What are the recommendations regarding changing scrubs and decontamination between surgical cases for anesthetists, surgeons, and nursing staff? 

Posted on April 18, 2020 by Brie Cawston-Grant and Kirsten Walters

Summary

Guidelines regarding showering and decontamination refer to any OR staff. Canadian guidelines do not have recommendations on showering or changing scrubs and showering in between surgical cases, however, showing before leaving work is recommended. Non-Canadian guidelines do recommend changing scrubs and showering in between surgical cases. All PPE, including head covering, should be doffed and re-donned between surgical cases as per provincial guidelines.

I.   Provincial health authority operating room guidelines:

  • Current Provincial OR guidelines do not have recommendations for routine showering between cases (1). However, showering before leaving work or immediately when arriving home is recommended (2).
  • If there is concern for contamination of the head or neck, washing that area should be considered according to Canadian guidelines (1).
  • No specific statements regarding changing scrubs between surgical cases were found in Canadian provincial guidelines.

II.   Recommendations from Canadian medical societies and associations:

  • The Canadian Association of Interventional Cardiology recommends changing scrubs and showering between cases (3).

III.   Non-Canadian procedures and directives:

  • Non-Canadian procedures and directives do recommend removing scrubs after each procedure and showering whenever possible between COVID-19 suspected and positive cases (4-6).
  • The Italian surgical and anesthesiologic societies recommend the following doffing procedure between  COVID-19 surgical patient management: (4)
    • PPE must be removed and disposed of outside the OR in dedicated doffing areas.
    • OR donning/doffing areas must be sanitized as soon as possible following each procedure.
    • Scrubs must be replaced after each procedure following showering whenever possible.
    • After each procedure, all involved personnel, whenever possible, should shower.

IV.   Canadian Personal Protective Equipment for all staff in COVID-19 OR:

  • Guidelines regarding use of N95 masks for all staff in the OR are province dependent.
    • Known provinces that recommend N95 masks for all OR staff independent of known or anticipated AGMP: Alberta (1), British Columbia (7), Saskatchewan (8).
    • Known provinces with discretionary use of N95 masks: Manitoba (9).
  • PPE that is always required: gloves, surgical gown, eye/face protection, surgical head covering.
  • Surgical head coverings should be doffed between each case (1).
  • Disposable boots should not be worn. Instead wear shoes that can be wiped down (1).
  • AHS recommends that the surgical head covering should be doffed as well when the rest of the PPE is doffed. Furthermore, the N95 mask does not need to be changed during longer cases and should not be adjusted/removed until the patient has left the OR (1).
  • AHS does not currently recommend showering post-doffing, however an observer should be present, as the greatest risk of contamination occurs during doffing (1).
  • The most contaminated elements of PPE which can lead to biosafety breach during their doffing includes #1 gloves, and #2 gown (10).

For further information on PPE guidelines according to each province, please see REAKT question: “What visual guidelines and online resources are available regarding PPE use.”

 

Questions? Comments? Does this need to be updated? Do you have valuable points to add ? Please email ask.reakt@ubc.ca.

References

  1. Alberta Health Services. Frequently asked questions related to PPE in operating rooms and surgical services. 2020 Apr 1 [Internet]. https://www.albertahealthservices.ca/assets/info/ppih/if-ppih-surgical-services-ppe-faq.pdf (accessed 2020 Apr 18).
  2. Northern Health BC. COVID-19 Implementing PPE protocol. 2020 Apr 23 [Internet]. https://physicians.northernhealth.ca/sites/physicians/files/physician-resources/covid-19/before-during-after-work-activities.pdf (accessed 2020 Apr 25).
  3. Wood DA, Sathananthan J, Gin K, Mansour S, Ly HQ, Quraishi A-U-R, et al. Precautions and Procedures for Coronary and Structural Cardiac Interventions during the COVID-19 Pandemic: Guidance from Canadian Association of Interventional Cardiology. Canadian Journal of Cardiology [Internet]. 2020 [cited 2020 Apr 18]; Available from: https://www.sciencedirect.com/science/article/pii/S0828282X20303007 [Epub ahead of print]
  4. Coccolini F, Perrone G, Chiarugi M, Marzo FD, Ansaloni L, Scandroglio I, et al. Surgery in COVID-19 patients: operational directives. World Journal of Emergency Surgery [Internet]. 2020 Apr 7 [cited 2020 Apr 18];15(25). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7137852/   
  5. Wong J, Goh QY, Tan Z, Lie SA, Tay YC, Ng SY, et al. Preparing for a COVID-19 pandemic: a review of operating room outbreak response measures in a large tertiary hospital in Singapore. Canadian Journal of Anesthesia [Internet]. 2020 Mar 11 [cited 2020 Apr 18];1–14. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7090449/ [Epub ahead of print]
  6. First Affiliated Hospital, Zhejiang University School of Medicine. Handbook of COVID-19 Prevention and Treatment [Internet]. Zhejiang, China. 2020 March 18 [cited 2020 Apr 18]. Available from: https://drive.google.com/file/d/1N2ARNHSYCmVuLSHWXmeYv2afqW7Tzk_A/view
  7. BC Ministry of Health. Interim Infection Prevention and Control (IPC) Protocol for Surgical Procedures Requiring Intubation during COVID-19 Pandemic – Adults and Older Adults. 2020 Apr 8 [Internet]. Available from: http://www.bccdc.ca/Health-Professionals-Site/Documents/Algorithm_COVID-19_Surgery.pdf (accessed 2020 Apr 18)
  8. Shared Health Manitoba. COVID-19 specific disease protocol (Winnipeg) – acute and community settings. 2020 Apr 14 [Internet]. Available from: https://sharedhealthmb.ca/files/IPC-acute-care-manual-winnipeg.pdf (accessed 2020 Apr 18).
  9. Saskatchewan Health Authority. Infection Prevention and Control protocol for surgical patient during the COVID-29 Pandemic: adults and older adults and obstetrics. 2020 Apr 14 [Internet]. Available from: https://www.saskatchewan.ca/-/media/files/coronavirus/info-for-health-care-providers/ppe/ipac-for-surgical-patient-during-covid-19-pandemic-adults-older-adults-and-obstetrics-april-14-2020.pdf (accessed 2020 Apr 18).
  10. Munoz-Leyva, F., Niazi, A. Common breaches in biosafety during donning and doffing of PPE Used in the Care of COVID-19 Patients. Canadian Journal of Anesthesia. 14 Apr 2020. [Online] https://link.springer.com/article/10.1007%2Fs12630-020-01648-x (accessed 22 Apr 2020)

Disclaimer

The above is intended to serve as a rapidly-created, accessible source of information curated by medical students and healthcare professionals. It is for educational purposes only and is not a complete reference resource. It is not professional medical advice, and is not a substitute for the discretion, judgment, and duties of healthcare professionals. You are solely responsible for evaluating the information above.