....This is the supplemenation materials at the end of the article. It's in a doc form...
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Supplementary Materials
Anesthesia and infection control management guidelines for emergency procedures in patients with confirmed or suspected 2019-nCoV
1. Anesthesiologists’ Procedures for emergency intubation of patients with confirmed or suspected of 2019-nCoV infection (Implemented on January, 19th, 2020)
1) Take level 3 protective measures for healthcare workers
① Wear scrubs or surgical gowns, wear medical protective masks and disposable skull caps;
② Coat disposable biological-proof protective suits in the outer layer, wear disposable latex gloves and disposable shoe-covers;
③ Wear face masks with protective eye-wears or goggles with face masks, or respirators and positive-pressure exhaust helmets (whole-skull protected)
④ Wear protective equipment in this order: hand disinfection → wear a cap → wear a medical protective mask → wear goggles/face screens/eye protective surgical masks → wear isolation gowns/protective suits→ wear shoe-covers → wear gloves
2) Carry induction medication for general anesthesia (propofol or etomidate, fentanyl and rocuronium bromide).
3) Carry intubation devices. The video laryngoscope should be isolated and stored by itself. Only use the video laryngoscope if there are no spare ones in the intubation-needed area, and it should be fully sterilized after each use.
4) Intubation after rapid induction with sufficient muscle relaxation is recommended for all patients who have fever or need mechanical ventilation for respiratory support. Procedures for medication and intubation are presented below.
5) Preoxygenation before induction: cover the patient's mouth and nose with two pieces of wet gauze, and then give oxygen inhalation with a face mask.
6) Anesthesia induction: intubate after rapid induction of anesthesia, enable adequate muscle relaxation to prevent coughing. It is suggested to use rocuronium bromide + propofol for rapid induction and administer opioids at last to avoid coughing. Intubate after complete elimination of spontaneous breathing (at least 90 seconds).
7) Take off protective equipment in this order: remove the shoe-covers → remove the gloves → hand disinfection → remove the isolation gowns/protective suits → hand disinfection → take off the goggles/face screens → hand disinfection → remove the medical protective masks → hand disinfection → remove the disposable skull caps → hand disinfection/hand washing → change personal clothing.
8) Protective clothing should be discarded on site or wrapped in double layers of yellow garbage bags and placed in designated areas.
Note: All operations must be completed with hand-washing disinfection using the seven-step surgical hand-washing technique.
2. Precautions for infection control in Pre-Anesthesia Evaluation Center and Outpatient Evaluation Center (Implemented on January, 20th, 2020)
1) Medical staff should make sure that proper personal protective measures are taken: properly wear disposable isolation gowns, surgical masks or N95 masks, disposable skull caps and gloves.
2) Patients are required to enter the clinic one by one and see one patient at a time to avoid congestion in the clinic.
3) Room temperature of each patient is routinely measured when stepping into the clinic (electronic ear thermometer). Halt the pre-anesthesia evaluation and report to the infection control office immediately if the patient has a high temperature. Medical staff should communicate with patients with fever and transfer the patient to fever clinic for further diagnosis and treatment.
4) Sterilize ear thermometers, blood pressure monitors and stethoscopes with ethanol each time for every use.
5) Disinfect or wash hands with hydrogen peroxide disinfectant after contact with patients.
6) Use hydrogen peroxide disinfectant wipes to wipe and disinfect the surfaces of table tops and chairs.
7) In case of suspected cases, report immediately to the infection control office of the hospital.
3. Precautions for infection control in the Operating Room (Implemented on January, 19th, 2020)
1) For all the patients who need surgery (elective or emergent), check the body temperature before entering the OR, routinely inquire about recent fever history, upper respiratory tract infection history, the history of activities around the Huanan seafood wholesale market and history of eating or contact with wild animals. Inquire that if the patient has recent contact with people with fever. Carefully check the preoperative examinations for each patient, especially the imaging data. If the patient has a fever with unknown causes, the test results show pulmonary infection or low oxygen saturation of unknown cause (SPO2<90%), try to communicate with the patient, family and the surgeon to suspend the surgery. Then conduct further examinations such as lung CT or throat swab virus screening and report this case to the infection control office of the hospital.
2) Single use of all anesthetic equipment, utensils and drugs for each patient must be guaranteed. Anesthetic devices in contact with the respiratory tract, such as video laryngoscope lenses, plastic respiratory pipes, filters, respiratory balloons, suction tubes, and sputum suction tubes should be discarded after each use. Use hydrogen peroxide disinfectant wipes to wipe and disinfect the surfaces of video laryngoscope after use.
3) Thorough disinfection and sterilization of the OR should be conducted at the end of the day or immediately after the surgery of confirmed or suspected 2019-nCoV cases. The sterilization includes routine disinfection of the anesthesia machine, whole-OR ultraviolet radiation, disinfectant spray and mopping. All these procedures should be inspected by the infection control team for backtracking purposes.
4) All medical waste should be strictly sorted out and discarded into yellow medical waste garbage bags but not into domestic garbage bags.
5) After intubation, consultation or postoperative patient transportation in the areas with confirmed or suspected of 2019-nCoV pneumonia infection, transmission-preventive protocols and disinfection measures should be properly followed before entering the operating room. It is forbidden to take any potentially contaminated clothing back to the OR.
6) All anesthesiologists should strictly follow the “Precautions for Infection Control of 2019-nCoV” issued by the infection control office of the hospital.
