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COVID-19 Resurgence: 3 Challenges and the Resources to Respond

Publish Date: November 11, 2020

The consistent spike in COVID-19 cases across the country and the world has forced many periop teams back to peak pandemic measures.

No matter what the resurgence is bringing to your periop setting, you are likely feeling the fatigue, burnout, frustration, and even depression and anxiety that come with the uncertainties of this pandemic.

Luckily, we have started to learn so much about best practices to respond to this latest resurgence, according to AORN Perioperative Practice Specialist Karen deKay, MSN RN CNOR CIC, and AORN ASC Education Specialist Terri Link, BSN, CNOR, CIC, CAIP, FAPIC.

“Perioperative personnel are more familiar with care of COVID-19 patient in OR, including transport, intubation and extubation, environmental cleaning, and donning and doffing PPE. Additionally, protocols for screening and testing of surgical patients for COVID-19 have been established over the last few months,” deKay says.


“ASCs have expanded their role in emergency preparedness and what they learned from the first wave will be part of their plan for a resurgence,” Link adds. She says these lessons learned will make an important difference in managing safe care for patients and team members, whether dealing with staffing, supplies, PPE, environmental cleaning, social distancing and traffic patterns, or telehealth and virtual waiting rooms.

DeKay and Link break down the top three challenges periop nurses are facing, and they share the resources nurses in inpatient and outpatient settings can tap to face this resurgence head on.

Challenge: Decrease in surgical volume with staff diverted to COVID-19 patient care.

Personnel are being asked to help in other areas or are having to decrease their hours. There’s a need for quick education to refresh knowledge for managing ventilators and interpreting EKGs. OR suites may also be used again to house COVID-19 patients.

Resources to help: These COVID-19 FAQs, available to AORN members only, cover over 70 questions and answers regarding PPE, surgical precautions, transmission-based Precautions, environmental cleaning, and leadership issues for inpatient and outpatient surgical care. 

Research and guidance in this COVID-19 Toolkit shares info on nursing skills, supply shortages, infection prevention and even self-care strategies.

Challenge: Increase in COVID-19-positive surgical patients.
PPE questions such as reprocessing N-95s and using PAPRs are important to answer, deKay suggests. She says staff also need to make sure they are competent in donning and doffing PPE. COVID-19 precautions during intubation and extubation are important to review. “Environmental cleaning should also be a dedicated focus area with attention to an adequate supply of EPA-registered hospital-grade disinfectants that may be different from what is used for standard daily cleaning.”

A change in staffing during the first wave may have resulted in layoffs or resignations so education is critical to ensure all staff are current with competencies and AORN guidelines, deKay cautions. And don’t forget to wear masks and practice social distancing in staff lounge areas and locker rooms, she adds.

Resources to help: This comprehensive playbook on Perioperative Care of the COVID-19 Patient provides evidence-based information, critical workflows, and recommendations to safely treat suspected or positive COVID-19 patients. Topics address all phases of perioperative care and also cover self-care tips for staff to reduce fatigue and burnout. A COVID-19-specific surgical safety checklist can help teams make sure critical safety practices are not being missed. Members save $10 on a 6-month subscription.

Challenge: Elective in-patient surgeries moving to outpatient surgery.
Procedures could move to ASCs from the hospitals because ASCs generally do not have overnight stays and require beds that are needed for COVID-19 patient care, Link explains. “During the first wave of the pandemic, many total joint procedures were transferred to ASCs in the first wave and surgeons have discovered that doing these procedures in an ASC has worked well. By moving procedures to an ASC, a hospital could avoid a complete shutdown of elective procedures during a coronavirus resurgence.”

Resources to help: This upcoming virtual education meeting sponsored by 3M and KCI on Nov. 20 and Dec. 4 covering COVID-19 Precautions: Protecting the Perioperative Team and Patients will cover a deep dive into key clinical topics with discussions with exercises led by AORN periop experts. Topics will include navigating droplet versus airborne transmission and precautions, proper PPE selection, and key differences between negative- and positive-pressure rooms as they relate to surgical site infection prevention. Leader Members get free registration!

Still have COVID-19 questions? Explore AORN’s COVID-19 town hall replays that have addressed a wide range of pandemic-related questions or ask a question in the ORNurseLink COVID-19 discussion forum (members only).

FREE Resources for Members

Additional COVID-19 Guidelines Support

Several of AORN’s Guidelines for Perioperative Practice address specific challenges you may be facing with the COVID-19 resurgence, including:

  • Guideline for Design and Maintenance of Surgical Suite
  • Guideline for Environmental Cleaning
  • Guideline for Transmission-based Precautions

Access the eGuidelines Plus or members-only Guideline Essentials and Tool Kits to review these recommended evidence-based practices and implementation resources. Plus, only members get free access to COVID-19 AORN Journal articles.

AORN Journal

Learn more on Honoring and Celebrating Our Differences in The Periop Life blog.