Learning and Leading: The Impact of COVID-19 in Perioperative Areas.

Abstract

On March 11, 2020, the World Health Organization declared that SARS-CoV-2 had reached pandemic proportions.1 Disruptions to the health care sector and associated supply chains already had been occurring, and massive changes would unfold during the coming months. No clinical area has been spared the effects of the pandemic, and perioperative services is no exception. Because of the novelty of this particular coronavirus,2 all human beings are vulnerable to contracting the disease state associated with SARS-CoV-2 infection (hereafter called coronavirus disease 2019 [COVID-19]). It has been more than a century since our last pandemic, and many of the lessons learned during the 1918 H1N1 influenza pandemic have been lost, forgotten, or do not readily translate to the 21st century. Globally, we are confronting this advancing crisis together, while creating and adapting policies, protocols, and workflows locally. True to our collective spirit, we are leading, learning, and supporting one another together as one perioperative community. The power of this communal perioperative group is even more obvious now: our community is global, interconnected, interwoven, and activated, and is committed to sharing best practices and lessons learned to advance perioperative care. Because the science is still evolving, there is much we do not know. However, as clinicians, we cannot wait for definitive answers; patients and their families need our care and expertise now. Although the Centers for Disease Control and Prevention, the World Health Organization, and countless other agencies have issued varying levels of guidance, AORN has rapidly disseminated targeted perioperative information in the form of joint statements with other professional organizations3 and a digital tool kit available on the AORN web site.4 Early published peer-reviewed reports have described operational changes in perianesthesia and perioperative areas that have been implemented in the face of this new infectious threat.5, 6 Additionally, articles are now widely available that show innovative ways to safely adapt anesthesia machines into ventilators and methods to transform blue surgical wrap into much needed surgical masks.7, 8 Because of the transmissibility and virulence of the SARS-CoV-2 virus, many reports have focused on personal protective equipment and safety measures related to aerosolizing procedures and surgical smoke.9-11 The articles and research papers referenced in this editorial were carefully selected to represent larger bodies of inquiry and advancements, but the situation on the ground is far from settled. The virus mutates; our therapies improve; the science continues to inform; and clinicians nimbly adapt to the ever-changing practices, surgical populations, and safety protocols. Early groundbreaking research has demonstrated that surgical patients with COVID-19 are at higher risk for postoperative mortality.12 As such, we must continue to learn, improve, and innovate. The articles selected for this special issue of the AORN Journal are the start, not the end, of describing improved care for perioperative patients with COVID-19 and their families, environmental safeguards for our workplaces, and enhanced training and professional development to ensure that all clinicians are competent to safely deliver care during this extraordinary time. This issue is dedicated to our brave patients and their families and to the perioperative nursing heroes who deliver excellent, evidence-based perioperative care daily and, often, against all odds. Daphne Stannard, PhD, RN, CNS, NPD-BC, FCCM, is the associate editor for Quality Improvement for the AORN Journal and for the QI Showcase: Lessons for Change and an associate professor at San Francisco State University, CA. Dr Stannard has no declared affiliation that could be perceived as posing a potential conflict of interest in the publication of this article.