Safety for Healthcare Workers and Their Patients during COVID-19 Pandemic

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Published on Apr 27th, 2020

Whose guidance should the healthcare workers (HCWs) follow regarding COVID-19?

Reference WHO, CDC, the state medical board, professional societies, and federal, state, and the local authorities daily for new rules and legislations. The situation is continually changing, and HCWs need to stay up-to-date with the most current knowledge and guidelines regarding COVID-19.

What kind of screening and testing should the patient receive if there is suspected COVID-19?

Follow the CDC’s patient assessment protocol for early disease detection. Patients should be screened using the CDC’s priorities for testing patients with suspected COVID-19 infection.

What kinds of screening tests are available for patients who have suspected COVID-19 infections?

There are two types of screening tests, RT-PCR and antibody tests, available for COVID-19 screening.

How should physicians triage suspected COVID-19 patients or persons under investigation “PUI”?

The CDC recommends ways other than face-to-face triage and visits, such as phone screening, telemedicine, or online questionnaires. See CDC’s “Healthcare Facilities: Preparing for Community Transmission” and COVID-19 Telehealth Resource Center for guidelines and assistance. Check with your local public health authorities for designated locations to triage PUIs so that you can limit exposures to general medical offices.

What measures should a medical practice take to prepare for COVID-19 patients?

There are many ways physicians can prepare their practices for COVID-19 patients. They include:

  • Postponing all nonessential or elective healthcare visits and group activities. For diagnostic and therapeutic interventions, including surgical procedures, the CDC provides recommendations for specific settings, including outpatient and inpatient facilities. American College of Surgeons provides suggestions on triage and management of surgical cases. Please also check with state and local regulatory agencies for any related mandates.
  • The physician should notify PUI or suspected COVID-19 patients of following new guidelines of the clinic through physical signs and phone messages to follow their local guidelines such as social distancing or stay-at-home rules to keep themselves and others safe.
  • Require your patients to sit at least 6 feet apart in the office or stay in their car while waiting if possible. Remove magazines and toys from the common areas and routinely disinfect the waiting room to lower possible risks of infection.
  • Designate a particular room or rooms to conduct evaluations of suspected COVID-19 cases individually. Have patients with suspected COVID-19 infections to enter the office in a different way, such as the back entrance, from other patients.
  • Once PUIs are inside the facility, instruct them to put on a face mask, utilize tissues and hand sanitizers, practice good hygiene, and dispose of waste in designated areas. WHO provides many educational resources for the general public.
  • All HCWs who interact with PUIs should wear personal protective equipment (PPE), including gloves, gowns, protective eyewear, and NIOSH-certified N95 respirators that have been properly fit-tested. If there is a shortage of PPE at your site, consult CDC’s resource page. Screen healthcare personnel daily for symptoms relevant to COVID-19.
  • Minimize staff exposure to PUIs. Ideally, the exam room for PUIs should be at the back of the office, far away from other staff members and patients.
  • Physicians should decide which patients would require screening tests based on symptoms, history, and community disease transmission. The physician should also contact the state or local health department to coordinate testing with available resources.
  • Physicians should also maintain records of staff-patient contact documenting in which staff members worked with a specific patient in the medical record.
  • Once each patient leaves the room, disinfect the room while the staff is still wearing PPE.

What are the steps to clean soiled bedding, towels, and linens from patients with COVID-19?

  1. Wear appropriate PPE, including gloves, mask, eye protection, long-sleeved gown, apron, and closed shoes, before touching soiled linen.
  2. Never carry soiled linen against the body; place soiled linen in a clearly labeled, leak-proof container.
  3. Scrap solid excrement like feces or vomit with a flat, firm object and put it in the toilet before putting linen in the designated container.
  4. Wash and disinfect linen: Washing linens by machine with warm water (60-90°C) and laundry detergent is the ideal way to disinfect linens. Soaking the linens in 0.05% chlorine is an alternative way to clean linens if warm water is not available.

What should PPE HCWs performing nasopharyngeal (NP) or oropharyngeal (OP) swabs on PUIs use?

Suitable PPE for HCWs doing NP and OP swab specimens from suspected or confirmed COVID-19 patients include a clean, non-sterile, long-sleeve gown, a medical mask, eye protection, and gloves. The HCW can request the PUIs to cover their mouth with a medical mask or tissue during an NP specimen collection.

Can patients with suspected or confirmed COVID-19 infections be cohorted in the same room?

Ideally, suspected and confirmed COVID-19 patients should be isolated in single rooms. However, cohorting is acceptable if there are not enough rooms available. Some patients with suspected COVID-19 infections may have other respiratory diseases, and they should be cohorted separately from patients with confirmed COVID-19 infections. There should be a minimum 1-meter distance between beds.

Should physicians hospitalize patients with suspected or confirmed COVID-19 infection if the symptoms are mild?

No. Patients who only have mild symptoms like low-grade fever, cough, rhinorrhea, and sore throat do not need to be hospitalized unless there is a concern for rapid clinical deterioration.

What are the recommended disinfectants for environmental cleaning in COVID-19 infection?

Currently, the WHO recommends two types of disinfectants:

  1. 70% ethyl alcohol to disinfect reusable dedicated equipment between uses
  2. Sodium hypochlorite at 0.5% (equivalent 5000ppm) for disinfection of frequently touched surfaces in homes or healthcare facilities

More information about environmental cleaning can be found here.

Is there a particular procedure regarding waste produced by patients with suspected or confirmed COVID-19?

No. One should treat waste produced by patients with suspected or confirmed COVID-19 infection as infectious waste. For more information on how to deal with infectious waste, WHO has a publication that talks about the proper steps to do so.

Are there special procedures for the management of bodies of those who died from COVID-19?

No, there are no special procedures for the management of bodies of persons who have died from COVID-19, according to WHO. HCW should refer to protocols from their medical facilities on postmortem management on people who have died from infectious diseases.

Should blood centers routinely screen blood products for the COVID-19 virus?

Since COVID-19 is a respiratory virus, they do not spread via blood transfusion, and, thus, there is no need to screen blood products for COVID-19. As precautionary measures, the blood centers should ask people with known COVID-19 infections or recent contact or travel from refraining from donating blood to prevent community spread of COVID-19 virus.

What kind of educational materials can health care providers provide to the PUIs and their family members?

Provide up-to-date information on COVID-19 to the PUIs and their close contacts, on how to follow infection-control practices at home, such as hand hygiene, in-home isolation, cough etiquette, waste disposal, and face mask use. Remind PUIs and their families to access information about the COVID-19 through reliable sources like CDC and WHO instead of social media.

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