Plastic and Reconstructive Surgery - Global Open Journal ...

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Plastic and Reconstructive Surgery - Global Open Journal Publish Ahead of Print DOI: 10.1097/GOX.0000000000002868 Our Experiences on Plastic and Reconstructive Surgery Procedures during COVID-19 Pandemic from Shanghai Ninth People's Hospital Zhichao Wang1, #, M.D., MPH, Wei Wang1, #, M.D., Ting Bai#, B.S.,Meihua Di1, B.S. Nurs., Tao Zan1, M.D., Ph.D., Bin Gu1, M.D., Shengli Li1, *, M.D., Ph.D., Qingfeng

D Li1, *, M.D., Ph.D.

1. Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's

E Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China 200011

2. Department of Medical Records and Statistic Service Management, Shanghai Ninth

T People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai,

China 200011

P Running Title: Shanghai PRS experience during COVID-19

Corresponding Author Contact Information: Prof. Shengli Li, M.D., Ph.D., Email:

E drlishengli@, Address: Department of Plastic and Reconstructive Surgery,

Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine,

C No. 639 Zhizaoju Road, Shanghai, China 200011, Telephone: 086-021-53315120

Prof. Qingfeng Li, M.D., Ph.D., Email: dr.liqingfeng@, Address: Department

C of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai AJiao Tong University School of Medicine, No. 639 Zhizaoju Road, Shanghai, China

200011, Telephone: 086-021-63089567 Financial Disclosure and Products Page: All authors declare no conflict of interests. Funding: None.

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This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

ACCEPTED

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Background: A novel Coronavirus disease (COVID-19) has rapidly become a health threat worldwide and announced to be a global pandemic by world health organization (WHO). Possible transmission routes, including respiratory droplets, close contacts and aerosol propagation, put plastic and reconstructive healthcare professionals at high risk, especially during surgical procedures. The aim of the study is to summarize and share our experience of infection control measures and corresponding outcomes during COVID-19 pandemic. Methods: Infection control measures, including workflow optimization, useful

D epidemiological survey methods and personal full protective clothing, were discussed.

Characteristics and outcomes of emergency cases and elective cases under local and

E general anesthesia during COVID-19 pandemic were summarized. T Results: A hierarchy of interventions were applied mainly from four aspects. First,

administration control and online consultation significantly decreased patient

P attendance. Second, a triage workflow was established to identify high/low risk

patients with clinical manifestations (fever, fatigue, cough, nasal discharge etc.),

E epidemiological survey, blood test, chest CT scan and coronavirus test if necessary.

Third, strict environmental control was adopted using increasing ventilation, isolated

C room for inpatients etc. Fourth, Proper rotation of healthcare staff to reduce workload

and minimize possible contact. A total of 904 emergency interventions, the procedures

C involved 2561 local anesthesia and 570 general anesthesia were performed and none of Athe cases/healthcare professionals were infected.

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Conclusion: Our experience could help global plastic and reconstructive healthcare professionals to get better preparation and continue to give qualified medical services during COVID-19 pandemic. Proper adjustments should be taken according to their own clinical settings. Key Words: Coronavirus, COVID-19, Plastic and Reconstructive Surgery, Infection

ACCEPTED control, Shanghai experience.

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Introduction Since the end of last December, the outbreak of a novel coronavirus (SARS-Cov-2) pneumonia (COVID-19) began in Wuhan, China and currently has increasingly become a global public health concern (1). SARS-Cov-2 virus is highly contagious and cause severe pneumonia in vulnerable population (2). Moreover, not only COVID-19 patients but also asymptomatic carriers are sources of infection (3), which creates huge challenges for infection control. Chinese government and healthcare professionals took strict measures to control the spread and rescue the infected (4). Currently the

D pandemic in China is greatly under control compared with situation one month ago.

However, as of March 31th, 2020, the infection spreads to more than 160 countries and

E more than 800,000 cases have been confirmed worldwide with total death over nearly T 40,000 cases (5). Therefore, on March 11th, 2020, the WHO declared the infection as

global pandemic, indicating the severity of the worldwide involvement of the disease.

P The transmission routes of COVID-19 include respiratory droplets and close contact

(6). Recently, possible aerosol propagation has also been proposed (6), which is

E implicated as a worrisome problem for our plastic and reconstructive healthcare

professionals as we are usually exposed to high concentration of aerosols for a long

C time in a relatively airtight environment during procedures, especially for

microsurgeries and procedures related to craniofacial regions. In addition, most of

C plastic and reconstructive healthcare professionals are sub-specialized and did not cope Awith contagious infections for a long time during their training program. This

inadequate experience further increased the risk for infections. However, the scheduled treatments cannot be cancelled or postponed totally and immediately when the epidemic started. Not to mention, emergency injury and trauma cases are the

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