Information shared from CDC, found here. Information has been reformatted with some rewritten for clarity.
COVID-19 is a coronavirus which is transmitted primarily by aerosol. Given the possible severity of the illness, which includes death, special measures are recommended for health care facilities and healthcare providers.
It goes without saying that one should maintain universal precautions with all patients of course. Frequent hand washing for 20 seconds and/or the use of antibacterial hand gel is recommended.
The first step is proper patient handling/room placement.
Put a mask on all patients presenting with respiratory symptoms.
Ideally patients with known or suspected COVID-19 should be in a single patient room with the door closed. If the patient is going undergo a nebulizer or other aerosol generating procedure (e.g. humidified oxygen), he or she should be moved to an airborne infection isolation room (AIIR).
High risk procedures include (per University of Iowa):
- Nebulized medication administration (consider MDI with spacer instead)
- Manual ventilation before intubation
- Endotracheal intubation
- High-frequency oscillating ventilation
- Open suctioning
- Sputum induction
Note that high-flow nasal cannula is not considered high risk
According to the CDC, AIIRs consist of:
- Single-patient rooms at negative pressure relative to the surrounding areas, and with a minimum of 6 air changes per hour (12 air changes per hour are recommended for new construction or renovation).
- Air from these rooms should be exhausted directly to the outside or be filtered through a high-efficiency particulate air (HEPA) filter directly before recirculation.
- Room doors should be kept closed except when entering or leaving the room, and entry and exit should be minimized.
- Facilities should monitor and document the proper negative-pressure function of these rooms.
Personal Protective Equipment:
Instructions on using PPE can be found here (from Sunnybrook Hospital).
Providers should use personal protective equipment (PPE) to reduce exposure to the virus. Recommended PPE consists of:
- Eye shields
- N95 or better masks/respirators/powered air-purifying respirators (PAPRs) with high-efficiency filters (A list of NIOSH-approved PAPRs is located on the NIOSH Certified Equipment List).
What if we are short on N95 masks? “Facemasks are an acceptable alternative when the supply chain of respirators cannot meet the demand. During this time, available respirators should be prioritized for procedures that are likely to generate respiratory aerosols, which would pose the highest exposure risk to HCPs” (see list above).
What if we are short of gowns? “If there are shortages of gowns, they should be prioritized or aerosol-generating procedures, care activities where splashes and sprays are anticipated, and high-contact patient care activities that provide opportunities for transfer of pathogens to the hands and clothing of HCP.
Information from the CDC Guidelines for Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings (last updated on March 15, 2020).