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Elective surgery COVID-19 response

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

Since 1 July 2020, NSW public hospitals have been returning to normal surgery activity levels.

Elective surgery should be considered dependent upon risk of COVID-19 exposure. If the procedure is urgent and must be undertaken in short time frame for clinical reasons, patients should be managed in a single room with contact and droplet precautions. The following advice is given dependent upon recent potential exposure.

Those who have been in areas of community transmission

There has been recent community transmission in NSW, other states and locations in New Zealand. If a person has visited one of these locations (see specific NSW isolation advice) in the past 14 days, elective surgery is to be postponed.

Screening 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 must 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.

Where 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-19 disease?
  • Ask date of diagnosis and time since recovery
  • 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), runny nose or a combination of other non-specific symptoms (headache, tiredness, muscle pain, 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
  • Ask about other risk factors in the last 14 days prior to illness onset
  • If no other risk factors, support the patient to get tested if they have not already done so:
  • Ensure the patient is appropriately isolated (whether at home or in hospital) until COVID-19 test result
  • 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
  • been in a location at a time associated with Australian or New Zealand community transmission (see NSW specific advice)
  • If symptoms and other risk factors, support the patient to get tested if they have not already done so:
  • Ensure the patient is appropriately isolated (whether at home or in hospital) as per public health guidance
  • 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 and 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.

On 24 July, the CEC have updated their information about masks for healthcare workers in line with the response and escalation framework.

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

More information

Current as at: Sunday 29 November 2020
Contact page owner: Health Protection NSW