What Healthcare Professionals Need to Know About the Coronavirus COVID-19 (Part 3)
February 19, 2020
From December 31, 2019 through January 3, 2020, a total of 44 case-patients with pneumonia of unknown etiology were reported to the World Health Organization (WHO) by national authorities in China. The Chinese quickly isolated a new coronavirus on January 7, 2020, and by January 20, 2020, there were 282 confirmed infected cases. The new virus was first detected in Wuhan City, Hubei Province, China, and continues to spread throughout the mainland there. Just a little over a month later, this novel coronavirus, named COVID-19, has now infected over 42,000 people in China, causing 1,107 deaths there, and has spread globally to 25 other countries. One person has now died in the Philippines. This coronavirus is a public health emergency of international concern.
We Are Still Learning About this Virus
At this point in time, there is limited information about the coronavirus in terms of disease severity, transmission efficiency, and shedding duration of COVID-19, and scientists continue to investigate this.
Understand Transmission and Safeguard Against It
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. “There have been reports of spread from an infected patient with no symptoms, to a close contact” (CDC, 2020). 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. It is currently unclear if COVID-19 can be transmitted when touching a surface where droplets landed, and then touching your mouth, nose, or eyes. Therefore, recommendations for PPE include the use of N95 respirators, gloves, eye shields, and gowns.
Recommendations for Infection Control & Prevention
Follow these important steps throughout the continuum of care for infection control and prevention:
ü 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.
ü Upon arrival at any facility, make sure the patient complies with respiratory hygiene precautions including cough etiquette and hand hygiene.
ü Patients with symptoms of suspected COVID-19 should not wait among other patients in the waiting area. Instead, they should be placed in a well-ventilated space that separates them from others by 6 or more feet. 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.
ü Rapidly triage patients who are identified as being at risk for COVID-19 (symptoms of lower respiratory illness, travel to China, or contact with an infected person). Recommendations:
o Cover their nose and mouth with a mask if not already done
o Place them in an airborne infection isolation room (AIIR) if available.
o Inform infection control personnel as well as local and state public health authorities. Have numbers on hand to facilitate prompt communication.
ü Use Standard Precautions
o Assume that every patient is potentially infected or colonized with a potentially transmissible pathogen.
o Perform hand hygiene with alcohol-based hand scrub before and after all patient contact and before donning and doffing PPE.
o Use soap and water for a 20-second wash if hands are visibly soiled.
ü Use Airborne Precautions
o “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 entry into the patient room or care area” (CDC, 2020). All healthcare personnel must be fit-tested to ensure a good fit. (NIOSH).
ü Use Contact Precautions
o Use gloves and a clean isolation gown before entering the room. Discard disposable gowns and gloves after each use and launder cloth gowns.
o 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.
ü If hospitalization is required, transfer to a facility with an AIIR. 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.
o Keep a log of all persons entering the AIIR.
o Limit healthcare personnel to minimize transmission risk.
ü All visitors should be monitored, managed, restricted, and trained.
ü Discontinuation of isolation precautions must be determined in collaboration with the local, state, and federal health authorities on a case-by-case basis.
ü If discharged to home because it is both medically and socially appropriate to do so, follow the health department’s recommendations for infection control in the home setting.
ü 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.
This blog post is an excerpt from a HealthStream white paper, What Healthcare Professionals Need to Know About the Coronavirus, about the global healthcare threat posed by the coronavirus COVID-19. It includes references that will provide you with detailed information that you need should you suspect COVID-19 or must manage confirmed cases. HealthStream put together this basic high-level information as an initial primer for healthcare professionals who want to know more about the coronavirus threat. As with any emerging infection, make sure that you become familiar with the resources available on the CDC website. The CDC updates information there as they learn it, so checking in daily and setting up an email notification for updates is strongly recommended.