Implementation of Standardized Coronavirus Disease 2019 Risk Assessment to Guide Personal Protective Equipment Wear in the Perioperative Setting

Background: Perioperative staff are at increased risk of contracting COVID-19 due to exposure to aerosol-generating procedures. Patients and staff who contract COVID-19 in the perioperative period are at risk for adverse outcomes. A Lack of consistent COVID-19 risk assessment and appropriate PPE wear by staff is a missed opportunity to mitigate risks to staff and patients alike. Methods: An evidence-based quality improvement framework and Plan-Do-Study-Act (PDSA) cycles were used to implement a standardized COVID-19 risk assessment process to guide appropriate PPE wear among perioperative staff in a large academic medical center. A PPE decision-making algorithm and chart labeling system were developed to facilitate risk assessment and communication. Staff were educated on the use of the algorithm and appropriate chart labeling. Compliance with chart labeling and identified PPE needs were measured after implementation. Results: After implementation, compliance with risk assessment and chart labeling was 21.6%, lower than our aim of 70%. Compliance was higher on weekdays (predominately scheduled cases) than weekends (predominately urgent cases) and positively correlated with facility COVID-19 rates (rho = 0.555, p = 0.040). When risk assessment was completed and the chart appropriately labeled, the use of required eyewear and N95 mask was 25.9%, below our aim of 90% and not correlated with facility COVID-19 rates (eyewear: rho = 0.175, p = 0.549; N95: rho = 0.521, p = 0.056). Conclusions: The healthcare team plays a vital role in preventing the spread of COVID-19 to patients and themselves. Compliance with perioperative COVID-19 risk assessment, chart labeling, and PPE wear did not meet the aims of this initiative. Change fatigue among staff was a significant barrier. Barriers to staff compliance with risk identification and PPE wear must be intentionally and continually addressed to increase the likelihood of successful implementation of this important and evidence-supported intervention in future initiatives