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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.   

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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).

7.    Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA 2020; 323:1061.

8.    McMichael TM, Clark S, Pogosjans S, et al. COVID-19 in a Long-Term Care Facility - King County, Washington, February 27-March 9, 2020. MMWR Morb Mortal Wkly Rep 2020; 69:339.

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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