Because more time is needed to prepare for surgery in a suspected/confirmed case of COVID-19, daily routines were set up regardless of whether surgery would happen. These included routine checks and cleaning of anesthetic machines and powered air-purifying respirator (PAPR) sets. Designated areas were prepared for donning and doffing of PPE. Steps were numbered in sequence and posters were put up to guide staff (Fig. 1).
Fig. 1 Personal protective equipment donning and doffing areas. Steps are colour-coded (A: blue for clean and red for contaminated) and marked in numerical sequence at designated areas just outside the OR, with posters to guide staff on the process. Step 1: Put on N95. Step 2: Donning PAPR (B). Step 3: Enter OR through scrub room. Step 4: Clean external surface of the PAPR face shield (C), remove surgical gown and outer gloves. Step 5: Doffing PAPR (D). OR = operating room; PAPR = powered air-purifying respirator