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Table 2 Summary of infection prevention and control measures

From: Preparing your intensive care unit for the COVID-19 pandemic: practical considerations and strategies

  Infection prevention and control measures
General measures Develop robust risk stratification criteria
Actively identify and isolate patients suspected to have COVID-19
Effective contact tracing
Rapid laboratory diagnostic testing
Care for suspected or confirmed cases in negative pressure AIIR—patients to wear face masks until transfer to AIIRs
Strict hand hygiene and standard precautions
Staff PPE requirements
For all patients: droplet and standard precautions, with additional airborne precautions when performing aerosol-generating procedures
For suspected/known COVID-19 patients: droplet, contact, and airborne precautions
Fit testing for all staff using N95 respirators
Staff training (and re-training) for appropriate use, donning, and removal of PPE, with pictorial guides and videos where applicable
Stockpile PPE and consumables for infection control
Single-use items for patients (e.g. disposable blood pressure cuff)
Disinfect shared equipment after use
Provision of (disposable) staff scrub suits in isolation wards
Appropriate handling of medical waste
Hospital issued guidelines for infection prevention, including handling of patient specimens and care of the deceased patient
Staff segregation and physical distancing
Centrally tracked staff surveillance (e.g. temperature monitoring) and access to designated staff clinics
Reduce face-to-face encounters with patients (e.g. video monitoring, telemedicine, wearables for vital sign monitoring)
Minimise patient movement or transport
Exclude visitors to patients with suspected or known COVID-19
Restrict unnecessary attendance at hospitals (e.g. medical students, members of public, research coordinators)
Minimise or postpone elective admissions and operations
Droplet and Contact PPE:
Surgical mask, eye protection, disposable gown, gloves, and cap
Droplet, Contact and Airborne PPE:
N95 respirator (consider PAPR use), eye protection, disposable gown, gloves, and cap
Aerosol-generating procedures Perform aerosol-generating procedures only in presence of a clear clinical indication
Consider alternative therapy (e.g. inhaled medications by metered dose inhaler and spacer rather than nebulised therapy)
Consider conventional oxygen therapy (instead of NIV and HFNC) and early intubation for COVID-19 pneumonia
Airborne precautions
Issue hospital guidelines on aerosol-generating procedures
Consider the use of PAPR if available and staff are trained in its use
Procedure to be done in AIIR or single room
Limit staff involved in aerosol-generating procedures
Limit duration and exposure during aerosol-generating procedures (e.g. stop ventilation before circuit disconnection)
ICU-specific measures Consider high-efficiency particulate air (HEPA) filters at (Fig. 2)
• Expiratory port of breathing circuit
• Bag-valve-mask interface
• NIV mask interface
Use heat and moisture exchanger (HME) instead of a heated humidifier
Use closed, in-line suction of tracheal tubes
Measures to reduce dispersion of aerosols during intubation (Table 3)
Use of single-use equipment (e.g. bronchoscopes)
Segregate ICU equipment (e.g. ultrasound machines)
Incorporation of infection control measures into ICU workflows (e.g. cardiac arrest and rapid response teams, transport, emergency operations and procedures)
In situ simulation sessions
  1. COVID-19 coronavirus disease 2019, AIIR airborne infection isolation room, PPE personal protective equipment, PAPR powered air-purifying respirator, NIV non-invasive ventilation, HFNC high-flow nasal cannula therapy, ICU intensive care unit