The door to the operating room should be kept closed throughout the procedure.

Minimize staff in the room and all staff involved should wear N95 or HEPA respirators.

Only medically necessary procedures should be scheduled “after hours.”.

2 This includes the following, if feasible: No, the American Society for Healthcare Engineering (ASHE) recommends the same strategy for COVID patients in the operating room as they do for other airborne diseases such as TB. Should the operating room (OR) ventilation be converted to negative pressure to protect the staff from COVID-19 exposure when caring for known or suspected COVID-19 positive patient? These basic requirements are the standard for all patients receiving care in the operating room. 1 In addition, air flow should be designed to create positive pressure in the operating room relative to areas outside the OR to prevent the entry of common pathogens (e.g., Staphylococcus aureus) that could contaminate an open wound. The American Institute of Architects (AIA) recommends 15 air exchanges per hour combined with a minimum of 3 air exchanges of outside (fresh) air for operating rooms. What are the current recommendations for ventilation in the operating room? What is the best strategy for OR ventilation when a COVID-19 patient, or a person under investigation (PUI), requires a procedure in the operating room? The existing approach of positive pressure ventilation is best to protect the patient coming to the OR, but how can the risk to staff and other patients from any aerosol generating procedures be minimized? The following is intended to provide the information needed to make an informed decision about the approach to OR ventilation best suited to the local conditions. While not a standard, negative pressure has been advocated for hospital rooms where a patient is known or suspected to be infected with an airborne pathogen. Negative pressure, where the pressure in the room is less than the adjacent areas, can be used to prevent airborne pathogens from leaving the room.

For all patients undergoing a surgical procedure, positive pressure is an accepted infection prevention strategy. This approach is employed to prevent circulation of pathogens that could contaminate an open wound from entering the OR. Positive pressure, where the pressure in the operating room is greater than the adjacent areas, is the typical approach to OR ventilation. American College of Emergency Physicians, Dec 22, 2015. Lessons learned from Hurricane Sandy and recommendations for improved healthcare and public health response and recovery for future catastrophic events.Overview of NFPA codes and standards that apply to emergency power systems in healthcare facilities.Jeffrey Feldman, MD, MSE is professor of Clinical Anesthesiology, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, and Chair of the APSF Committee on Technology.

Charles Cowles, ASA liaison to the National Fire Protection Association (NFPA), details the important considerations for developing a local approach to caring for these patients. While APSF does not have definitive recommendations as you have requested, the following response from Dr. Clinical Professor Director of Airway Management Co-Chair Performance Improvement Committee Department of Anesthesiology Cedars Sinai Medical Center

Has APSF developed definitive recommendations regarding negative pressure operating rooms for patients who are known or suspected to have SARS-COV-2 infection? If not, when will it happen? The present version is updated and modified by the author for the present APSF Newsletter. This article was previously published on the APSF online portal.

Building a negative pressure room