COVID-19 Interventional Platform Testing Criteria for Surgeries and Procedures Purpose: To provide lab requirements and patient criteria for high and low risk infectivity procedural and surgical cases Applicable Locations: 500P, 300P, Lane Surgery Center, Cath Lab, Endoscopy, Pavilion D, CCSB, Emeryville, OSC Surgeries/Procedures with Anesthesiology Procedures with RN Sedation Lab Requirements Results required prior to determining to proceed* Results required prior to determining to proceed Sedation Type General Anesthesia/MAC RN Sedation • Endoscopy/Colonoscopy Cardiology • Bronchoscopy (Flexible or Rigid) • TEE (with A-Fib, VT ablations) • OHNS • Esophageal temperature probe during A-Fib ablations • Airway Surgery • Over night stay including procedures: Pacemakers, ICD, AF ablations, SVT ablations • CT Surgery • Exercise Stress Test • Thoracic Surgery • Right Heart Catheterization • TEE • Coronary Angiogram • Endomyocardial Biopsy • Left Heart Catheterization Patient and Procedure Powered Instrumentation of the Airway (COVID Test 1 midnight PRIOR to procedure): • Pericardiocentesis Criteria • Endonasal procedures • PCI (including CTO) • Transsphenoidal procedures • ASD/PFO Closure • FESS due to fungal sinusitis • Maxillary Artery Ligation (Embolization) Interventional Radiology • All Otology Surgeries • Lung Biopsy TBA/23 Hour Observation • Lung Cryoablations • New G or GJ Tubes Placement • All patients scheduled to stay at least one midnight • Overnight stay including procedures: UFE ALL Inpatients will be COVID tested before • Chest Tubes Interventional Platform Procedures: see page 3 for Inpatient algorithm. • Bronchial artery embolization Neuro Interventional Radiology *Emergency Cases will not be delayed for RESULTS (Results may be pending) • Epistaxis Treatment • Head and Neck Tumor Embolization Pain Cases • Spinal cord stimulator implant/Intrathecal Pump Implant • Orofacial Procedures • Neck-Scapular-Clavicular Procedures 1 • Sacral-Pelvic Procedures COVID-19 Pre-Hospital Preoperative Testing Protocol Symptomatic and Asymptomatic Patients Purpose: Pre-hospital screening and testing guidelines to determine whether to proceed with TBA/Overnight/Outpatient Anesthesia procedures Patient 1. Patient to F/U with PCP for scheduled for COVID-19 APEC management Surgery/ symptom Visit 2. Surgery postponed Procedure screening scheduled (RN positive Sedation or Anesthesia) Yes Yes APEC to order and APEC to order COVID-19 coordinate to arrange 3 No (LABSARSCOV2) midnight testing of All Proceed to COVID-19 No RN test and inform TBA/Overnight Surgery/ Positive? Sedation? Surgeon/Proceduralist Observation and All Procedure Outpatient Anesthesia Patients Yes No Process Follow RN Sedation APEC to Protocol COVID-19 Test order and Decision positive or currently Powered Yes coordinate to symptomatic? Instrumentation of Airway? arrange 1 midnight Yes No testing Wait for results Yes 1. Patient to F/U with Patient Able to PCP formanagement APEC Orders Obtain Testing No 2. Surgery postponed RAPID COVID-19 Prior to Date of Procedure (LABSTATCOV2) 2 Day of Surgery Approved by PORT, Professional Practice, & CEPD 1.26.2021 COVID-19 Pre-Procedure Testing Protocol for Inpatient, ED, Transfer Center, Congregate Setting (e.g. jail, SNF) Patients Purpose: Screening and testing guidelines to determine how to proceed with moderate sedation high infectivity/anesthesia procedures for Inpatient, ED, Transfer Center, Congregate Setting patients Previous NEGATIVE Patient scheduled for Yes Proceed to OR with Stanford test AND Surgery/Procedure appropriate PPE and no NEW Precautions based respiratory on Surgical symptoms? Infectivity Class No 1. No need to wait for COVID-19 Order and Send test results ROUTINE COVID-19 (LABSARSCOV2) 2. Proceed to OR as PUI and use Order and Send COVID-19 Yes Urgent No appropriate PPE and Surgery within 3 midnight (LABSARSCOV2) Test – precautions if results not Test – <12 available hours? Primary Surgical/ Primary Surgical/ Procedural Team Procedural Team No Transplant (Heart, Lung, Kidney, Liver) COVID- COVID-19 Positive or considered urgent and have a RAPID Test 19 Results Not Returned with prior to transplant. Heart and Lung can Positive Symptomatic ? Positive Screen proceed without result with proper PPE. Yes No Inpatients with a negative test on admission and Yes scheduled for a surgery/procedure on Interventional Consider risks/ Process Platform within 13 midnights, will require COVID test benefits of delay within “3 midnight rule”. After day 14 no more testing versus COVID-19 + COVID-19 +/PUI Continue Standard Decision Procedure Protocol Post- Op Care needed if no new symptoms. 