FAQs for clinicians on elective surgery

This was a National Cabinet decision, based on the advice of the Australian Health Protection Principal Committee (AHPPC) and its Infection Control Expert Group (ICEG). AHPPC and ICEG advised that, given the low prevalence of COVID-19 in Australia, it is now possible to ease restrictions on elective surgery without increasing the risk of COVID-19 transmission. This cautious approach aims to maintain the capacity of the hospital system, while mitigating the harm and risk of deferral of surgery, investigations and procedures.

The advice for personal protective equipment (PPE) use for elective surgery, investigations and procedures is consistent with the Australian Guidelines for the Prevention and Control of Infection in Healthcare and specific ICEG guidance. For clinical care of, or procedures on, patients who are NOT suspected of having COVID-19, standard and transmission-based precautions should be implemented. Additional COVID-19 specific precautions are not required.

Commission resources: Infection Prevention and Control COVID-19 Personal Protective Equipment and Special precautions for COVID-19 Designated Zones.

Health services should develop an organisational-wide Risk Management Strategy to identify, manage and reduce the risk related to the transmission of COVID-19. In particular, this strategy should address the requirements of Action 1.10 of the National Safety and Quality Health Services (NSQHS) Clinical Governance Standard and Actions 3.1, 3.5, 3.6, 3.11 and 3.12 of the Preventing and Controlling Healthcare-Associated Infection Standard.

Assessors may review the organisation-wide Risk Management Strategy as evidence, when assessing a health service organisation.

In accordance with the AHPPC Statement on the restoration of elective surgery, the principles for allocation of lists for surgery, investigations and procedures are:

• Equitable access for all patients determined by clinical decision making and safety; this means, prioritisation on the basis of clinical urgency and risk to the health of the patient in the event of further delays
• Preservation and appropriate use of PPE
• Compliance with state, territory and national monitoring requirements in relation to volume of procedures, PPE availability and new COVID-19 cases.

In general, the current prevalence of COVID-19 in the Australian context does not require all asymptomatic individuals to be classified as suspected COVID-19 cases or to be quarantined prior to elective surgery, investigations of procedures. Patients should be screened for clinical and epidemiological risk of COVID-19 based on the current Australian definition of a probable or suspect case.

The definition incorporates travel history, contact with known or suspected cases of COVID-19, and signs and symptoms associated with COVID-19, including fever.

Depending on local rates of community transmission, individual states and territories may recommend testing to manage risks for patients, healthcare workers and health service organisations. The mortality and morbidity rates for patients who have COVID-19 undergoing both elective and emergency surgery are higher than otherwise expected, even when such surgery is relatively minor. Therefore, it is usually safer to postpone elective surgery for someone who is symptomatic or who tests positive for COVID-19. Emergency surgery should not be delayed either because a patient is a COVID-19 case or while waiting for a test result where there is additional risk to the patient's clinical condition.

The low prevalence of COVID-19 in Australia means it is not appropriate or necessary to test all patients for COVID-19 prior to elective surgery, investigations or procedures.

Instead, screening for clinical and epidemiological risk of COVID-19, based on the current Australian definition of a probable or suspect case, is recommended as part of assessment of the patient prior to determining that they are eligible to be considered for elective surgery, investigations or procedures. This screening supports appropriate PPE use and assessment of risks to health system capacity associated with the planned surgery, investigation or procedure.

Depending on local rates of community transmission, individual states and territories may recommend testing to manage risks for patients, healthcare workers and health service organisations. The mortality and morbidity rates for patients who have COVID-19 undergoing both elective and emergency surgery are higher than otherwise expected, even when such surgery is relatively minor. Therefore, it is usually safer to postpone elective surgery for someone who is symptomatic or who tests positive for COVID-19. Emergency surgery should not be delayed either because a patient is a COVID-19 case or while waiting for a test result where there is additional risk to the patient's clinical condition.

Patients who, on screening, require further investigation of COVID-19 risk should be referred for COVID-19 testing and further assessment, as appropriate. These patients should only be considered for emergency surgery, investigations or procedures.

The care of patients who are not suspected of, or who do not have, confirmed COVID-19, in operating suites and procedure rooms should be consistent with Australian Guidelines for the Prevention and Control of Infection in Healthcare 2019.

This means routine operating suite attire: surgical mask, theatre cap, eye protection, gown, and gloves, including for aerosol-generating procedures (AGPs).

No. There are specific recommendations for the use of PPE during hospital care of people with COVID-19, which are not applicable to patients who are negative for COVID-19. These specific recommendations are included in the Commission’s resources: Infection Prevention and Control COVID-19 Personal Protective Equipment and Special precautions for COVID-19 Designated Zones and the specific ICEG guidance.

In addition to standard precautions, contact and droplet precautions should be used for the routine care of COVID-19 patients in quarantine/isolation, or those under investigation for COVID-19 or with confirmed COVID-19. Contact and airborne precautions should be used when performing AGPs on these patients.

Earlier advice to use airborne precautions for the care of patients with severe coughing has been withdrawn because viral load does not necessarily correlate with the clinical condition; coughing generates droplets, predominantly, and surgical masks used by the patient, if possible, and healthcare worker provide adequate protection.

Yes. Health services should ensure that they meet physical distancing requirements at all times during planning, preparation and post treatment. This applies to all staff, patients and relatives.

In situations where physical distancing is not possible, such as during physical examinations and providing care, staff and/or patients may use a surgical mask to reduce the risk of spread of COVID-19.

The requirements for informed consent apply at all times. These include discussion with the patient about the:

• Rationale for the procedure
• Risks and benefits to them of having the surgery, investigation or procedure at this time
• Actions that will be taken to reduce their risks
• Likely outcomes for them should they not proceed with the surgery, investigation or procedure at the recommended time
• Alternatives to the proposed surgery, investigation or procedure.

Specific recommendations are included in the Commission’s resources: Infection Prevention and Control COVID-19 Personal Protective Equipment and Special precautions for COVID-19 Designated Zones and the specific ICEG guidance.