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Table of Contents
Year : 2020  |  Volume : 36  |  Issue : 3  |  Page : 289-290

Surgical safety checklist in the COVID era

Department of Anaesthesia Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India

Date of Submission01-Sep-2020
Date of Acceptance02-Sep-2020
Date of Web Publication16-Oct-2020

Correspondence Address:
Reshma P Ambulkar
Department of Anaesthesia Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Dr Ernest Borges Road, Parel, Mumbai - 400 012, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/joacp.JOACP_529_20

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How to cite this article:
Ambulkar RP, Singh P, Divatia J. Surgical safety checklist in the COVID era. J Anaesthesiol Clin Pharmacol 2020;36:289-90

How to cite this URL:
Ambulkar RP, Singh P, Divatia J. Surgical safety checklist in the COVID era. J Anaesthesiol Clin Pharmacol [serial online] 2020 [cited 2021 Jul 27];36:289-90. Available from:

In December 2019, we were woken up to the rapid spread of human–human transmission of novel coronavirus 19 (SARS-CoV2) causing COVID-19.[1] The management of patients during the time of COVID-19 pandemic adds a new challenge due to the added risks of infection to healthcare workers caring for infected patients. With no vaccine or proven treatment yet available, the only way to protect the healthcare workers is by ensuring minimal exposure to the pathogen, wearing personal protective equipment (PPE) and key infection preventing strategies.[2],[3],[4] Operating rooms (ORs) are considered high risk areas where aerosol generating procedures are conducted. Safe surgery during this pandemic must also include safety of healthcare workers. Surgical safety checklist (SSC), a simple tool for over a decade has proven that successful implementation has decreased errors, improved communications and teamwork among OR professionals while conducting complex surgical procedures all around the globe.[5] The need of the hour is a modified version of the checklist to prompt the OR team of important steps that can increase staff safety, which can be otherwise missed in this complex scenario. A “Fixed COVID checklist” might be useful.[6] However, it may not fit the local circumstances and practice. A modified version reflecting the local needs and encouraging all the team members to buy in would improve the implementation and acceptance, in addition encourage ongoing teamwork. It is important that all the team members should have the opportunity to give input and feedback in creation of modified hospital-specific checklist before it is implemented. This is important as the availability of resources would vary from place to place and a hospital-specific checklist best suits the safety needs of the facility that uses it. While modification is essential, the basic skeleton of the checklist with three pause points need to be preserved. The checklist should include items which would benefit in improving safety of all the team members (minimize aerosol generation; all staff wearing PPE), steps which can be easily missed and addressed by including it in the checklist. We at tertiary care oncology setup incorporated important items in our existing checklist to avoid duplication and to make it more acceptable [Figure 1]. As suggested by Lifebox foundation and Jhpiego, it is important to have SMART (specific, measureable, achievable, results focused and time bound) goals during implementation of COVID-19 SSC in your hospital setup. We at our institute audited the compliance with the use of PPE by healthcare workers of the operation theatre complex which was found to be 96.3%.[7] Another important aspect is educating all the healthcare workers about the risks of COVID-19 infection and the role of checklist in minimizing the transmission of the infection. The importance of team-building and communication cannot be overemphasized for successful implementation of the checklist.
Figure 1: Modified Surgical Safety Checklist

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In conclusion, the management of patients in the current COVID-19 era presents a new challenge for the OR healthcare workers with a higher risk of contracting the infection. Modification of the checklist can be considered as an easily attainable and positive step in the direction of improving safety for the OR healthcare workers caring for patients and patients undergoing surgery.

  References Top

World Health Organisation. Scientific brief. Transmission of SARS-CoV-2: Implications for infection prevention precautions. 2020. Available from: [Last accessed on 2020 Sep 01].  Back to cited text no. 1
Wilson NM, Norton A, Young FP, Collins DW. Airborne transmission of severe acute respiratory syndrome coronavirus-2 to healthcare workers: A narrative review. Anaesthesia 2020;75:1086-95.  Back to cited text no. 2
Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: A systematic review. PLoS One 2012;7:e35797.  Back to cited text no. 3
Wilson N, Corbett S, Tovey E. Airborne transmission of covid-19. BMJ 2020;370:m3206.  Back to cited text no. 4
Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AH, Dellinger EP, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 2009;360:491-9.  Back to cited text no. 5
COVID-19 Surgical Patient Checklist. Available from: [Last accessed on 2020 Sep 01].  Back to cited text no. 6
Prakash G, Shetty P, Thiagarajan S, Gulia A, Pandrowala S, Singh L, et al. Compliance and perception about personal protective equipment among health care workers involved in the surgery of COVID-19 negative cancer patients during the pandemic. J Surg Oncol 2020. doi: 10.1002/jso. 26151.  Back to cited text no. 7


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