3 Approved by PORT, Professional Practice, & CEPD 1.26.2021 COVID-19 Pre-Testing Protocol for Procedures with RN Sedation Purpose: Screening and testing guidelines to determine whether to proceed with procedures requiring RN sedation Patient COVID-19 scheduled symptom procedure with Patient to F/U with PCP for Process screening RN sedation. management and positive No Clinic to screen Procedure postponed for at least for symptoms 20 days. Refer to positive patient Decision when booking Yes algorithm Primary Procedural Team order COVID-19 test Primary Procedure Team (LABSARSCOV2) to order and arrange 3 midnight test through Yes Yes Stanford or acceptable Patient Able outside facility to Obtain COVID-19 No Testing Prior Positive? Proceed to to Date of Procedure Procedure Primary No Procedural Team RAPID COVID-19 Wait for results 1. Patient to F/U with (LABSTATCOV2) Yes PCP formanagement COVID-19 Test No Day of Surgery 2. Procedure postponed positive or currently 3. Primary Procedural symptomatic? Team reports to County 4 Approved by PORT, Professional Practice, & CEPD 1.26.2021 +++ Algorithm for positive patients within 90 days of their first positive. If patient is over 90 days from first positive please refer to initial algorithm of testing all patients Preoperative Patients Test Positive For COVID-19 for first time. THESE PATIENTS DO NOT REQUIRE MIDNIGHT TIMING OF TESTING.+++ Purpose: Guidelines for preoperative patient test positive for COVID-19 Workflow Cancel the case and May reschedule for provide patient with surgery/procedure >20 Patient tested instructions on self- days and within 90 days RT-PCR Negative positive for COVID-19 quarantine protocols of first positive. RT-PCR (Asymptomatic or to be ordered by Symptomatic). MD/clinic at 5 days* before new surgery date RT-PCR Positive. Add- Proceed to on Strand test and Surgery/ Procedure and need time to get result RT-PCR or strand test Is the May reschedule after Case result valid for Yes MINUS RNA another 10 days IF No review 90 days post strand RNA Strand patient remains Urgent first positive Detected? Test asymptomatic. ? result Yes *Must be at least 10 days after first positive test No AND - Appropriate permission from Chair/Chief of Anesthesia, Surgical Dept and Medical at least 3 days after last symptom Director must concur to place patient on the schedule Process - Appropriate PPE for the risk of the procedure should be adhered to - The case should be put5 on the end of the day Decision to allow for terminal clean following the case if possible Approved by PORT, Professional Practice, & CEPD 1.26.2021 Test Results COVID REGULAR SWAB RNA STRAND TEST Detects: Detects: PLUS AND/OR MINUS STRAND MINUS STRAND (Any Viral Particles) First Positive Detection: Patient is considered N/A Infectious and RNA strand test not indicated Positive Detection after Initial Test: Patient might be Infectious Not Detected: NOT Infectious Patient can be “Positive” on the test for weeks and no longer infectious Not Detected: NOT Infectious NO RNA STRAND TEST NEEDED 6 Previous Positive Test Results Test Result Type Actions Previous Positive test result: No further testing needed for 90 days from • Past CDC time-based window for quarantine * date of original positive test result AND • Negative RT-PCR or minus strand not detected Previous Positive test result: • Obtain RT-PCR or • Consider RNA Strand Test Under Guidance • Within 10-20 days of positive COVID result AND of Infection Control at least 3 days post symptoms Previous Positive test result >90 days Patient resets and follows standard testing algorithm * 10 days if asymptomatic or 3 days post symptoms, whichever is longer 7 COVID-19 Interventional Platform Testing Window Purpose: To provide lab testing requirements timeframes for high and low risk infectivity procedural and surgical cases 3 Midnight Reference Table IF COVID-19 TEST IS REQUIRED, NEEDS TO BE DONE WITHIN 3 MIDNIGHTS OF SURGERY/PROCEDURE unless patient is known COVID-positive 3 Midnights Before 1 Midnight Before Surgery Surgery 2 Midnights Before (Latest test can be done Day of Surgery (Earliest test can be Surgery prior to day of surgery) done) Friday Saturday Sunday 3PM Monday Saturday Sunday Monday 3PM Tuesday Sunday Monday Tuesday 3PM Wednesday Monday Tuesday Wednesday 3PM Thursday Tuesday Wednesday Thursday 3PM Friday Wednesday Thursday Friday 3PM Saturday Thursday Friday Saturday 3PM Sunday Approved by PORT, Professional Practice, & CEPD 1.26.2021 8.