Reopening Your ASC with COVID-19 in Mind

Written by: Crissy Benze, MSN, BSN, RN

In the past few months, the following words have found their way into the mainstream lexicon: coronavirus, COVID-19, pandemic, virus, face mask, social distancing, and at-risk population. COVID-19 dominates the conversation, as it has impacted every single person in some way. Its impact to ambulatory surgery centers (ASCs) has been equally dramatic, with facilities still not back to “business as usual.”

Where we are now

Following a multitude of state executive orders passed in mid-March calling for the restriction or cessation of elective surgery, late April saw some governors beginning to allow elective surgery to resume. Current reopening directives vary by state; therefore, it is imperative ASCs check with their state to determine their specific directives. All states point to guidance from the Centers for Disease Control and Prevention (CDC). One common and critical prerequisite for reopening is an adequate supply of personal protective equipment (PPE). The following are additional standards and protocols that ASCs must implement to safely restart elective surgery:

  • Patient screenings. All patients must be screened prior to their day of surgery via phone. COVID-specific screening questions must be integrated into the standard preop screening regimen. Some states also require COVID-19 testing prior to admission. Upon arrival to the ASC, patients must have their temperature checked, answer COVID screening questions again, and wash their hands.
  • Employee and medical staff screening. All employees and medical staff are expected to self-monitor. Symptomatic staff members must self-isolate. Some states also require COVID-19 testing of staff. Temperature screening is standard for all persons entering the ASC, including staff.
  • Universal masking. All staff members — even those not directly involved in patient care — must wear a face mask at all times while in the facility. Extended wear of masks is allowed, as long as the face mask is intact, not moist, and unsoiled. All patients and visitors must also wear a face mask or face covering at all times while in the facility (except during surgery possibly). If the facility is unable to provide patients masks, patients will be instructed to bring one from home.
  • Social distancing. Facility waiting rooms must be reconfigured to allow for social distancing. Responsible adults who accompany patients are asked to wait in their cars or leave and return upon the patient’s discharge, if possible. Staff breaks and lunches must be staggered to maintain social distancing.
  • Intubation/extubation for COVID-19. Facilities must work with their heating, ventilation, and air conditioning (HVAC) vendor to determine how many minutes should be allowed after intubation and extubation of a patient for air exchange contaminant removal. This standard must be integrated into the operating room (OR) turnover protocol.
  • Respiratory protection program. Facilities whose scope of care includes aerosol generating procedures (AGP) must implement a respiratory protection program for N95 respirators. Staff members need an initial fit test documented prior to wearing the N95 respirator.
A Look Back

Most of us first heard about this novel coronavirus affecting people in China back in January, though epidemiologists had wind of it as early as November 2019. The World Health Organization (WHO) declared a global health emergency on Jan. 30, 2020. Since then, the virus and its worldwide impact has been fast and furious. The first coronavirus death in the United States was reported at the end of February, and President Donald Trump declared a national emergency on March 13. “Stay-at-home” or “shelter-in-place” orders along with directives for businesses to close or significantly curtail operations quickly followed throughout the U.S.

Given that most ASCs are small businesses, the reality of having to shut their doors without a known reopening date was devastating to owners, their staff, and some patients. ASCs that remained open, moved to a severely reduced schedule limited to urgent or emergent procedures. For all facilities, it has been a challenging few months, especially given the onslaught of ever-changing information and guidance.

The Biggest Challenges

Most ASCs are back in business performing elective surgeries, though not without obstacles. Those challenges include:

  • Pre-admission COVID-19 testing in terms of test availability, cost management, and logistics.
  • Staffing due to ASCs not operating at full capacity. Until a facility is close to pre-COVID volume, some full-time positions are not justified.
  • The PPE supply chain, especially N95 respirators. This problem, which is the biggest one for most ASCs, has been exacerbated by a flood of counterfeit products and price gouging. Unfortunately, evidence suggests this supply chain issue will not be solved quickly.

Getting Back to it

ASCs across the country are grateful to get back to business and have been tackling these reopening challenges with the vigor and dynamism we have long associated with our industry. Yet, this time is not without frustration. It is more important than ever to work together by networking with industry colleagues to find creative solutions to implement in our “new normal.”

HELPFUL RESOURCES: To help ASCs navigate their reopening and operations efforts, Progressive Surgical Solutions recently created COVID-19 toolkits. Learn more about these kits on Progressive’s COVID-19 Information Hub.