The multidisciplinary surgical center team’s response to the COVID-19 pandemic

Report on the implementation of assistance protocols in the face of the COVID-19 pandemic developed in the surgical center of a large university hospital in Rio Grande do Sul.

Method:

Experience report on the implementation of paramentation and deworming assistance protocols by the multidisciplinary surgical center team in the fight against the COVID-19 pandemic, at a large university hospital in Rio Grande do Sul, held between March and April 2020.

Results:

In the confrontation of the pandemic by the multidisciplinary team of the surgical center, the activities adopted in the development of its action plan were described in two moments. The multiprofessional team carried out educational training on the process of paramentation and deworming as well as the preparation of professionals in the care of the patient COVID-19.

Conclusion:

With the established routines and a large number of trained professionals, it was possible to observe a better preparation of the multidisciplinary team in face of the needs imposed by the new coronavirus.

Descriptors:
Coronavirus; Surgical Centers; Patient Care Team, Personal Protective Equipment, Inservice Training

Flow and Paramentation		De-paramentation
1.	Presentation of the areas intended for the care of patients suspected or diagnosed with the new coronavirus infection and scheduling and admission flow;	8.	Reinforcement of the need to follow the department checklist displayed on an illustrative poster in the designated room;
2.	Orientation of the established perioperative routine;	9.	Observation of trained professional for guidance and/or assistance in case of self-contamination;
3.	Presentation of PPE for the service;	9.
4.	Orientation of the correct use of PPE items;	10.	Demonstration and orientation of the step by step department;
5.	Demonstration of the step by step of the paramentation aiming at the inexistence of failures;	11.	Reinforcement of the importance of hand sanitizing with alcoholic solution or water and soap as recommended in the preestablished checklist;
6.	Follow-up of the checklist displayed in the preparation room for the paramentation;	11.
7.	Clarification of possible doubts and evaluation of suggestions for improvement of the established process;	12.	Recommend the professionals' bath after exposure.

Paramentation		De-Paramentation
1.	N95 mask;	1.	Loosen the side loop and loosen the Velcro of the apron and then remove the first pair of gloves;
2.	Hand hygiene;	1.
3.	Goggles of protection or personal (of degree);	2.	Remove the waterproof apron with the second pair of gloves, rolling it up to dispose of it in infectious waste;
4.	Cap, covering all the hair and ears and rods of the glasses;	2.
5.	Face protector (face mask);	3.	Clean the hands with alcoholic solution and put on procedure gloves to remove the external cap from front to back (being careful to keep the arms away from the body), facial protector (removing it from the front and putting it on a bench protected with field for later cleaning) and shoe protector (items considered contaminated and should be discarded in infectious garbage);
6.	Second cap (cap, protecting elastics of the facial protector)⁽⁹9 Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Lancet Resp Med [Internet]. 2020 [2020 Apr 8];8(4):e21. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7118626/pdf/main.pdf https://www.ncbi.nlm.nih.gov/pmc/article... ⁾;
7.	Waterproof shoe protector;
8.	Hand hygiene;
9.	Waterproof apron;
10.	Surgical glove, covering fist completely;	4.	Remove the procedure gloves, dispose of them in infectious waste, perform hand hygiene with alcoholic solution and put on a new pair of procedure gloves;
11.	Second pair of gloves (can be surgical or procedure, according to the professional's function)⁽⁶6 Tao KX, Zhang BX, Zhang P, Zhu P, Wang GB, Chen XP. Recommendations for general surgery clinical practice in novel coronavirus pneumonia situation. Chinese J Surg [Internet]. 2020 & [cited 2020 8];58(0):E001. doi: 10.3760/cma.j.issn.0529-5815.2020.0001 https://doi.org/10.3760/cma.j.issn.0529-... ⁾.	5.	Proceed to the cleaning of the facial protector with dressing and ammonia quaternary solution, remove procedure gloves and perform hand hygiene with alcoholic solution;
		6.	In front of the changing room, in the toilet with mirror, remove the lower cap, disdain it (perform hand hygiene with water and soap), remove protective glasses or personal (proceed to their cleaning), perform hand hygiene with water and soap;
		7.	Remove the N95 mask (without bending it), by the straps, (take care not to touch the previous area, make your guard), keep the straps externally, make the hygiene of the hands with water and soap;
		8.	Continue to the bath⁽⁷7 Ti LK, Ang LS, Foong TW, Wei BS. What we do when a COVID-19 patient needs an operation: operating room preparation and guidance. Canad J Anesthesia. 2020;67:756-8. doi: 10.1007/s12630-020-01617-4 https://doi.org/10.1007/s12630-020-01617... ⁾.

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[1] Corresponding author: Ana Karina Silva da Rocha Tanaka. E-mail: ana.tanaka@ufrgs.br