Recommendations: Operating room setting
Preprocedural recommendations
- Perform adequate patient screening for potential COVID-19 infection. (Screening should be independent of symptoms and not be limited to those with clinical symptoms.)
- Limit the number of health care team members in the operating procedure room.
- To minimize unnecessary staff exposure, have surgeons and staff not needed for intubation remain outside the OR until intubation is completed and leave the OR before extubation.
Intraprocedure recommendations
- Limit personnel in the OR to a minimum.
- Staff should not enter or leave the room during the procedure.
- When possible, use conscious sedation or regional anesthesia to avoid the risk of viral dissemination at the time of intubation/extubation.
- Choose the device that will allow an effective and fast procedure.
- Favor non–smoke-generating devices, such as hysteroscopic scissors, graspers, and tissue retrieval systems.
- Connect active suction to the outflow, especially when using smoke-generating instruments, to facilitate the extraction of surgical smoke.
Postprocedure recommendations
- When more than one case is scheduled to be performed in the same room, allow enough time in between cases to grant a thorough OR decontamination.
- Expedite postprocedure recovery and patient discharge.
- After completion of the procedure, staff should remove scrubs and change into clean clothing.
- Use standard endoscope disinfection procedures, as they are effective and should not be modified.
Conclusions
The COVID-19 pandemic has caused a global health emergency. Our knowledge of this devastating virus is constantly evolving as we continue to fight this overwhelming disease. Theoretical risk of “viral” dissemination is considered extremely low, or negligible, during hysterosocopy. Hysteroscopic procedures in COVID-19–positive patients with life-threatening conditions or in patients in whom delaying the procedure could worsen outcomes should be performed taking appropriate measures. Patients who test negative for COVID-19 (confirmed by PCR) and require hysteroscopic procedures, should be treated using universal precautions. ●