Prevention of COVID-19 transmission in the healthcare setting
Revisión del 17:30 26 mar 2020 de Rossdonaldson1 (discusión | contribs.) (→Contact with Patients at Risk/Persons Under Investigation)
See COVID-19 for main article
Background
COVID-19 PPE Summary Table
| Contact Category | Precations | Room Type |
| General (all persons) | Social distancing; meticulous hygiene; basic mask | NA |
| Undifferentiated patients at risk (e.g. prior to evaluation or testing) | Contact and droplet precautions, including eye protection | Negative-pressure NOT required |
| Persons Under Investigation | Contact and droplet precautions, including eye protection | Negative-pressure NOT required |
| Aerosol-Generating Procedures | Contact and airborne precautions, including eye protection | Negative-pressure required |
See prevention of COVID-19 transmission in the healthcare setting for full PPE recommendations
Transmission
- Simply walking into a room is NOT a recognized risk of transmission. Must make contact with respiratory droplet (directly or indirectly)
- Masks: MOST IMPORTANT utility is to put on the coughing individual
- Research clearly demonstrates it decreases shedding of infectious material in the environment
- This is more effective than HCWs wearing masks prophylactically to prevent catching the infection when not actually performing close contact patient care
- How long to shut a patient room down after a COVID patient is in there?
- It’s not about the risk of contracting the infection but about the ability to clean room safely without respiratory protection precautions by the cleaner
- 30-40 minutes usually sufficient (for most modern facilities) as long as no aerosol-generating procedure performed (longer, time not clearly stated at this time)
- Most modern rooms designed to have 12 air exchanges per hour
- Ventilation symptoms vary. So, older / fewer exchanges per hour => more time.
Isolation
- Persons diagnosed with COVID-19 are considered cleared after 14 days from symptom onset or 3 days after resolution of fever and improvement of other symptoms, whichever is longer.
- CDC: Reasonable to isolate patients with unexplained fever and respiratory symptoms (and no travel history) at this time
General Measures
- Exercise general infection precautions
- Person-to-person transmission occurs with close contact (6 feet)
- Direct Transmission: contact with mucous membranes or respiratory droplets
- Indirect Transmission: cough —> secretions left on surface —> 2nd person touches surface secretions and touches face & mucous membranes
- Hygiene General Recommendations
- Avoid touching your face
- Frequent Handwashing
- Alcohol based hand sanitizer
- Diligent hand wasing
- 20 seconds minimum
- Image shows commonly forgotten areas: thumb (ulnar aspect), fingertips, WRIST (Borrowed from WHO Hand Hygiene for Healthcare)
- Wear a mask if you develop respiratory symptoms (fever, cough, rhinorrhea, congestion) to prevent spread
- Avoid unnecessary travel
- Stay home if symptomatic
- Home care does not mean being out in the parks with other groups of people
- Contact your supervisor: due to expected HCW shortages, minor symptoms may be allowed to continue working with adequate PPE to prevent infection spread
Contact with Patients at Risk/Persons Under Investigation
Recommended PPE
Contact and droplet precautions including eye protection
- Droplet = surgical mask, eye protection
- Contact = gown and gloves
- If gowns in short supply, consider reserving for PUIs and/or aerosol-generating procedures
- Negative pressure room preferred may be prefered for PUIs, but not required
- See video below indicates the proper order for donning and doffing PPE for clinical evaluation of a patient
Patients and Procedures Included in this Category
- General care of PUI patients
- Collection of nasopharyngeal swab specimens
Aerosol-Generating Procedures
Due to higher risk of aerosolizing droplets; infection itself doesn’t seem to be spread via airborne route
Recommended Provider PPE
Contact (including eye protection) and airborne precautions
- N95 mask or higher-level respirator (e.g. PAPR), plus eye protection, gloves, and gown[1]
- Consider head coverage: sterile disposable cap with gown or bunny suit
- Consider two pairs gloves, one under sleeves of gown and one over
- Consider shoe covers
- Consider buddy system for donning/doffing
- If using PAPR, then need pre-assigned RN outside the room to help decontaminate it by wiping it down with purple wipes before you take it off
- Negative pressure room required, if at all possible
- Limit personnel in room to only those essential for patient care
Mask Use Technique
- Mask donning (often incorrectly done):
- Wash hands BEFORE touching mask
- Grip mask by loops/bands/ties only
- Coloured portion typically faces outward
- Mold / pinch the stiff edge to the shape of your nose
- Pull the bottom of the mask over your mouth AND chin
- Make sure you are up to date with fit testing
- Mask removal:
- Wash hands BEFORE touching mask
- Only make contact with the loops/bands/ties. DON’T TOUCH THE MASK ITSELF!
Aerosol-generating procedures list
Avoid these procedures when possible
- Bag-valve-mask (BMV)
- CPAP/BiPAP
- Intubation
- Nebulizer administration (if possible, use MDI instead)
- Bronchoscopy
- Chest PT
Intubation of Potential COVID-19 Patients
Aerosol-generating procedure: see this link for PPE recommendations and related precautions
- Use checklist if available (see example: File:Harbor COVID Airway Management v3-16-20.pdf)
- Use BVM with viral filter or avoid BVM altogether, if possible
- Use RSI to prevent coughing gagging; consider higher dosing of paralytics.
- Use video laryngoscopy to keep provider face further away from patient (afterwards, clean with grey wipes, observe 3 min wet time)
PPE Shortage and Conserving Supplies Guidelines
In case of PPE shortage or in an attempt to save on PPE supplies, the following guidelines were approved by CDC 3/13/20:
- Same respirator can be worn for multiple serial patient contacts (e.g. in between successive COVID/PUI (patients under investigation) without exchanging respirator. Therefore, in between each patient:
- No need to change mask or eye protection
- BUT need to change gown and gloves
- Respirator reuse possible? Higher risk because of having to touch the mask and either self-inoculate or transmit to another patient (e.g. wear it for a patient, then you remove, and then you put it back on)
- If you must do this because of limited supplies, don and doff properly and perform proper hand hygiene in between
- CDC / NIOSH will allow certain N95s to be used beyond manufacture-designated shelf life
- See list of appropriate models here (manufactured between 2003-2013)
- N95 Reuse? Probably okay to re-use same N95 during an 8 hour shift as long as no tears or visible contamination. Store facedown in labeled re-sealable bag/container.
- Based on non peer reviewed reports from Washington State
See Also
COVID-19 Pages
- COVID-19 (main)
External Links
Video
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