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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_controlIPCU – ‘By working together we promote a culture of safety to reduce preventable infections and transmission of multi-resistant organisms’
________________________________
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Hello Fiona
We have just converted a theatre to a negative pressure theatre.
We also did some CFD modelling beforehand and dust monitoring after.
Its being maintained at -5Pa.
So far it seems to be operating satisfactory.
Cheers
Sent from LR Consulting Engineers
> On 11 Jun 2020, at 12:10 pm, De Sousa, Fiona M wrote:
>
>
> 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
>
>
>
> CONFIDENTIALITY NOTICE AND DISCLAIMER
> The information in this transmission may be confidential and/or protected by legal professional privilege, and is intended only for the person or persons to whom it is addressed. If you are not such a person, you are warned that any disclosure, copying or dissemination of the information is unauthorised. If you have received the transmission in error, please immediately contact this office by telephone, fax or email, to inform us of the error and to enable arrangements to be made for the destruction of the transmission, or its return at our cost. No liability is accepted for any unauthorised use of the information contained in this transmission.
> MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
> The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
>
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> You can unsubscribe manually from this list by sending ‘signoff acipclist’ (without the quotes) to listserv@aicalist.org.auMESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
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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
MareeMaree 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.auThe 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_controlIPCU – ‘By working together we promote a culture of safety to reduce preventable infections and transmission of multi-resistant organisms’
________________________________
CONFIDENTIALITY NOTICE AND DISCLAIMER
The information in this transmission may be confidential and/or protected by legal professional privilege, and is intended only for the person or persons to whom it is addressed. If you are not such a person, you are warned that any disclosure, copying or dissemination of the information is unauthorised. If you have received the transmission in error, please immediately contact this office by telephone, fax or email, to inform us of the error and to enable arrangements to be made for the destruction of the transmission, or its return at our cost. No liability is accepted for any unauthorised use of the information contained in this transmission.
________________________________
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
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MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
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Thankyou Fiona,
I have a similar concern on negative pressure. Im located in Lae Morobe in
Papua New Guinea and for the COVID-19 hospital all pts that meet the
criteria to be admitted will be in one unit. Currently, the unit is
designed with an air extractor that uses the wind current. It isn’t safe.
My question is if air conditioning is to be installed, what properties
should I look for… For a HEPA system is it inbuilt in all air conditions?
or is it different?Thankyou,
Betty
On Thu, Jun 11, 2020 at 12:40 PM De Sousa, Fiona M wrote:
> 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 *
>
>
>
>
> * —————————— CONFIDENTIALITY NOTICE AND DISCLAIMER The
> information in this transmission may be confidential and/or protected by
> legal professional privilege, and is intended only for the person or
> persons to whom it is addressed. If you are not such a person, you are
> warned that any disclosure, copying or dissemination of the information is
> unauthorised. If you have received the transmission in error, please
> immediately contact this office by telephone, fax or email, to inform us of
> the error and to enable arrangements to be made for the destruction of the
> transmission, or its return at our cost. No liability is accepted for any
> unauthorised use of the information contained in this transmission. *
>
> * MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND
> DO NOT REPRESENT THE OPINION OF ACIPC. The use of trade/product/commercial
> brand names through the list is discouraged by ACIPC. If you wish to
> discuss specific reference to products or services by brand or commercial
> names, please do this outside the list. Archive of all messages are
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> listserv@aicalist.org.au *MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
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Hi Fiona,
The thought of a negative pressure operating theatre is very scary – that they are positive pressure is to protect the patient from infection of an open wound. With negative pressure theatres they just become a sink for any bits of dust and bacteria and fungi floating around in the air. The risks to the patient are huge. What antibiotic prophylaxis would you use when you know you have unclean air flowing over the patient with an open wound on a table? How will this risk be communicated to the patient prior to surgery so they have informed choice about the risks of their surgery? Is there any point operating on the patient if they are then at high risk of overwhelming infection?
With proper airflow, the HEPA filtered air flows from the roof, past the staff and then to the patient and away across the floor to the exhausts. The air flow direction helps protect the staff, along with proper PPE.
Airflow in theatres is not changed for measles of TB patients, so why for COVID if this is based on a proper risk assessment rather than fear?
If your Facility Manager is a member of the Institute of Hospital Engineers Australia (IHEA), we have had two webinars on air conditioning during COVID with some very experienced air conditioning/theatre air supply specialists, including on negative pressure operating theatres that were recorded, and would be good for anyone contemplating this to listen to – any IHEA member will have access and probably wouldn’t mind you having a listen.
Regards,
Sarah Bailey MSc, PGDip Med Myc
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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_controlIPCU – ‘By working together we promote a culture of safety to reduce preventable infections and transmission of multi-resistant organisms’
________________________________
CONFIDENTIALITY NOTICE AND DISCLAIMER
The information in this transmission may be confidential and/or protected by legal professional privilege, and is intended only for the person or persons to whom it is addressed. If you are not such a person, you are warned that any disclosure, copying or dissemination of the information is unauthorised. If you have received the transmission in error, please immediately contact this office by telephone, fax or email, to inform us of the error and to enable arrangements to be made for the destruction of the transmission, or its return at our cost. No liability is accepted for any unauthorised use of the information contained in this transmission.
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
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The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
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