Coronavirus disease 2019 (COVID-19): A closer look in Infection control in health care and home settings By the end of year 2019, a novel coronavirus
Coronavirus
disease 2019 (COVID-19): A closer look in Infection
control in health care and home settings
By the end of year 2019, a novel coronavirus has been identified
as an etiology of a cluster of pneumonia cases in Wuhan,
a city in the Hubei Province (China).
With its rapid spread, the WHO started
to declare a public health emergency in late Jan 2020
and then it has been termed it as a pandemic in March 2020. The virus causing COVID-19
is designated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
Limiting the possibility of SARS-CoV-2 infection transmission is a crucial
item of ptns care with suspected/documented COVID-19.
That is including the standard universal source
control (e.g., covering the nose &
mouth to limit respiratory secretions), early recognition & isolation
of ptns with suspected disease, utilization of the proper personal protective equipment (PPE) during
nursing ptns with COVID-19,
in addition to environmental disinfection measures.
Person-to-person transmission
of SARS-CoV-2 is believed to occur primarily
through the respiratory
droplets, as it happens with the spread of influenza. However, in view of the current uncertainty regarding
transmission mechanism of SARS-CoV-2,
considering the airborne
precautions is currently recommended in certain situations. Consequently,
in hospitalized ptns, the following measures of infection
control should be applied to subjects
with suspected/confirmed COVID-19:
1)
Ptns should better
be placed in a single-occupancy room with the door closed and dedicated bathroom for him; however, if it is
not possible, ptns with confirmed COVID-19
can be all nursed together. An airborne
infection isolation room (ie, a single-ptn
-ve-pressure room) should be prepared for ptns under aerosol-generating procedures.
2)
All health care providers
entering the room of a ptn with suspected/confirmed COVID-19 should wear the standard PPE to limit the risk
of exposure. This may include the use of gowns,
gloves, respirators or medical mask, and eye
or face protection. Respiratory protection may include: N95 respirator
should be used for all aerosol-generating
procedures (the provided exhalation valves are
not sufficient for source management). If supplies are sufficient, an N95 respirator instead
of a medical mask when caring for all ptns with suspected/confirmed
COVID-19.
Medical masks
are an accepted alternate for the non-aerosol-generating
procedure when PPE is
limited. This protocol is consistent with recommendation provided by the US Centers for Disease Control & Prevention.
3) Health care providers should specifically consider the proper sequence of putting on/off PPE to prevent the contamination.
In certain
hospitalized ptns, the suspicion for COVID-19
still high despite
the initial
negative results. Here, transmission-based preventive measures
for COVID-19
should be undertaken pending more additional tests. In zones of ongoing transmission, infection control measures
enhancment (e.g., respirator machine for
aerosol-generation procedure, face shield), with universal masking, are reasonable
to apply for all ptns regardless of the personal suspicion for COVID-19. When PPE
facilities is limited,
protocols to keep the supply may include postponing
the non-urgent procedures or visits that
would necessitate the use of PPE and directing the use of certain PPE to the highest
risk ptns.
Careful
extended or limited reuse of PPE
and decontaminated PPE for reuse can
also be carefully considered in select cases. To limit the spread of COVID-19, environmental
infection control measures should
be applied in both health care and home situation.
Only the products permitted by the Environmental
Protection Agency (EPA) for emergently appeared viral pathogens should
be utilized. OPD ptns with suspected/confirmed COVID-19 (including ptns awaiting test
results) who do not require hospitalization should be at home & be separated
from others. Other protocols to help preventing the transmission within the
household include use of masks, not to
share items with others e.g. dishes, towels,
& bedding, with contact surface disinfection.
Most ptns with COVID-19, non-test-based protocols should be
used to inform when infection control precautions could be withdrawn. The specific criteria rely
primarily on disease severity and the magnitude of specific co-morbidities.
Test-based protocols can also be used to withdraw precautions in selected
settings; however, the decision to use this approach must be individualized,
since some ptns have persistently +ve PCR testing for SARS-CoV-2. If ptns are ready to be discharged
home before meeting criteria for holding the precautions, they can be sent home
with instructions of self-isolation until the necessary criteria have been met. Once
infection control precautions/home isolation are discontinued, ptns should
still continue to follow the standard public
health precautions for wearing masks in
public places.
REFERENCES
1.
Centers
for Disease Control and Prevention. 2019 Novel coronavirus, Wuhan, China.
Information for Healthcare Professionals.
https://www.cdc.gov/coronavirus/2019-nCoV/hcp/index.html (Accessed on February
14, 2020).
2.
World
Health Organization. Novel Coronavirus (2019-nCoV) technical guidance.
https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance
(Accessed on February 14, 2020).
3.
Centers
for Disease Control and Prevention. Interim Infection Prevention and Control
Recommendations for Healthcare Personnel During the Coronavirus Disease 2019
(COVID-19) Pandemic.
https://www.cdc.gov/coronavirus/2019-nCoV/hcp/infection-control.html (Accessed
on July 02, 2020).
4.
World
Health Organization. Infection prevention and control during health care when
novel coronavirus (nCoV) infection is suspected. January 25, 2020.
https://www.who.int/publications-detail/infection-prevention-and-control-during-health-care-when-novel-coronavirus-(ncov)-infection-is-suspected-20200125
(Accessed on June 30, 2020).
5.
Infectious
Diseases Society of America guidelines on infection prevention for health care
personnel caring for patients with suspected or known COVID-19.
https://www.idsociety.org/globalassets/idsa/practice-guidelines/covid-19/infection-prevention/idsa-covid-19-guideline_ip_version-1.0.pdf
(Accessed on April 29, 2020).
6.
World
Health Organization. Transmission of SARS-CoV-2: Implications for infection
prevention precautions.
https://www.who.int/publications/i/item/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution-recommendations
(Accessed on July 10, 2020).
9.
Infectious
Diseases Society of America. COVID-19 Prioritization of Diagnostic Testing.
https://www.idsociety.org/globalassets/idsa/public-health/covid-19-prioritization-of-dx-testing.pdf
(Accessed on March 22, 2020).
10.
United
States Centers for Disease Control and Prevention. Duration of isolation and
precautions for adults with COVID-19.
https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolation.html (Accessed
on July 24, 2020).
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