Steps to handle Corona patients or suspects in OR

	Check	Column3	Steps
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1			Operating room and other medical staff
2		1	Assign one OR for COVID19 patients, patient should come directly to OR
3		2	The procedure should be urgent or necessary
4		3	When possible do the case in a negative pressure room ( airborne isolation), or the patient own room
5		4	Try to do the case when there are least number of health care worker around ( end of the day)
6		5	Make sure to have an area outside the OR to place the PPE
7		6	Assign roles during the huddle ( Surgeon , Anesthesiologists, Technologist, OR nurses, transporter )
8		7	Assign staff to call support services operation system, to secure the track in which the patient will come through ( involving security, housekeeping)
9		8	Assign one person to put signs outside OR entrance
10		9	Assign one person to make sure that OR doors ( hallway and sterile area doors ) are locked after patient is in OR
11		10	Count the people involved in the case and make sure it is as minimum as possible
12		11	Make sure all unnecessary equipments are removed from OR, cell phones are to be removed or placed in a zipper plastic bag that can be re sterilized latter if needed
13		12	Assign one extra Anesthesiologist and Technologist outside OR in case of any urgent need or to relieve after 4 hours
14		13	Anesthesia team is responsible of bringing patients from ICU/ED and they should be Warring all PPE if close contact with patient
15		14	Call SSOC to arrange security and housekeeping to protect and sanitize the route of the patient from OR to his room
16		15	Make sure all gases from ventilator are relieved through scavenging system
17			How to put on PPE
18		1	Assign one person to monitor you when putting PPE on
19		2	Use hospital OR attire only , including OR shoes, shoe cover, and bonnet
20		3	Sanitize your hands
21		4	Put N95 first ( your own tested size)
22		5	Put head and neck hoody
23		6	Place eye goggles or plastic disposable vesiors
24		7	Put on water resistant gown ( an overall is preferred)
25		8	Put on 2 gloves
26			Technologist duties
27		1	Put on all PPE's
28		2	Make sure to cover the anesthesia monitors, , Ventilator, computer, Omnicell with plastic covers
29		3	Place IV starting , airway equipment, in special area over plastic sheets
30		4	Make sure to have Vedio- Laryngoscope with proper size blade ( it must be used)
31		5	Place a HEPA filter between the Y-piece of the breathing circuit and the patient's mask, endotracheal tube or laryngeal mask airway.
32		6	HEPA filter can be placed at expiratory end of the corrugated breathing circuit before expired gas enters the machine in pediatrics.
33		7	HEPA filter connected to sampling tubing
34		8	Make sure to elongate the ventilator circuit
35		9	Help in preparing all IV fluids, emergency drugs, or any drugs that might be needed and place it in special area over plastic sheets
36		10	If patient is already Intubated a HEPA filter inserted between the bag-valve-mask breathing device and the patient.
37		11	Transparent plastic /glass barrier to separate head of patient from other staff , specially if airway is not secured and connected to a closed circuit
38		12	Move patient to OR table, place monitors, avoid unnecessary touch
39		13	Connect closed suction system immediately after intubation , just before starting mechanical ventilation
40		14	Avoid using a stethescope
41		15	Give enough time to properly discard, clean, or sterilize after patient is out of OR
42			Anesthesiologist duties
43		1	Put on all needed PPE's
44		2	Prepare all IV fluids, emergency drugs, or any drugs that might be needed and place it in special area over plastic sheets
45		3	During transport, If not intubated patients should have a protective mask over his face or oxygen mask, make sure oxygen is at low flow rate
46		4	Transparent plastic /glass barrier to separate head of patient from other staff , specially if airway is not secured and connected to a closed circuit
47		5	Avoid big Tidal Volume ( TV) if patient needing ventilation support during transport or in OR
48		6	Avoid CPAP-BiPAP
49		7	Do not inflate bair hugger until airway is secured and the protective barrier is placed
50		8	Designate the most experienced anesthesia professional available to perform intubation, if possible
51		9	Avoid awake fiberoptic intubation unless specifically indicated
52		10	Oxygenate the patient for 5 minutes, place clear plastic drape between you and the patient if not ETT inflated and secured
53		11	Stop oxygen flow just before intubation
54		12	RSI, using Vedio laryngoscop
55		13	Place the Video laryngoscope in a plastic bag immediately after intubation for re-Sterilization
56		14	After inflating ETT, place clamp over it
57		15	Connect a closed suction tubing system ( the one used in ICU)
58		16	Connect ventilator do not start it until it is securely tight on , keep oxygen flow and TV as low as possible
59		17	Don't use stethoscope to confirm ETT position
60		18	After intubation remove the outer gloves, sanitize the inner gloves , and put a new one on top of the inner gloves
61		19	Repeat previous step every time you touch near airway and before leaving OR when accompanying the patient
62		20	Stay far away from patient throughout the case
63		21	The other Anesthesia hospitalits not involved in airway should manage documentation
64		22	if decided to extubate keep the patient on 100% FIO2
65		23	Reverse muscle relaxant and prepare for awake extubation
66		24	Keep transparent plastic barrier throughout extubation and even while applying oxygen mask , keep low flow
67		25	Suction ETT using closed suction system without disconnecting the ventilator
68		26	After extubating, place the ETT into a plastic bag to be discarded
69		27	After successful extubation , place face mask oxygen for transport with low flow
70		28	Place a protective mask over the oxygen mask
71		29	Recover patient in OR, If no available staff or isolation room in PACU
72		30	After delivering patient to his isolated room the person in close contact with the airway should do the duffing if its proper area
73			Duffing procedure
74		1	Remove outer glove
75		2	Sanitize the inner gloves
76		3	Remove shoe cover from outside, don't touch inside
77		4	Sanitize the inner gloves
78		5	Remove the visor or goggle without touching the inner part
79		6	Sanitize the inner gloves
80		7	Remove protective gown without touching inner part starting with shoulder and fold it so that the outer part is to the inside
81		8	Sanitize the inner gloves
82		9	Remove the hoody without touching the inner side close your eyes , don't touch your head
83		10	Sanitize the inner gloves
84		11	Remove the inner gloves
85		12	Sanitize your hands
86		13	Leave duffing area, remove the N95 without touching the outer surface, through in the designated area
87		14	Hand wash with water and soap
88		15	Change the operating room attire
89		16	Some advice taking a shower