Infection Control


MINIMIZE EXPOSURE

  • Limit or postpone non-essential appointments in symptomatic patients by rescheduling them as phone appointments.
     
  • Practice and teach cough etiquette.
     
  • Use physical barriers (ex: glass or plastic windows) where possible.
     
  • Triage symptomatic patients upon entry to the clinic.
     
  • Practice hand hygiene before and after patient interaction.
     
    • Wear PPE when appropriate (see PPE section below)
       
  • If you develop symptoms, stay at home. Call your occupational health and safety or infection control office for instructions and how to be screened for COVID-19.

 

PERSONAL PROTECTIVE EQUIPMENT

ppe_article



Current guidelines according to CDC (Updated March 19, 2020)1
 

DONNING& DOFFING TECHNIQUES

  • Refers to dressing and undressing PPE
     
  • Please see videos for donning and doffing HERE
     
  • NOTE: doffing is a potentially high-risk maneauver that may result in contamination of self or others.
     
  • Use a buddy system (spotter) if available.
     
  • For routine care of patients suspected or confirmed to have COVID-19 (Droplet/contact precautions):
    • Wear an fluid resistant Level II gown, goggles or face shield for eye protection, and surgical mask.
       
  • Please refer to your site-specific training for donning and doffing techniques. All healthcare personnel should have training as well as up-to-date respirator mask-fit testing.
     
  • Click HERE for an infographic


HOW TO CONSERVE PPE (e.g.N95 masks)

  • Make sure you use the right type of PPE for every situation (See infographic)
     
  • Droplet/Contact Precautions – Unlike measles or tuberculosis, COVID-19 is unlikely to spread through airborne transmission. Healthcare workers wearing appropriate droplet/contact PPE (eye protection, surgical mask, gown, gloves) are unlikely to acquire the virus when providing routine care for patients with COVID-19.
     
  • N95s should only be used in anticipation of an Aerosol Generating Medical Procedures (AGMPs), and used in conjuction with droplet and contact precautions.
     
  • Minimize the number of staff entering the room of patients on precautions.
     
  • Avoid unnecessary or inappropriate use of PPE – follow IPAC recommendations and clarify policies as needed.
     
  • Practice social distancing whenever possible, with exception to delivery of care. Limit visitors to the hospital and encourage alternative mechanisms to interactions such as video calls.

Reuse of PPE (controversial)

  • Reuse of N95 respiratory (controversial) - Some centers allow for respirator extended use or reuse as long as they are not grossly contaminated or damaged. Wear N95 masks and not take them off for as long as possible to avoid having to get a new one.1
     
  • Many decontamination processes have been previously described. Of which ultra-violet germicidal irradiation and ethylene oxide treatment showed no discernable effect on damaging the N95 respirator.2
     
  • Reuse of face shields (controversial) - Some centers allows face shields to be wiped down and reused for the day as long as they are not grossly contaminated or damaged.
     
  • Repurpose anesthesia mask and ventilator filter as an alternative to N95 respirators if a shortage exists (described but not approved in 3).
     
  • 3D printing protective equipment may alleviate shortages; however, more research and outsourcing is required.
     

WHEN DO PATIENTS NEED PPE

  • Any patient suspected or confirmed to have COVID-19 or any other respiratory viral infection should don a Level I procedure mask (also termed a medical mask) to minimize contamination of the environment.

 

AEROSOL GENERATING EVENTS

Contact, Droplet and Airborne Precautions

  • Airway procedures
     
    • Endotracheal intubation & extubation
       
    • Open airway suctioning
       
    • Cardiopulmonary resuscitation (CPR) not including first responder chest compressions
       
    • Cricothyroidotomy
       
    • Non-invasive positive pressure ventilation (NIV) for acute respiratory failure (CPAP, BiPAP)
       
    • High flow oxygen therapy (HFNO)
       
    • Sputum induction (Diagnostic or Therapeutic)
       
  • Surgical Procedures
     
    • Tracheostomy
       
    • Bronchoscopy (Diagnostic or Therapeutic)
       
    • Autopsy

 

FAQs

Use of Cell Phone

  • It is essential to clean multiuse devices, such as cell phones, when using them in clinical areas. Please refer to your specific manufacturer’s guidelines. If you have an iPhone, please click here (updated March 09, 2020)
     

PPE and patient transport

  • Each institution will have guidelines regarding patient transport. The use of an N95 respirator will depend on the likelihood of exposure to aerosols. If low risk and minimal exposure to head and face, standard droplet/contact precautions are encouraged.
     

Contaminant Removal after a patient encounter

  • Room decontamination time after cleaning is multifactorial; thus, no specific timeline can be given. We have attached here the CDC table for contaminate removal; however, suggest following site-specific guidelines.