Amongst the anxiety and misinformation about how best to protect healthcare staff from infection and the profusion of minorly conflicting State, National and Medical Specialist society advice, it is important that healthcare organisations and staff, in particular, appreciate and apply the basics of infection prevention & control (IPC). There is good evidence from China, Hong Kong and Singapore that IPC is highly effective at virtually eliminating SARS-COV-2 transmission to healthcare staff. A similar situation occurred early in the HIV pandemic with demands for special (or vertical) infection control measures that played down the greater impact of precautions applied to everyone (horizontally).
This WHO Guidance (19/3/20) provides a good overview: Infection prevention and control during health care when COVID-19 is suspected. Five strategies are listed:
1. Triage, early recognition, and source control (isolating patients with suspected COVID-19)
2. Applying standard precautions for all patients (below)
3. Empiric additional (transmission-based) precautions for suspected cases of COVID-19
4. Implementing administrative controls
5. Implementing environmental and engineering controls
What are standard precautions (SP) and why are they so important?
Standard precautions (Table) protect healthcare staff from contact and droplet transmission across the board, regardless of patient infection status. SP will prevent exposure/infection from asymptomatic or pre-symptomatic carriers of SARS-COV-2 if physical distancing occurs during consultation and use of masks (by source and HCW) occurs during close physical examination.
Additional transmission-based precautions (gown, gloves, eye protection and mask) provide additional protection when the COVID-19 status of a patient is known . Refer to WHO guidance below for further information.
Personal work clothing hygiene is also an important component- ensure your clothing (uniform or scrubs preferred) is clean every day and is removed after the shift for washing (preferably at work). Showering after the day of work is a good routine practice. Wash clothes on a normal cycle and dry either in a dryer or in the sun. Hot wash not required.
- WHO Operation Guidance document (19/3/20) is seminal: Operational considerations for case management of COVID-19 in health facility and community
- WHO Technical Guidance website
- Reliable source for questions: Q&A on infection prevention and control for health care workers caring for patients with suspected or confirmed 2019-nCoV.
- Australian IPC Guidelines (NHMRC) : including links to posters