What Nurse Anesthetists Need to Know About COVID-19.

The American Association of Nurse Anesthetists issues guidelines to prevent infection and provide safe patient care.

To prevent its spread and achieve the best patient outcomes, nurses need to be informed about how to best care for patients with suspected or confirmed Coronavirus Disease 2019 (COVID-19).

The American Association of Nurse Anesthetists has gathered resources to help certified registered nurse anesthetists develop strategic steps to care for these patients.  

“CRNAs are on the frontlines of patient care. To guide them as they deliver safe and effective anesthesia care while keeping themselves healthy, the AANA has provided a series of considerations specific to the perioperative setting and summarized recommendations from top national and international healthcare organizations,” Brett Morgan, DNP, CRNA, AANA senior director of education and practice says in a news release.

“As highly trained advanced practice registered nurses, CRNAs provide anesthesia care to all patients and are called upon to help manage patients experiencing respiratory distress and failure. This often involves invasive airway management, which places CRNAs at high risk for disease exposure,” Morgan says. “COVID-19 can spread from person-to-person through respiratory droplets, therefore it is imperative for CRNAs and all healthcare providers to be prepared with the most current infection control precautions and considerations to remain safe.”

Recommendations include:

• Enforce frequent, meticulous hand hygiene. Hand hygiene is essential to preventing infection and must take place before and after donning or doffing PPE.
   
• Personal Protective Equipment must be available for all providers. N95 masks should be worn for all known or suspected cases of COVID-19 and any asymptomatic open airway cases. A powered air-purifying respirator (PAPR) may also be called for.
   

• Wear disposable OR caps and beard covers. Disposable fluid-resistant long-sleeved gowns, goggles, and disposable full-face shields are recommended for frontline providers.
   
• Prior to intubation don appropriate gloves, facemask/PAPR, eye shield, and gown. Plan to limit the distance traveled with contaminated equipment. Double glove and use the outer glove to sheath the laryngoscope blade after intubating.
   
• Select the most experienced anesthesia professional to intubate the patient. Limit the number of staff members during airway manipulation to reduce the risk of unnecessary exposure.
   
• Allocate ORs specifically for patients with confirmed or suspected COVID-19.  In addition, these patients should not be brought to preoperative holding or recovery areas.
   

• Take steps to minimize aerosolization of the virus. Preoxygenate the patient for five minutes with 100% FiO2 and perform rapid sequence induction to avoid manual ventilation of the patient’s lungs. Use a video-laryngoscope to improve intubation success and avoid awake fiberoptic intubations, when possible. Atomized local anesthetic will aerosolize the virus.
   
• Use a high-efficiency hydrophobic filter. Place a high-efficiency hydrophobic filter between the facemask and breathing circuit or between the facemask and reservoir bag to avoid contaminating the atmosphere.
   
• Follow strict environmental cleaning and disinfection procedures. Dispose of all used airway equipment in a double-zip-locked plastic bag for proper decontamination and disinfection.

 “We will continue to monitor the situation, particularly as CRNAs may be called upon to care for patients infected with the disease,” Morgan says. “Excellence in care, safety, and continuous improvement of care are hallmarks of the CRNA profession.”