Prevention of COVID-19 transmission in the healthcare setting

See COVID-19 for main article

General Measures

Hand Hygiene.png
  • 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


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

External Links

Video

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References

  1. ↑ https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fhcp%2Finfection-control.html#take_precautions
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