Covid-19 also known as Corona virus has placed a strain on hospitals throughout the country as well as our entire health care system. The virus is transmitted rapidly from person to person. After the pandemic struck the United States, the U.S. Centers for Disease Control and Prevention recommended that surgeons delay all non-emergency operations including hernias to ensure those patients critically ill with Covid-19 will have available hospital beds and resources.
You surgeon was asked to decide which hernia operations were an emergency and which operations could wait. One of the pitfalls of having surgery was the potential exposure of patients to a hospital where Covid-19 patients were being treated, thus risking the transmission of the virus to hernia patients undergoing an elective operation. In addition, operating rooms have ventilators which may have been needed for the support of Covid-19 patients.
The Covid-19 crisis resolves in different areas at different rates and at different times. Surgery in calm areas can be scheduled sooner. Whereas surgery in Covid-19 hot zones needs to be scheduled once there is some resolution of the pandemic or a “flattening of the curve”. You should ask your surgeon whether or not it is safe to undergo hernia surgery in your community. Patients with co-morbidities such as heart, lung or kidney disease may need to wait prior to undergoing elective surgery.
Pre Op Evaluation
At the Hernia Center of Southern California, we began performing elective hernia surgery when the Governor of California gave the go ahead for elective surgery. Currently, elective surgery protocols have changed since the Covid-19 crisis. In order to meet the recommended Covid-19 guidelines surgeons must adapt to this ever changing environment.
Surgery Center protocol since Covid-19
Prior to scheduling surgery, our surgeons determine the risk of whether the patient may either have been infected of exposed to Covid-19. The process starts with an interview over the phone.
Covid – 19 Questionnaire
- Have you or a close contact traveled outside of the U.S. or Canada in the last 30 days?
- Have you had a fever greater than 100.4°F in the past three days?
- Have you had a new rash in the past three days?
- Do you have a cough or shortness of breath and have you had close contact with a confirmed patient or a patient under investigation of Corona virus within the past 14 days?
- Do you have a cough or shortness of breath and have you traveled to a geographic area with widespread cases of corona virus such as China, Iran, Italy, Japan, or South Korea within the past 14 days?
Patients who are either suspected of having or have been exposed to Covid-19 have their elective surgery postponed.
Patients are tested for the Covid-19 virus prior to all elective surgery.
If the patient is symptomatic for Covid-19 we postpone the surgery for an additional 14 days past the resolution of their symptoms. They are referred to their primary care physician for evaluation.
Prior to the daily start of surgery all surfaces such as countertops, exam tables, door and cabinet handles, and bathrooms are wiped down with medical germicidal wipes. Our staff is required to cover their hair and well as skin. No short pants or short sleeves. Our staff wears masks. In addition, our staff wears gloves whenever they are in contact with patients. Staff members have their temperature taken. They are instructed not to come to work if they are ill. We have placed a waiting room plexiglass barrier that separates personal from patients. We encourage frequent hand washing. We abide by social distancing. Staff works at a distance of six feet away from their co-workers.
Patients wear masks at all times. Visitors accompanying patients are asked not enter our facility but rather to wait in their car. Waiting room chairs are placed six feet apart. On entering the facility, the patients have their temperature taken. If they are febrile they are immediately referred to their primary care physician and their surgery is postponed. If they have a normal temperature they can be admitted to the surgery center. Once admitted for surgery, patients are taken to a washing station where they are instructed to wash their hands up to their elbows for at least 20 seconds. They are then instructed to gargle with a germicidal mouthwash solution. They are then taken to the preoperative area where we begin the pre-operative process. All staff must wear masks and gloves when in contact with patients. The patients are examined by the physician prior to surgery to determine if they are Covid-19 free. Once this has been established, they are prepared for surgery in the privacy of the pre-operative area.
During surgery, the patient is placed in a protected environment where their upper torso is placed in a plastic box or tent to lessen to risk or respiratory exposure. The entire surgery center including operating rooms take special precautions and follow the surface cleaning guidelines by the CDC and AORN. All surfaces are cleaned with germicidal wipes. Our staff wears personal protective equipment which is discarded at the end of surgery. Our staff wears n-95 masks.
Currently it takes more time and requires additional expenses to treat patients during the Covid-19 crisis. It is important to protect our patients and staff by being vigilant.
The majority of our post operative visits are performed using telemedicine to avoid unnecessary exposure between patient, staff, and physician.