Prevention of COVID-19 transmission in the healthcare setting: Difference between revisions

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''See [[COVID-19]] for main article''
==Background==
{{COVID PPE summary table}}
{{COVID PPE summary table}}
{{COVID virology}}
{{COVID epidemiology}}
=== 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==
[[File:Hand Hygiene.png|thumb|]]
* 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==
==Aerosol-Generating Procedures==
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===Aerosol-generating procedures list===
===Aerosol-generating procedures list===
''Avoid these procedures when possible''
''Minimize exposure with these procedures when possible''
* [[Bag-valve-mask]] (BMV)
* [[Bag-valve-mask]] (BVM)
* CPR
* CPAP/[[BiPAP]]
* CPAP/[[BiPAP]]
* [[Intubation]]
* [[Intubation]]
* Nebulizer administration (if possible, use MDI instead)
* Nebulizer administration (if possible, use MDI instead)
* Bronchoscopy
* Bronchoscopy
* Chest PT
* Chest physiotherapy
 
*[[Oxygen therapy|High-Flow Nasal Cannula]]
{{COVID-19 intubation}}
 
==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==
==See Also==
{{COVID see also}}
{{Special:Prefixindex/COVID-19 |hideredirects=1}}


==External Links==
==External Links==
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[[Category:ID]]
[[Category:ID]]
[[Category:COVID-19]]

Revision as of 17:30, 16 June 2021

COVID-19 PPE Summary Table

Example summary flow chart for determining PPE use














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

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

Minimize exposure with these procedures when possible

See Also

External Links

Video

{{#widget:YouTube|id=exV5hEG62CY}}

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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