Health Organization (WHO), CDC, and FDA, European Center for disease prevention, regional/local authorities and Peer-reviewed scientific publications.
IOM PRACTICE MEASURES IN COVID-19 PANDEMIC
General measures are being implemented in most hospitals to prevent perioperative nosocomial spread of SARS-CoV-2. One of the most detailed reports of such actions comes from a large tertiary hospital in Singapore3. The following table is a perfect example.
3-Neurosurgery, nyaa157, https://doi.org/10.1093/neuros/nyaa157
At the moment, current information about the transmission mechanisms of the coronavirus (SARS Cov-2) is still evolving and needs to be updated periodically.
Another review about recommended operating room practice during the COVID-19 pandemic has been recently published by Welsh Surgical Research Initiative (WSRI) Collaborative. In this review, the suggestions classified under five different domains.
For example, one type of Neurosurgical intervention deemed to be carrying high risk. These are transsphenoidal endoscopic approach surgeries. (Hypophysis adenomas or basis cranii tumors.) In this particular surgery, if Neuromonitoring requested, full precautions need to be taken. PPE, N95 masks, prevention from the droplet, and aerosol dissemination.
Sars Cov-2 transmission has not been reported via body fluids (urine, blood) during surgery. However, in Neuromonitoring practice, needle prick can be one of the common problems. In this scenario, the protocol should be the same as the bloodborne virus diseases required by the hospital perioperative service incident reporting, even though this type of dissemination has not been reported.
The IOM machine and reusable electrode (if applicable) cleaning process is a critical part of the prevention of virus transmission. Cleaning must be performed after every surgery with COVID -19 positive patient. In hospitals, various cleaning products are offered for this process. However, we need to be aware of some of these chemicals have corrosive or oxidative effects on metal parts (amplifier pins, stimulator outputs). Isopropyl Alcohol 70% is one of the safe alternatives for this cleaning process. Please note that isopropyl alcohol is banned from operating rooms in the USA.
Personal protective equipment (PPE)
Respiratory masks
N95 masks are the most critical PPE for the protection of IOM staff. N95 masks require a fit test, and facial hairs significantly impair their effectivity.
The following table shows medical masks comparison in terms of efficiency4.
Due to the shortage of N95 masks, standard surgical masks wearing over N95 masks are advised for protection from aerosol contamination.
Face shields
In high aerosol producing surgery (Transnasal endoscopic surgery), the face shield is a necessary PPE. In general, face shields should be used for every operation on COVID -19 positive patient.
Using a face shield without an N95 mask is not an adequate protection from COVID -19.
Full body suits
Full body PPE dressing is Fluid resistant plastic or Tyvek material gown worn before entering Operating Room. This type of PPE sometimes requires assistance from another person. Fluid resistant leg and shoe coverings should also be worn if available.
The Covid-19 pandemic significantly changed working conditions for almost all healthcare providers. Working with full PPE is not a comfortable experience, and it requires a certain level of attention not to violate contamination rules. Protecting all healthcare workers in this long and grueling conditions is the vital goal to keep services running.
Related documents
WHO-2019-nCov-HCWadvice-2020.2-eng.pdf
WHO-2019-nCoV-IPC-2020.3-eng.pdf
WHO-2019-nCoV-IPCPPE_use-2020.2-eng.pdf
1-s2.0-S1471491420300654-main.pdf
Please also look at our Paper of the Month December 2020 in the members corner to read a letter about ‘Lessons from the present: Intraoperative neurophysiological monitoring organization during the COVID-19 pandemic in Lombardy, northern Italy’