Table 2 Summary of 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