Embedded Files
Page 12
confirmed COVID-19 [57,64]. When using PPE, the correct donning and doffing process should be followed; further information on these procedures can be found in the ECDC Technical Document ‘Guidance for wearing and removing personal protective equipment in healthcare settings for the care of patients with suspected or confirmed COVID-19’ [65]. [66] Rational use of PPE and hand hygiene materials for the care and management of COVID-19 As of March 2020, countries worldwide that are facing COVID-19 are experiencing reduced access to PPE and hand hygiene materials [67]. An immediate priority has been set at EU level to ensure adequate production and supply of PPE for healthcare workers and patients, and a joint procurement process has been launched by the European Commission for interested EU Member States. Coordinated supply chains for PPE should ensure distribution of such materials to healthcare systems to reduce the potential for healthcare-associated transmission to vulnerable groups and to healthcare-workers [66] Cross-border supply and donations to highly affected areas should continue in order to decrease overall infection pressures in EU/EEA countries. The ECDC guidance document ‘Infection prevention and control for the care of patients with novel coronavirus in healthcare settings – 1st Update’ [60] highlights both best practice for PPE and also highlights options for hospitals and LTCFs that have limited access to such materials. The main priorities in this document for rational use are in concordance with detailed guidance published by WHO in February 2020 [68]. A nasopharyngeal swab is an aerosol-generating procedure (AGP), because, for example, it can induce coughing [69]. In order to maximize the use of available PPE in the event of insufficient stocks, staff should be allocated to perform a procedure, or set of procedures in designated areas. For example, designate staff for swabbing procedures in a dedicated swabbing area. Priorities for use of respirators (FFP2/3) · The highest priority is for healthcare workers, most particularly those performing AGP, including tracheal intubation, bronchial suctioning, bronchoscopy, and sputum induction. ECDC emphasises that taking a nasopharyngeal swab as part of a test for COVID-19 is an AGP; · Respirators can be used for up to 4 hours for multiple patients without removing them [68], unless the respirator is damaged, soiled or contaminated, for example a symptomatic suspected case coughing on them.; · In the absence of FFP2/3 respirators, healthcare workers should use masks with the highest available filter level; · If there is an insufficient stock of respirators, then staff engaged in environmental cleaning and waste management should wear a surgical mask, in addition to gloves, goggles and gown [66]. Priorities for use of surgical masks · The highest priority are for symptomatic confirmed cases of COVID-19, followed by suspected cases; · The next highest priority is for those caring for COVID-19 patients, if no respirators are available. Priorities for use of alcohol-based hand rub · Prioritise rigorous hand-washing practices using water and soap, ensuring access to hand-washing facilities; · If alcohol-based hand rub is not available, the highest priority is at the point-of-care, prioritising confirmed cases. If sufficient stocks are available, place in common areas with high footfall outside of designated COVID-19 areas. Priorities for use of other PPE and hand hygiene products · If insufficient quantities of gowns are available, use aprons; · If insufficient quantities of goggles and/or visors are available for the recommended uses described below, use products that can be decontaminated, if available. Otherwise, consider decontamination and reuse, consulting the guidelines of the manufacturer; · Regular cleaning followed by disinfection is recommended, using hospital disinfectants active against viruses, for rooms accessed by patients/residents, furniture and frequently touched surfaces. In the event of shortages of hospital disinfectants, decontamination may be performed using 0.1% sodium hypochlorite (dilution 1:50 if household bleach at an initial concentration of 5% is used) after cleaning with a neutral detergent, although no data are available for the effectiveness of this approach against COVID-19 [70]. Surfaces that may become damaged by sodium hypochlorite may be cleaned with a neutral detergent followed by a 70% concentration of ethanol; · In LTCFs with insufficient quantities of paper towels, use clean cloth towels and replace them regularly, washing them with a detergent such as household washing powder [71]. Clinical case management of COVID-19 cases Clinical presentation among reported cases of COVID-19 varies in severity from asymptomatic and subclinical infection or mild illness to severe or fatal illness. Some reports suggest there is the potential for clinical deterioration during the second week of illness. Chinese data suggest a severity profile of about 80% mild cases (including subclinical), 13-15% moderate to severe cases requiring oxygen supplementation and hospitalisation and up to 5% critically ill, requiring ICU support [16,25,72,73]. For a description of
Report abuse