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Hello Fiona,
Below is a summary of my assessment and the sections of relevant documents (see attachments) which led to my view.
I should add, I did discuss with other health professionals as well.
Ultimately you/your team will need to decide.
In my personal experience I have known patients to require surgery who have had an airborne transmissible disease (TB & chickenpox ) and we have not changed air handling in the operating room.
I would be asking the question that given the low community transmission, is this really necessary?
1. Building code references
a. Maintenance standards for critical areas in Victorian health facilities
i. Describe the pressure gradients for operating rooms between 9-30 pa (p 34)
b. Australian Health Facility Guidelines- Part D Infection Prevention and Control (p 16)
i. Combining alternating pressure rooms (either -ve or +ve) is not recommended ( this refers to isolation rooms but the risks remain for any clinical area) There are other documents defining OR as +ve pressure to protect the pt.
1. the difficulty in the configuration of appropriate airflow for two fundamentally different purposes;
2. the risk of operator error;
3. the need for complex engineering; and
4. the absence of failsafe mechanisms
ii. My view-air pressures have changed.
1. Hepa filters for +ve pressure are mounted after the supply air so clean air enters the room. HEPA filters for -ve pressure rooms are located on the return air. Have the filters been altered in anyway or were there HEPA filters already located on the return air?
2. Have the rooms been checked by an air engineer (or whatever they are called)?
2. Two papers (these are highly technical articles. One of them says that the benefit may not be for those in the theatre but for those outside, in corridors and adjoining rooms however this is not supported in the document. Refer then to the UK guideline below)
a. Chow TT, Kwan A, Lin Z, Bai W. Conversion of operating theatre from positive to negative pressure. Journal of Hospital Infection (2006) 64, 371-378
i. “In principle, a positive pressure operating theatre with adequate air changes could quickly eliminate the virus from the environment, and it has been shown that the risk of cross-contamination from airborne is low if staff are adequately protected with appropriate PPE”.
b. Park J, Yoo SY, Ko JH, Lee SM, Chung YJ, Lee JH, Peck KR, Min JJ. Infection Prevention Measures for Surgical Procedures during a Middle East Respiratory Syndrome Outbreak in a Tertiary Care Hospital in South Korea. Scientific Reports (2020) 10:325
i. “Overall the risk of cross-contamination from airborne infection is low if staff are adequately protected with appropriate PPE….”
3. UK guidelines
a. https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control/reducing-the-risk-of-transmission-of-covid-19-in-the-hospital-setting
8. Operating theatres (where these continue to be used for surgery)
It is recommended that ventilation in both laminar flow and conventionally ventilated theatres should remain fully on during surgical procedures where patients may have COVID-19 infection. Air can bypass filtration if a respirator is not fitted perfectly or becomes displaced during use. Those closest to aerosol generation procedures are most at risk. The rapid dilution of these aerosols by operating theatre ventilation will protect operating room staff. Air passing from operating theatres to adjacent areas will be highly diluted and is not considered to be a risk.
In summary, if staff comply with the correct PPE no changes need to be made to the operating room pressures.
Regards
Maree
Maree Sommerville
Infection Control Consultant
VICNISS Coordinating Centre
Doherty Institute | Level 2
792 Elizabeth St Melbourne VIC 3000
T: +61 3 9342 9362 | F: +61 3 9342 9355 | http://www.vicniss.org.au
The Peter Doherty Institute for Infection and Immunity
792 Elizabeth Street | Melbourne | Victoria | Australia | 3000
doherty.edu.au
[VICNISS_RGB – Copy]
Hi All,
In response to COVID, and for future planning I have been asked to consider the creation of a negative pressure operating theatre for use in emergency surgery for a COVID positive case (e.g. C-section, post MVA).
I am aware that this is against the usual recommendations which are for positive pressure operating theatre to reduce risk of Surgical Site Infection. However it has been raised with me that the risk of unexpected intubation of a COVID positive patient in a positive pressure theatre puts staff at risk.
I am interested in how other facilities are responding to this issue and balancing risk to staff with risk to patient.
Kind regards,
Fiona De Sousa CICP-E| Nurse Manager | Infection Prevention & Control Unit
Launceston General Hospital, Level 2, Launceston TAS 7250
phone: 6777 6715 | mobile: 0408 487 197 | fax: 6777 5170 | email: fiona.de.sousa@ths.tas.gov.au |
intranet: http://www.dhhs.tas.gov.au/intranet/thon/infection_control
IPCU – ‘By working together we promote a culture of safety to reduce preventable infections and transmission of multi-resistant organisms’
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