Reducing contact
We performed surgical procedures in two different surgical units, on two different floors. Patients with negative swab, normal chest radiograph, and absence of fever, cough, or history of contact were treated in a clean surgical unit, according to usual pre-operative, intra-operative, and post-operative procedures. COVID-19, suspected COVID-19, and patients without swab results, who needed rapid access to the OR, were operated on in a specific surgical unit. The unit was divided into three areas. The operating theatre was defined as contaminated area, or “red zone,” in the presence of an infected patient. The corridor between the ward and the OR, including recovery area, was considered partially contaminated area, or “gray zone.” The space including locker rooms, storage areas, relax zone, computer, and surgical report facilities was uncontaminated, or “white zone.” The patient, coming from the ward, wearing a surgical mask, was brought directly into the operatory room, passing through a gray zone, without any stop in recovery areas. All anaesthesiologic, surgical, and radiological procedures on the patient were performed inside the OR. At the end of the procedures, the patient left the theatre, and through the “gray zone” was brought directly to the ward (Fig. 3).
Fig. 3 Surgical unit divided into red zone (red mesh), gray zone (gray mesh), and white zone. Pathways for healthcare professionals (blue) and patients (red)
Healthcare operators and professionals dressed differently according to the area they were operating in. In the white zone, allowed dressing consisted in clean scrubs, cuff, surgical mask, and clean clogs. Before accessing the red zone, it was mandatory to wear the “COVID-19 kit” (Table 2).
Table 2 Personal protection equipment in every “COVID-19 kit”
COVID-19 kit
1. Two head caps
2. FFP2 facial mask (FFP3 for aerosol generating procedures such as orotracheal intubation)
3. Protective goggles or visor
4. Two pairs of gloves
5. Surgical gown
6. Two pairs of long shoe covers
In order to leave the red zone, all healthcare professionals stepped over a puff embedded with chloro-derivate solution. Undressing procedure consisted in removing one pair of gloves, head cap, goggles/visor, gown, radiological protections, one pair of long shoe covers, and the remaining pair of gloves. Friction with hydro-alcoholic solution after every step and quick exit from the gray zone were recommended; before entering the white zone, the remaining pair of long shoe covers had to be removed and, after washing hands, a new surgical mask was worn.