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Elective surg​ery COVID-19 response

On the 8 July 2020 NSW closed its borders to Victorian residents. Currently anyone who has been or returned from Victoria is required to self-isolate for 14 days. If a person has been to Victoria in the past 14 days, elective surgery should be postponed. Since 10 July in NSW there have been several cases identified in areas of Sydney. People identified as being a close contact by location (see specific NSW isolation advice​) are also asked to get tested and self-isolate. If a person has visited one of these locations in the past 14 days, elective surgery should be postponed.

On 21 April 2020, the Australian Health Protection Principal Committee (AHPPC) recommended elective surgery could incrementally recommence from Monday 27 April, without increasing the risks of the COVID-19 pandemic whilst ensuring the capacity of the hospital system is maintained to respond when needed. 

On 25 March 2020, NSW public hospitals suspended all non-urgent elective surgery to ensure adequate hospital capacity to respond to COVID-19. 

Current situation (as at 26 July 2020)

On 15 May 2020, National Cabinet advised that it is now considered safe to reopen elective surgery activity in an incremental way, involving 3 stages. 
  • Stage 1 – up to 50 per cent of normal surgical activity levels
  • Stage 2 – up to 75 per cent of normal surgical activity levels
  • Stage 3 – up to 100 per cent of normal surgical activity levels or as close to normal activity levels as is safely possible.
Private Hospitals in NSW should mirror the state’s approach to surgical activity.

Screenin​g patients prior to surgery

Management of patients prior to surgery should be according to current public health guidance for testing and home isolation:

  • All patients should be asked if they have ever been diagnosed with COVID-19 infection
    • Time since diagnosis and recovery should be confirmed to support the decision around whether clearance testing is required
  • Anyone with respiratory symptoms or unexplained fever or loss of smell or loss of taste should be tested for COVID-19
    • Public health and clinical judgement should be used in testing patients who do not have the typical respiratory symptoms or fever or loss of smell or loss of taste for COVID-19 prior to elective surgery
    • See COVID-19 testing advice
  • Close contacts of confirmed cases and exempted travellers should follow the relevant NSW Health self isolation guidelines
    • Health services should follow release from isolation guidelines for patients confirmed to have COVID-19 who are required to enter a healthcare setting.
  • Anyone, who in the last 14 days have been in Victoria or is a close contact of a NSW cases (see specific NSW advice must comply with the relevant NSW Health self isolation guidelines
    • Health services should follow release from isolation guidelines for patients confirmed to have COVID-19 who are required to enter a healthcare setting. If the person has been in Victoria or is a close contact of a NSW case, the elective surgery should be deferred until 14 days after the person was last in Victoria, and the person should be instructed to self-isolate for that time and to monitor themselves carefully for symptoms.
    • If the procedure is urgent, patients should be managed in a single room with contact and droplet precautions.

For elective surgery that has recommenced, staff are required to screen patients at the time of booking confirmation as part of routine risk assessment. Ask the patient if they have:

Question Action if confirmed
Ever been diagnosed with COVID-1​​9 disease?
  1. Ask date of diagnosis and time since recovery
  2. Organise COVID-19 clearance testing as part of pre-​surgery work-up in accordance with:
    • national guidelines on clearance of recovered cases entering high risk settings
    • advice from Clinical Excellence Commission
Any symptoms suggestive of COVID-19: fever (≥37.5°C) or history of fever (e.g. night sweats, chills) or acute respiratory infection (e.g. cough, shortness of breath, sore throat) or a combination of other non-specific symptoms (headache, tiredness, muscle pain, runny nose, loss of sense of taste or smell, diarrhoea, nausea/vomiting or loss of appetite)?

Clinical and public health judgement should be used when considering testing individuals with the other non-specific symptoms for COVID-19 and may depend on other risk factors for infection (CDNA National guidelines for public health units).

If the patient has no symptoms, remind them if they develop new respiratory symptoms or fever to call healthdirect on 1800 022 222 or their GP for advice
  1. Ask about other risk factors in the last 14 days prior to illness onset
  2. If no other risk factors, support the patient to get tested if they have not already done so:
  3. Ensure the patient is appropriately isolated (whether at home or in hospital) until COVID-19 test result
  4. Postpone surgery until COVID-19 is excluded after testing negative if it will not significantly impact patient outcomes – this decision will require discussion with the clinical team

Ensure the surgery is re-scheduled as soon as practicable after COVID-19 is excluded after testing negative.

Symptoms and in the last 14 days prior to illness onset, has the patient:

  • had close contact with a confirmed case
  • travelled internationally
  • travelled on a cruise ship as a passenger or crew.
  • Been in Victoria in the last 14 days
  • A close contact of a NSW confirmed case (see NSW specific advice)
  1. If symptoms and other risk factors, support the patient to get tested if they have not already done so:
  2. Ensure the patient is appropriately isolated (whether at home or in hospital) as per public health guidance
  3. Postpone surgery until 14 days after the last contact day if it will not significantly impact patient outcomes – this decision will require discussion with the clinical team.

Ensure the surgery is re-scheduled as soon as practicable after the 14-day exclusion period has lapsed or COVID-19 is excluded after testing negative.

Infection control considerations for operating theatres

The Clinical Excellence Commission (CEC) has developed general COVID-19 Infection Prevention and Control Advice for Health Workers, which should be followed by all NSW Health staff.

In addition, operating theatre staff should abide by the following advice:

More information

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Page Updated: Thursday 30 July 2020
Contact page owner: Health Protection NSW