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College develops guide for elective surgery return

RANZCO has provided guidance for the resumption of elective surgery this week, cautioning that operating lists and through-put will be restricted by social distancing and infective precautions.

On Monday, the college published a new resource titled Return to elective surgery – guidance during COVID-19, which is designed to help ophthalmologists navigate the return of elective eye surgery after it was suspended for three and a half weeks from 1 April.

According to the college, recommencement of elective surgery must be carried out with care and recognition there is an ongoing risk of community spread of COVID-19.

“This cannot yet be a return to ‘business as usual’ and lists and patient through-put will inevitably be limited by the necessity to maintain social distancing and infective precautions,” the guide stated.

It offered advice on how ophthalmologists should handle asymptomatic patients with no known symptoms, as well as confirmed or suspected cases. It also advises on the appropriate measures if ophthalmologists are required to perform ‘aerosol generating procedures’ such as phacoemulsification, vitrectomy surgery and laser refractive surgery on a COVID-positive patient.

RANZCO advises surgery centres to telephone screen and brief patients prior to surgery. Patients deemed at-risk must be referred for COVID-19 testing and have their surgery deferred unless it is ‘emergent’. Patients should also be instructed not to present for surgery if they develop any relevant fever or respiratory symptoms.

The college also states that screening by questionnaire should occur, as well as body temperature testing on arrival. Patients that screen positive for at-risk characteristics must be sent home and referred for COVID-19 testing.

The guide also says patients should wear surgical masks and maintain a distance of 1.5m from other patients at all stages through the preoperative and post-operative process.

“If correct precautions are followed then there should be no need for other patients to be quarantined if a positive case occurs,” RANZCO noted.

Protecting staff

According to the college, all staff should consider wearing surgical masks, maintain social distancing and limit total patient contact to no more than 15 minutes.

For theatre staff, RANZCO states they are to wear surgical masks and standard person protective equipment (PPE). It says eye protection, such as goggles or face masks, are recommended but at the surgeon’s discretion due to a compromised view through the operating microscope.

“If these protocols are followed then there should be no need for isolation of patients who may be returning to communal living arrangements,” the college notes.

Patients known to have risk factors or symptoms, as well as those who are COVID-positive, should be referred for testing and surgery should be deferred until the patient has been cleared of COVID-19 – unless it is emergent and cannot wait for medical reasons.

“For at risk and COVID-positive patients undergoing surgery before they are cleared, PPE should be worn according to the Australian Government Department of Health Interim recommendations for the use of PPE during hospital care of people with COVID-19,” RANZCO stated.

“At this stage, phacoemulsification, vitrectomy surgery and laser refractive surgery should be considered to have the potential to be aerosol generating procedures (AGPs) and lacrimal surgery is considered high risk. Contact and airborne precautions are recommended with long-sleeved gown, fit-checked P2/N95 respirator, face shield or goggles and gloves.”

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