Coronavirus disease (COVID-19) technical guidance by WHO Infection prevention and control | Page 2

Infection prevention and control during health care when COVID-19 is suspected: interim guidance
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wash hands with soap and water when they are
visibly soiled.
The rational, correct, and consistent use of PPE also helps
reduce the spread of pathogens. PPE effectiveness depends
strongly on adequate and regular supplies, adequate staff
training, appropriate hand hygiene, and appropriate human
behaviour. 2,5,6,7
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It is important to ensure that environmental cleaning and
disinfection procedures are followed consistently and
correctly. Thoroughly cleaning environmental surfaces with
water and detergent and applying commonly used hospital-
level disinfectants (such as sodium hypochlorite) are effective
and sufficient procedures. 8 Medical devices and equipment,
laundry, food service utensils, and medical waste should be
managed in accordance with safe routine procedures. 2,9
3.
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Implementing empiric additional precautions
3.1 Contact and droplet precautions
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a
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in addition to using standard precautions, all
individuals, including family members, visitors and
HCWs, should use contact and droplet precautions
before entering the room of suspected or confirmed
COVID-19 patients;
patients should be placed in adequately ventilated
single rooms. For general ward rooms with natural
ventilation, adequate ventilation is considered to be
60 L/s per patient; 10
when single rooms are not available, patients
suspected of having COVID-19 should be grouped
together;
all patients’ beds should be placed at least 1 metre
apart regardless of whether they are suspected to
have COVID-19;
where possible, a team of HCWs should be
designated to care exclusively for suspected or
confirmed cases to reduce the risk of transmission;
HCWs should use a medical mask a
(for specifications, see reference 2);
HCWs should wear eye protection (goggles) or
facial protection (face shield) to avoid
contamination of mucous membranes;
HCWs should wear a clean, non-sterile,
long-sleeved gown;
HCWs should also use gloves;
the use of boots, coverall, and apron is not required
during routine care;
after patient care, appropriate doffing and disposal
of all PPE and hand hygiene should be carried out. 5,6
A new set of PPE is needed when care is given to a
different patient;
equipment should be either single-use and
disposable or dedicated equipment
(e.g. stethoscopes, blood pressure cuffs and
thermometers). If equipment needs to be shared
among patients, clean and disinfect it between use
for each individual patient (e.g. by using ethyl
alcohol 70%); 9
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HCWs should refrain from touching eyes, nose, or
mouth with potentially contaminated gloved or bare
hands;
avoid moving and transporting patients out of their
room or area unless medically necessary. Use
designated portable X-ray equipment or other
designated diagnostic equipment. If transport is
required, use predetermined transport routes to
minimize exposure for staff, other patients and
visitors, and have the patient wear a medical mask;
ensure that HCWs who are transporting patients
perform hand hygiene and wear appropriate PPE as
described in this section;
notify the area receiving the patient of any necessary
precautions as early as possible before the patient’s
arrival;
routinely clean and disinfect surfaces with which the
patient is in contact;
limit the number of HCWs, family members, and
visitors who are in contact with suspected or
confirmed COVID-19 patients;
maintain a record of all persons entering a patient’s
room, including all staff and visitors.
3.2 Airborne precautions for aerosol-generating
procedures.
Some aerosol-generating procedures, such as tracheal
intubation, non-invasive ventilation, tracheotomy,
cardiopulmonary resuscitation, manual ventilation before
intubation, and bronchoscopy, have been associated with an
increased risk of transmission of coronaviruses. 12,13
Ensure that HCWs performing aerosol-generating procedures:
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Medical masks are surgical or procedure masks that are flat or pleated
(some are like cups); they are affixed to the head with straps. 2
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perform procedures in an adequately ventilated
room – that is, natural ventilation with air flow of at
least 160 L/s per patient or in negative- pressure
rooms with at least 12 air changes per hour and
controlled direction of air flow when using
mechanical ventilation; 10
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. 2,13 When HCWs
put on a disposable particulate respirator, they must
always perform the seal check. 13 Note that facial hair
(e.g. a beard) may prevent a proper respirator fit; 13
use eye protection (i.e. goggles or a face shield);
wear a clean, non-sterile, long-sleeved gown and
gloves. If gowns are not fluid-resistant, HCWs
should use a waterproof apron for procedures
expected to create high volumes of fluid that might
penetrate the gown; 2
limit the number of persons present in the room to
the absolute minimum required for the patient’s care
and support.