and who encounter patients during admission, assessment, care,
housekeeping, specimen collection, and triage, for instance, must
implement infection control precautions. Identification and
isolation are essential in preventing unnecessary exposure among
patients, healthcare workers, and visitors. Detailed
recommendations can be found on the CDC website, Interim
Infection Prevention and Control Recommendations for Patients with
Suspected or Confirmed Coronavirus Disease 2019 (COVOD-19) in
Healthcare Settings.
At this point in time, scientists continue to study disease severity,
transmission efficiency, and shedding duration of COVID-19.
Considering what we know about SARs, MERs, and other viruses
such as influenza, transmission risk is more likely when symptoms
are present because shedding is more common during that time
with most viruses. What we do know now is that the virus spreads
easily from person to person, in fact, more efficiently than influenza
but not as efficiently as the measles. Some people without
symptoms may be able to spread the virus. This is why the
CDC has strongly advised social distancing. Most recently, those
who go out in public should wear a cloth mask to protect others.
The incubation period is estimated to be at about 5 days.
It is important to be mindful of the fact that when droplets of
various sizes enter the air through coughing or sneezing, they can
land in the mouths and noses of people nearby (within 6 feet) and
can then be inhaled. They can also land on surfaces and it may be
possible that a person can get COVID-19 from touching a
contaminated surface, then touch their eyes, nose or mouth.
Thus, hand hygiene is extremely important. This is also why
recommendations for PPE include the use of N95 respirators,
gloves, eye shields and gowns. Follow these important steps
throughout the continuum of care for infection control
and prevention:
� Persons who call a healthcare facility with symptoms of
respiratory illness should be advised to wear a mask prior to
arrival. If emergency medical services are transporting a patient
with respiratory illness, they should take appropriate protective
precautions and alert the receiving facility prior to arrival so they
can prepare.
� Install barriers to limit contact with patients at triage.
� Upon arrival at any facility, make sure the patient complies with
respiratory hygiene precautions including cough etiquette and
hand hygiene.
� Patients with symptoms of suspected COVID-19 should not wait
among other patients in the waiting area and should be placed in
a well-ventilated space with the door closed. They should be
provided with respiratory hygiene supplies. It is appropriate to
ask them to wait in their vehicle during the waiting time if they
can be contacted by phone when they are ready to be seen.
� Rapidly triage patients who are identified as being at risk for
COVID-19 (symptoms of lower respiratory illness, traveled from
a high risk area, or contact with an infected person).
• Cover their nose and mouth with a mask if not already done.
• Place them in an airborne infection isolation room (AIIR) if
available. AIIRs should be reserved for patients with
COVID-19 undergoing aerosol-generating procedures and for
other patients with airborne disease (e.g. tuberculosis,
measles, varicella).
• Inform infection control personnel and local and state public
health authorities. Have numbers at hand to facilitate prompt
communication.
� Use Standard Precautions assuming that every patient is
potentially infected or colonized with a potentially transmissible
pathogen.
• Perform hand hygiene with alcohol-based hand scrub before
and after all patient contact and before donning and doffing PPE.
• Use soap and water for a 20-second wash if hands are
visibly soiled.
� Use Airborne Precautions
• Use respiratory protection (i.e., a respirator) that is at least as
protective as a fit-tested NIOSH-certified disposable N95
filtering facepiece respirator before performing any aerosol-
generating procedures. All healthcare personnel must be
fit-tested to ensure a good fit (NIOSH).
� Use Contact Precautions
• Use gloves and a clean isolation gown before entering the
room. Discard disposable gowns and gloves after each use and
launder cloth gowns.
• Protect your eyes from accidental touching or droplets, by
wearing a face shield. If goggles are used, they must be
cleaned and disinfected after each use according to the
manufacturer’s instructions.
• Cohort patients with COVID-19.
• Limit the numbers of staff providing care to COVID-19 patients.
� If hospitalization is required, transfer to a facility with an AIIR.
AIIRs should be prioritized for patients who require aerosol-
generating procedures. Keep doors closed and minimize entry
and exit. Personnel should always wear appropriate PPE,
ensuring proper donning and taking care during PPE removal
to avoid self or surface contamination. Once in the AIIR, the
patient’s face mask may be removed but they should wear a
facemask if transport to another department or hospital
is required.
• Keep a log of all persons entering the AIIR.
• Limit healthcare personnel to minimize transmission risk.
After a patient is discharged from an AIIR, ensure that any
personnel entering the room don appropriate PPE because it is
not yet known how long the COVID-19 remains infectious in
the air.
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