COVID-19 – Infection Prevention and Control

General IP&C Guidance

Horizon IP&C Policies

Donning and Doffing

SJRH Emergency Department IP&C Guidance

External IP&C Resources and Evidence

IP&C Research

SJRHEM

 


 

Active Screening for Emergency Department Staff before Shift

At shift handover ask the following questions:

  • Do you have any Influenza Like Illness symptoms?
  • Have you reviewed the SJRHEM COVID webpage and Daily Updates?
  • Have you read the Donning-Doffing Posters?
  • Are you aware the Donning and Doffing requires a Buddy?

 


COVID-19 Routes of Transmission

Currently what we know is that among humans, Coronaviruses are most readily transmitted via respiratory droplets produced when an infected person coughs or sneezes, similar to how influenza and other respiratory pathogens spread. Presently these respiratory infections are managed in our healthcare settings following IP&C Droplet/Contact Precautions.

COVID-19 is a rapidly evolving outbreak and this guidance is based on the information available about this illness related to disease severity, transmission efficiency, and shedding duration. It will be revised and updated as more information becomes available and as our response needs change.


Hierarchy of Controls

 


Aerosol Generating Medical Procedures

Aerosol Generating Procedures

An AGMP is any procedure conducted on a patient that can induce production of aerosols of various sizes, including droplet nuclei. Examples include:

  • non-invasive positive pressure ventilation (CPAP and BiPAP)
  • high-flow nasal cannula (Optiflow, AIRVO or equivalent)
    • these devices provide flow to patients, at 40-60 litres per minute; heated and humidified to standard body temperature and pressure. This may also be referred to as Heated High Flow or Heated High Flow Nasal Oxygen.
  • bag-mask ventilation
  • endotracheal intubation and related procedures (e.g., extubation, manual ventilation, open endotracheal suctioning)
  • cardiopulmonary resuscitation (CPR)
  • bronchoscopy
  • open suction of respiratory tract
  • sputum induction
  • nebulizer therapy/ aerosolized medication administration
  • mechanical ventilation
  • high frequency oscillatory ventilation
  • tracheostomy care
  • chest physiotherapy
  • nasogastric Tube (NG) Insertion
  • Cough Assist Machines
  • Home CPAP/BiPAP in Hospital
  • Autopsy
  • Transesophageal echocardiogram
  • Gastroscopy
  • Laryngectomy care and management, including:
    • surgical voice restoration (voice prosthesis changes; and open stoma inspection)
    • communication management/assessment with laryngectomy patients due to risk of coughing

The use of an Airborne Infection Isolation Room (AIIR) is the recommended standard of care when performing an AGMP. If an AIIR is not available, a single room with the door closed should be used for the procedure.

An AGMP should only be performed on a suspect/confirmed patient when all HCWs in the room are wearing a fittested, seal-checked N95 respirator, gloves, gown and goggles or face shield.

 


Horizon – Infection Prevention & Control Guidance for The Management of Suspect / Confirmed COVID-19 Patients – April 14 2020 – Version 3

Point of Care Risk Assessment (PCRA) Prior to every patient interaction, Healthcare workers (HCWs) have a responsibility to perform a PCRA to assess the infectious risk posed to themselves and others. A PCRA will help determine the correct PPE required to protect the HCW in their interaction with the patient and patient environment. •

  • The PCRA is based on the HCWs professional judgment (i.e. knowledge, skills, reasoning and education) about the clinical situation as well as up-to-date information on how the healthcare facility has designed and implemented engineering and administrative controls and the use and availability of PPE.
  • PCRA is an activity implemented by the HCW in all healthcare facilities to evaluate the likelihood of exposure to them and others to infectious agents (e.g., COVID-19) o Every HCW will;
    • Assess the risk involved in the specific interaction,
    • Assess the risk involved with a specific task,
    • Assess the risk involved with a specific patient,
    • Assess the risk involved in the specific environment, and
    • Assess the risk involved in the specific available conditions.
    • Select the appropriate actions and/or PPE to minimize the risk of exposure for the specific patient, other patients in the environment, the HCWs, visitors and others.

Version 3 – Table Below:

 

Full Document Download

 


Donning and Doffing PPE

  • When removing PPE, always start by first applying alcohol-based hand sanitizer to your gloves.
  • After fully removing PPE, sanitize hands and wrists with alcohol-based hand sanitizer again.

  • Note that we recommend also wearing a scrub hat,cap or bonnet to reduce risk of fomite transmission

 

Official Dalhousie Donning and Doffing Video

 

 

 

 


SJRH Emergency Department Patient & Staff IP&C Flow Map

Traffic Flow

(March 13, 2020)

COVID- 19:

  • Triaged at main ED vestibule
  • Travel the patient corridor until back entrance to RAZ à into the unit
  • For external procedures travel down the public corridor following all precautions

Clean patients needing x-ray or other external sever (ambulatory or via Porter)

  • Out internal RAZ doors (11.523) and travel down the main staff corridor
  • Returning via the staff corridor and can us AMB intercom for Safety service to provide re-entry

ED Staff / physicians

  • Travel the main staff corridor and loop back into the public corridor (11.161)
  • Will use the new card access doors to gain entrance to the “anti-room”

EMS

  • Any suspect case to park at the ED main entrance and use the established path to the Covid-19 Unit via the public corridor

Inpatient and Visitor traffic

  • All this traffic will be filtered through the main entrance
  • After hours that will be monitored by Safety services

 

Control points

  • Main staff corridor
  • RAZ- back entrance (main staff entrance to Covid-19 space)
  • RAZ – emergency exit into staff corridor (access needs to be restricted)
  • New access point @ link corridor (by ED conference room)
    • Need lists for who will be provide access
  • Public hall by RAZ waiting room entrance
    • Option 1- physical barrier with wall and door (bed accessible)
    • Option 2 – staff presence

CAEP PPE and Wellness Town Hall