Practice Policy Update Regarding COVID-19
COVID-19 TESTING
I am very pleased to inform you that we have been able to secure antibody testing for our patients in order to allow for elective procedures in compliance with AZ Dept of Health and Governor Ducey’s Executive order. We hope everyone understands the test is mandatory per the order.
Antibody tests are extremely scarce and range in cost from $ 75-400. Still, the mass majority are not FDA approved as of yet so we are using local experience by medical practices handling COVID-19 to ascertain the quality of the test we have chosen for our patients.
The test examines two Antibodies.
IgM-indicates a recent infection within 30 days.
IgG indicates conversion from a distant infection meaning you potentially have immunity.
Test Results:
If you test positive for IgM then your surgery will be delayed at least 30 days until clear by a retest.
Although the practice would like to provide these tests at no charge, due to the elective nature of our procedures we will not receive any from the Health Department or any government agency. I encourage all of our patients who are able to seek their own testing either at free community locations or through their practitioner if covered by insurance. Otherwise, we can provide an antibody test to all preop patients at our own cost of purchase ($75). Some may require a second test depending on the initial result. Once again it is a mandate per the health dept to obtain testing prior to any elective procedure at any and all surgical facilities in Arizona.
I and the entire staff at Preferred Plastic Surgery will continue to be devoted to your safety as our utmost priority.
Please review our practice protocol below for our reopening. I believe it is beyond comprehensive and likely to set the new standard of patient flow and care during these challenging times. It will reassure any and all of your concerns regarding your safety and reduction of all unnecessary exposure during your time in our facility.
SURGERY CENTER PROTOCOL
Scottsdale outpatient surgery
Peri-Operative Standardization and Maintenance for COVID-19 Safety Policy and Procedural Protocols.
FACILITY
The facility is a single Operative suite with one pre-operative bay and 2 PACU bays.
- the facility will be used 2 days a week
- only one procedure is performed at a time and there will be strict limitation of traffic to anyone except the patient and staff directly in contact and actively managing that patient
- no known or Covid-19 positively tested patients will be treated at the facility
- staff at the facility will be COVID -19 antibody tested on a routine basis as well as closely monitored for any signs of symptoms through a COVID-19 specific questionnaire
- daily temperature checks will be performed on all staff and patients prior to entry into the facility
- PPE supplies are available and a greater than 14 day supply will be in stock at all times
- the required inventory list is in place for all PPE and is maintained daily for reorders and necessary fulfillment
- this supply will not be reliant upon county or state supplies
- all staff will wear PPE at all times while in the facility
- PPE is changed between treating different patients
SCREENING PROTOCOLS
- Covid-19 Questionnaire involving all the following are asked of all patients staff and others prior to all visits whether preop, operative or post-op.
- Symptoms of fever, cough, fatigue, shortness of breath or tightens when breathing, gastrointestinal upset or diarrhea, loss of sense of taste or smell.
- Exposure to other household members or coworkers who are sick or report any of the above symptoms
- the questionnaire also applied to staff
PRIORITIZATION OF SURGERY
- surgeries are performed in the order of priority as in regard to pain discomfort, interference with routine lifestyle, or where delay leads to the need of potentially more complicated procedures
PRE-OPERATIVE PROTOCOLS
- In addition to necessary and appropriate pre-op medical clearance additional COVID-19 identification and prevention requirements are introduced to every patient prior to being accepted for surgery.
- Questionnaire involving all the following are performed at each and all visits whether preop, operative, or post-op.
- Symptoms of fever, cough, fatigue, shortness of breath or tightens when breathing, gastrointestinal upset or diarrhea, loss of sense of taste or smell.
- Exposure to other household members or coworkers who are sick or report any of the above symptoms
- Strict limitation in social contacts and distancing 21 days prior to the procedure.
- This limits the patient to contact only with family members of the same household. No travel within 4 weeks, and if working it must be either from home or in a strictly controlled setting which provides more than adequate distancing practices
- An on-site in office Covid antibody screening test is performed 10 days prior to the procedure (IgG, IgM), the result is obtained on-site within 15 minutes
- Repeat testing is performed the day of surgery in pre-op
- Patient is further instructed on strict social distancing in the time leading up to surgery including avoiding all public spaces except for work and home
- Subsequent careful monitoring of the patient for any newly developing symptoms of possible Covid-19 from that preop visit leading up to the day of surgery.
OPERATIVE DAY PROTOCOLS
Equipment is standard as for routine surgeries performed following universal precautions with additional safety measures
PPE (Personal Protective Equipment) :
- Sterile masks (N95)
- surgical masks
- Eye protection
- Cavicide solution
- Sanitization wipes/ sprays
- Gloves at all stations
Protocols for surgery receiving (preop through discharge)
- arrival times are staggered for one patient only.
- 2-4 total patients maximum per day at the facility with no overlap of any patients at any stage of pre-op, OR, or in Pacu
- patient calls center upon arrival to the parking lot
- Patient is greeted outside and a temperature gun is used to brain a reading prior to entry into the facility.
- If the temperature is normal the patient is escorted alone into receiving and the family returns only for pickup after the patient is recovered
- No family in the waiting room or lobby
- Patient is directed into the preop bathroom for a urine sample and then preop bay for changing into a gown and being prepared for surgery
- Nursing applies a finger prick Covid-19 antibody test ( this is a repeat of the preop test administered 10 days earlier.
- The Patient is given a mask to wear while interacting with staff in preop/receiving.
- All staff members are wearing gloves and mask/protective eyewear
- Intravenous catheter placement is performed by nursing
- Anesthesia and surgeon separately interview the patient
- Patient taken into OR suite and their face mask is removed for airway management and administration of anesthesia.
- Upon completion of surgery patient is moved to the post-anesthesia care unit
- One assigned PACU nurse strictly dedicated for one-on-one care will recover patient in protective gear until discharge
- Patient is discharged when appropriately stable
- Nurse reviews instructions with one single family member who must be in a mask at 6/8 foot distance in the discharge area
- Typically at the exterior canopy
- Nurse replaces all PPE prior to receiving the next recovery patient
Facility sanitization and maintenance:
Each bay is mopped, bedding sheets changed and all surfaces sanitized before use by each individual patient. (Pre-op, OR, Pacu)
Cleaning of the facility including receiving and discharge areas daily as well as between patients when used.
POST-OPERATIVE CARE (follow-up)
- each post-operative visit is done on a one on one basis.
- no lobby or waiting room visitation is allowed
- NO-STANDING, NO-WAITING protocol is followed at all times in the office as patients are only directed to and from the outside between their vehicle and a single prepared examination room.
- patients call into office upon arrival to the parking lot
- patient and any accompanying family member must wear a face mask into the facility on all visits
- the patient alone is escorted directly into an examination room by a staff member wearing a face mask and at an appropriate distance of 6 feet or greater (exceptions are allowed if the patient needs assistance to walk in or out of office by a family member who will also be required to wear a mask
- physician examination is performed with mask and gloves protective wear
- if the patient is seen alone instructions and clarifications are made by the physician to family members via phone as appropriate
- each examination room is completely sanitized prior to re-use
- follow up appointments are made by phone once the patient leaves the premises.
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