Standard Precautions for Healthcare Workers on COVID -19

Introduction

Corona viruses (CoV) belong to a family of viruses that cause illness ranging from the common cold to more severe diseases. A novel corona virus is a new strain that has not been previously identified in humans. The infection is spread through respiratory route i.e. respiratory droplets and direct human contact. Healthcare personnel (HCP) are at risk of infection through respiratory routes and direct contact with infectious patients.

The Guidelines have been adapted from the existing WHO & CDC recommendations:

Standard recommendations to prevent infection spread include standard precautions, contact precautions and respiratory precautions.

Patients suspected of having Corona viruses infection should be shifted to the isolation facility from the triage area as soon as possible. The HCP should do this after donning appropriate PPE. The patient should wear mask/respirator.

   Standard precautions:

Health-care workers caring for PUI (Patient under investigation) patients should implement standard infection control precautions. These include basic hand hygiene, use of personal protective equipment, respiratory etiquettes, and environmental disinfection.

Patient placement:

The PUI has to be admitted in an isolation room with negative pressure and at least 6 air changes per hour.

• Only essential personnel should enter the room. Implement staffing policies to minimize the number of HCP who enter the room.
• Facilities should keep a log of all persons who care for or enter the rooms or care area of these patients.
• Use dedicated or disposable noncritical patient-care equipment (e.g., blood pressure cuffs). If equipment will be used for more than one patient, clean and disinfect such equipment before use on another patient according to manufacturer’s instructions.
• HCP entering the room soon after a patient vacates the room should use respiratory protection.

Advice on the usage of PPE in the context of COVID-19:

The following are recommendations for the rational use of personal protective equipment (PPE) at health care facilities. PPE includes gloves, medical masks, goggles or a face shield, and gowns, as well as for specific procedures, respirators (i.e., N95) and aprons. It is intended for HCPs, infection prevention and control (IPC) professionals and health care managers.

General Advice:

Hand hygiene remains one of the most important measures for all persons for the prevention and control of majority of the respiratory viral infections -, including 2019-nCoV infections or COVID-19. This can be performed with soap and water or alcohol-based hand rubs. Wearing a medical mask is one of the prevention measures to limit spread of certain respiratory diseases, including 2019-nCoV, is useful when worn by the persons suffering from the disease or contacts of the patients. These measures must be combined with other IPC measures to prevent the human-to-human transmission of COVID-19, depending on the specific situation.

Community setting (Applicable to all staff):

    Individuals without respiratory symptoms should:

• Avoid agglomerations and frequency of closed crowded spaces;
• Maintain distance of at least 1 meter from any individual with 2019-nCoV respiratory symptoms (e.g., coughing, sneezing);
• Perform hand hygiene frequently, using alcohol-based hand rub if hands are not visibly soiled or soap and water when hands are visibly soiled;
• If coughing or sneezing, cover nose and mouth with flexed elbow or paper tissue, dispose-off tissue immediately after use and perform hand hygiene;
• Refrain from touching mouth and nose;
• A medical mask is not required, as no evidence is available on its usefulness to protect non-sick persons. However, masks might be worn according to local cultural habits. If masks are used, best practices should be followed on how to wear, remove, and dispose of them and on hand hygiene action after removal (see below advice regarding appropriate mask management).

Individuals with respiratory symptoms should:

• Wear a medical mask and seek medical care if experiencing fever, cough and difficulty breathing, as soon as possible or in accordance with to local protocols;

Health Care Facilities:

Individuals with respiratory symptoms should:

• Wear a medical mask while waiting in triage or waiting areas or during transportation within the facility;
• Wear a medical mask when staying in cohorting areas dedicated to suspected or confirmed cases;
• Do not wear a medical mask when isolated in single rooms but cover mouth and nose when coughing or sneezing with disposable paper tissues. Dispose them appropriately and perform hand hygiene immediately afterwards.

Health care workers should:

1. Wear a medical mask when entering a room where patients suspected or confirmed of being infected with 2019-nCoV are admitted and in any situation of care provided to a suspected or confirmed case;
2. Use a particulate respirator at least as protective as a US National Institute for Occupational Safety and Health (NIOSH)-certified N95, European Union (EU) standard FFP2, or equivalent, when performing aerosol-generating procedures such as:

• Tracheal intubation
• Non-invasive ventilation
• Tracheotomy
• Cardiopulmonary resuscitation
• Manual ventilation before intubation and
• Bronchoscopy

Hand Hygiene:

When Do We Need to Practice Hand Hygiene:

 

Masks management:

If medical masks are worn, appropriate use and disposal is essential to ensure they are effective and to avoid any increase in risk of transmission associated with the incorrect use and disposal of masks.

The following information on correct use of medical masks derives from the practices in health- care settings:

• Place mask carefully to cover mouth and nose and tie securely to minimise any gaps between the face and the mask;
• While in use, avoid touching the mask;
• Remove the mask by using appropriate technique (i.e. do not touch the front but remove the lace from behind);
• After removal or whenever you inadvertently touch a used mask, clean hands by using an alcohol-based hand rub or soap and water if visibly soiled
• Replace masks with a new clean, dry mask as soon as they become damp/humid;
• Do not re-use single-use masks;
• Discard single-use masks after each use and dispose-off them immediately upon removal.

Rational use of personal protective equipment:

PPE use is based on the risk of exposure (e.g., type of activity) and the transmission dynamics of the pathogen (e.g., contact, droplet or aerosol). Observing the following recommendations will ensure rational use of PPE:

1.    The type of PPE used when caring for COVID-19 patients will vary according to the setting and type of personnel and activity (Below Table).

2.    Healthcare workers involved in the direct care of patients should use the following PPE:

a.    gowns,

b.    gloves,

c.     medical mask and

d.    eye protection (goggles or face shield).

3.    Specifically, for aerosol-generating procedures (e.g., tracheal intubation, non-invasive ventilation, tracheostomy, cardiopulmonary resuscitation, manual ventilation before intubation, bronchoscopy) healthcare workers should use respirators (N95), eye protection, gloves and gowns; aprons should also be used if gowns are not fluid resistant.

4.    Respirators (e.g., N95, FFP2 or equivalent standard) have been used for an extended time during previous public health emergencies involving acute respiratory illness when PPE was in short supply. This refers to wearing the same respirator while caring for multiple patients who have the same diagnosis without removing it, and evidence indicates that respirators maintain their protection when used for extended periods. However, using one respirator for longer than 4 hours can lead to discomfort and should be avoided.

5.    Among the general public, persons with respiratory symptoms or those caring for COVID-19 patients at home should receive medical masks.

6.    For asymptomatic individuals, wearing a mask of any type is not recommended.

 

7.    Wearing medical masks when they are not indicated may cause unnecessary cost and a procurement burden and create a false sense of security that can lead to the neglect of other essential preventive measures.

Written by:

Dr. Praveen Bajpai

Director of Ingenious Healthcare Consultants Pvt. Ltd.
Founder of Skill Sathi

MBA in Hospital administration, PG Diploma in Quality Accreditation, PG Diploma in Medico Legal System, M. Phil in Hospital Mgmt. from BITS Pilani, P.hD in Management, Certified NABH Auditor, Certified NABL Auditor, Certified Auditor for Clinical Audits, Green Belt in Six Sigma, Certified in Hospital Infection Control Practices, Certified trainer for International Patient Safety Goals, Certified Auditor for JCI 7th Edition Standards 

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