Houston Methodist’s policies designed to avoid the spread of severe acute respiratory syndrome coronavirus 2 during hospital-based surgeries or procedures led to a postintervention nosocomial Covid-19 infection rate of 0.1% during the first 19 months of the pandemic. Preoperative polymerase chain reaction testing was found to be particularly effective. During the initial onset of the Covid-19 pandemic, there was little information regarding how to deliver surgical care safely. Houston Methodist, an eight-hospital system with a flagship academic medical center (Texas Medical Center), adopted and implemented policies that were driven by science and expert opinion, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction preoperative testing to decrease patient risk of Covid-19 diagnosis postintervention. In examining outcomes of the policies during the first 19 months of the pandemic, the authors discovered from a retrospective cohort study of 141,439 patients that the policies — especially SARS-CoV-2 preoperative testing — were effective in reducing postintervention Covid-19 disease, with an overall rate of 0.6%. Analysis of patients who had Covid-19 after intervention found that most had contracted the disease from community sources, which led to a nosocomial Covid-19 rate of 0.1%. Effective policy implementation was associated with successful delivery of safe surgical care during the pandemic.