Intervention Protocol of the Orthopedics and Traumatology Department of a High-Complexity University Hospital to Cope with the COVID-19 Pandemic

doi:10.1055/s-0040-1712972

Acessibilidade / Reportar erro

Brasil

Revista Brasileira de Ortopedia

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Articles • Rev. bras. ortop. 55 (3) • May-Jun 2020 • https://doi.org/10.1055/s-0040-1712972 copy

Intervention Protocol of the Orthopedics and Traumatology Department of a High-Complexity University Hospital to Cope with the COVID-19 Pandemic^* * Study developed at the Orthopedics and Traumatology Department, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil.

About the corresp SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To describe the protocols implemented to adapt the orthopedic team to the COVID-19 pandemic; a secondary objective is to assess the behavior of hospital and departmental variables when implementing such measures.

Methods

The present is a retrospective study describing three protocols: 1) reduction in the risk of infection for patients and healthcare workers; 2) adaptation of work, academic and scientific activities; and 3) adaptation of the orthopedic treatment during the pandemic. We analyzed hospital and departmental variables, including the number of patients seen in the emergency room and outpatient clinic, the number of hospitalized patients, suspected and confirmed cases in patients and orthopedic team members, changes in teaching activities from on-site attendance to videoconferencing, and number of surgeries. Period A, from March 3 to 16, was compared with period B, from March 17 to 30, 2020, which corresponded to the implementation of the protocols.

Results

There was a decrease in the number of outpatients and inpatients. One confirmed and two suspected cases were notified. Among the departmental members, there were 12 suspected and 6 confirmed cases. The weekly frequency of classes was maintained, while the clinical-scientific meetings decreased from ten to three. In addition, the number of surgeries was reduced.

Conclusions

The present study demonstrated the feasibility and efficiency of the rapid implementation of intervention protocols in the midst of the COVID-19 pandemic. The protocols focused on reducing the risk of infection for patients and healthcare professionals, adapting work, academic and scientific activities, and modifying the orthopedic treatment. With the application of the protocols, the healthcare, academic and scientific activities remained functional, prioritizing measures to confront the COVID-19 pandemic.

Keywords
COVID-19; hospital management; orthopedics; pandemics; occupational safety; severe acute respiratory syndrome

SECTOR	PERSONAL PROTECTIVE EQUIPMENT
Emergency room and outpatient clinic	• Specific clothing; • Single-use apron; • Goggles or faceshield; • Gloves; • Surgical mask.
Surgical ward	• Specific clothing; • Single-use apron; • Goggles; • Gloves; • Cap; • Surgical or N95 mask (N95 is mandatory when caring for COVID-19-suspected or confirmed cases).
Surgical center	• Specific clothing; • Single-use apron; • Goggles or faceshield; • Gloves; • Cap; • N95 mask.

		Period A		Period B
Sector		Total	Mean/day (minimum-maximum)	Total	Mean/day (minimum-maximum)
Emergency room visits		1.136	81.1 (38-110)	294	21 (10-48)
Outpatient visits		1.575	157.5 (81-209)	619	61.9 (30-123)
Surgeries	Elective	74	5.3 (0-8)	21	1.5 (0-8)
	Urgent	32	2.3 (0-3)	15	1.1 (0-3)
	Total	106	7.6 (2-13)	36	2.6 (0-10)

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Address for correspondence Ewerton Borges de Souza Lima, MD, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), Rua Três de Maio 130, apto. 183, Vila Clementino, São Paulo – SP, 04044-020, Brasil (e-mail: ewertonbslima@gmail.com).

Emergency Room	• Installation of alcohol-based hand sanitizer dispensers throughout healthcare sites; • Patient education on the pandemic (hygiene measures, importance of social isolation, warning signs and symptoms, when to seek medical and hospital care); • Reduction in the number of visit numbers.
Outpatient clinic	• Same measures implemented at the Emergency Room; • Scheduling only recent postoperative consultations or cases that require close monitoring; • Non-urgent appointments rescheduled for 6-12 months through telephone contact by professionals and secretaries from the group responsible for the outpatient clinic; • Appointments scheduled at spaced times to avoid crowding • Orientation of only one support person per patient.
Surgical ward	• Installation of alcohol-based hand sanitizer dispensers at the entrances of the rooms and strategic sites at the ward • Patient education on the pandemic (hygiene measures, importance of social isolation, warning signs and symptoms, when to seek medical and hospital care); • Identification and isolation of suspected and confirmed cases; • Nasal swab test and chest computed tomography scan for suspected cases; • Referral of confirmed cases to the infectious diseases ward; • Reduction in the number of people in academic rounds; • Reduction in the number of patients per room; • Surgical masks on all patients.
Surgical center	• Surgical masks on all patients; • Attention to the sequential removal of personal protective equipment: gloves, followed by goggles, apron and, finally, mask; • Adequacy of the structure of the operating room and anesthetic procedures; • Preparation of a large operating room to receive suspected or confirmed cases; • Negative pressure at the operating room and terminal cleaning at the end of each surgery; • Anesthetic equipment and machinery specifically prepared to be used exclusively in this group of patients; • Preference for anesthesia with peripheral and spinal blocks to avoid aerosol-releasing procedures; • Intubation for general anesthesia, when required, aided by a visualizer and with only one assistant with the anesthetist during the procedure; anesthetic team education on the use of acrylic protection cubes to intubate and extubate to reduce aerosol dispersion.

Emergency room	• Preference for non-surgical treatment in borderline surgical/non-surgical orthopedic cases; • Preference for immobilization with orthoses instead of plastered splints or plaster for better hygiene. Alternatively, use of removable plaster splint; • Written and verbal guidance to patients on injury evolution, onset of movement, loading and rehabilitation to reduce visits motivated by doubts and other reasons; • Performance of fracture reduction and minor procedures at the Emergency Room, under controlled aseptic conditions, using antisepsis and sterile fields, instead of hospitalization and intervention in the operating room; • Scheduling of surgeries in a day-hospital regimen whenever possible.
Outpatient clinic	• Same measures implemented at the emergency room.
Surgical ward	• Scheduling of surgeries in a day-hospital regimen whenever possible.
Surgical center	• Suspension of elective surgeries until further notice; • Maintenance of emergency, urgency and neoplasms surgeries that require early intervention; • Performance of the surgeries as quickly as possible and with the least number of professionals in the room; • Attention to the use of devices such as hammers or cutters that can spread bodily fluids. These procedures must be performed using the refined technique, with sharp blades and drills; in addition, the surfaces to be used must be kept clean of blood with the aid of an aspiration device; • Electric scalpels must be carefully used due to the release of heat-generated aerosols. When required, including for dissections, the settings of the electric scalpels must be adjusted to the lowest power while maintaining the desired efficiency; • No burial of percutaneous fixations, enabling their future removal at outpatient clinics and avoiding another procedure in the operating room.