The American Association of Nurse Anesthetists (AANA) has compiled resources to help Certified Registered Nurse Anesthetists (CRNAs) develop strategic steps for managing patients with expected or confirmed infection of the Coronavirus Disease 2019 (COVID-19).
“CRNAs are on the frontlines of patient care. To guide them as they deliver safe and effective anesthesia care while keeping themselves healthy, the AANA has provided a series of considerations specific to the perioperative setting and summarized recommendations from top national and international healthcare organizations,” said Brett Morgan, DNP, CRNA, AANA senior director, Education and Practice.
“As highly trained advanced practice registered nurses, CRNAs provide anesthesia care to all patients and are called upon to help manage patients experiencing respiratory distress and failure. This often involves invasive airway management, which places CRNAs at high risk for disease exposure,” said Morgan. “COVID-19 can spread from person-to-person through respiratory droplets, therefore it is imperative for CRNAs and all healthcare providers to be prepared with the most current infection control precautions and considerations to remain safe.”
Recommendations include frequent, meticulous handwashing and the use of personal protective equipment (PPE) for all anesthesia professionals. The AANA also recommends that CRNAs follow strict environmental cleaning and disinfection procedures and other measures to minimize spread of the virus.
Considerations specific to the perioperative setting include:
· Enforce frequent, meticulous hand hygiene. Hand hygiene is the single most important measure in protection against cross infection. Hand washing is essential before and after donning or doffing PPE.
· PPE must be available for all providers. N95 masks should be worn for all known or suspected cases of COVID 19, as well as for any asymptomatic open airway cases. A powered air-purifying respirator (PAPR) may also be warranted.
· Wear disposable OR caps and beard covers. Disposable fluid-resistant long-sleeved gowns, goggles and disposable full-face shields are recommended for frontline providers.
· Prior to intubation, don appropriate gloves, facemask/PAPR, eye shield and gown. Plan to limit the distance traveled with contaminated equipment. Double glove and use the outer glove to sheath the laryngoscope blade after intubating.
· Select the most experienced anesthesia professional to intubate the patient. Limit the number of staff members during airway manipulation to reduce the risk of unnecessary exposure.
· Allocate ORs specifically for patients with confirmed or suspected COVID-19. In addition, these patients should not be brought to preoperative holding or recovery areas.
· Take steps to minimize aerosolization of the virus. Preoxygenate the patient for five minutes with 100% FiO2 and perform rapid sequence induction (RSI) to avoid manual ventilation of the patient’s lungs. Use a video-laryngoscope to improve intubation success and avoid awake fiberoptic intubations, when possible. Atomized local anesthetic will aerosolize the virus.
· Place a high-efficiency hydrophobic filter between the facemask and breathing circuit or between the facemask and reservoir bag to avoid contaminating the atmosphere.
· Follow strict environmental cleaning and disinfection procedures. Dispose all used airway equipment in a double-zip-locked plastic bag for proper decontamination and disinfection.
While these recommendations are tailored for patients with known or suspected COVID-19, it may be prudent to take these actions for all patients in this environment of rapid spread and unconfirmed cases.
