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Obedience to Standard, Contact, and Airborne Safety measures, including the Use of Eye Protection

Standard Precautions presume that each person is potentially contaminated or colonized with a pathogen that could be transmitted in the healthcare setting. Standard Precautionary Elements applicable to patients with respiratory infections, including those caused by Covid-19, are listed below.

Education on proper use, proper donation (putting on) and doffing (taking off) and disposal of any PPE should be taken care. This document does not highlight all aspects of the Standard Precautions (e.g., injection safety) needed for all patient care; the full description is given in the Isolation Guideline

Patient Placement

Install a patient with known or suspected Covid-19 (i.e., PUI) in an AIIR built and maintained in compliance with current guidelines.

AIIRs are single-patient rooms with negative pressure compared to surrounding areas and with at least 6 air changes per hour (12 air changes per hour are recommended for new or revamped construction). Before recirculation, air from these rooms should be exhausted directly to the outside or filtered through a high-efficiency particulate air filter (HEPA). Room doors should be shut except when entering or exiting the room and there should be minimal entry and exit. Facilities should track and log those rooms ' proper negative-pressure work.

If no AIIR is open, patients requiring hospitalization should be moved to an AIIR facility as soon as possible. Ifthe patient does not need hospitalization, when considered medically and socially necessary, they may be discharged to the home (in conjunction with the state or local public health authorities). Pending transfer or discharge, place the patient in a facemask and isolate him ∕ her in an exam room with the door closed. Ideally, the patient should not be put in any space within the building where exhaust is re-circulated without HEPA filtration.

Once an AIIR is in operation, the facemask of the patient may be removed. Restrict the patient's travel and movement outside the AIIR to medically necessary purposes. If not in an AIIR (e.g. during travel, or if there is no AIIR), patients will wear a facemask to prevent secretions.

Personnel entering the room, as mentioned below, should use PPE, including respiratory protection;

The room should be accessed only by essential personnel. Implement personnel policies to reduce the number of HCP people entering the room.

Facilities will consider taking care of these committed HCP patients to reduce risk of transmission and exposure to other patients and other HCP patients.

Facilities should keep a log of all individuals who care for or access certain patients ' rooms or areas oftreatment.

Using ïîï-critical, dedicated or disposable patient care devices (e.g., blood pressure cuffs). When equipment is used for more than one patient, clean and disinfects this equipment according to manufacturer's instructions prior to use on another patient.

HCP should use respiratory protection when entering the room soon after a patient has vacated the bed. (See Personal Protective Equipment section below) The standard practice for airborne pathogens (e.g., measles, tuberculosis) is to prevent unprotected individuals, including HCP, from accessing a vacant space before sufficient time has elapsed for sufficient air changes to eradicate potentially infectious particles (more detail on clearance rates under various ventilation conditions).

We still don't know how long Covid-19 remains infectious in the soil. In the meantime, adding a similar time period before entering the room without respiratory protection as used for pathogens transmitted through the airborne route (e.g., measles, tuberculosis), is appropriate. The space should also undergo proper cleaning and surface disinfection before returning to daily use.

• Hand hygiene

HCP should perform manual hygiene using ABHS before and after all patient contact, contact with potentially infectious material, and before putting on and removing PPE, including gloves. Hand-hygiene in healthcare environments can also be done for at least 20 seconds by washing with soap and water. Use detergent and water before going back to ABHS, if the hands are visibly soiled.

Healthcare facilities should ensure that portable hygiene products are readily available at any place oftreatment.

• Personal protective equipment

Employers should pick suitable PPE equipment and provide it to HCP in compliance with OSHA's PPE regulations (29 CFR 1910 Subpart I). HCP must be educated and demonstrate an understanding of when to use PPE; what PPE is needed; how to properly donate, use, and doff PPE to avoid self-contamination; how to properly dispose of, or clean, and preserve PPE; and the drawbacks of PPE. Each reusable PPE will need to be properly washed, decontaminated and maintained after and between uses. Facilities should have policies and procedures outlining a prescribed sequence for secure dressing and doffing of PPE:

Gloves: perform hand hygiene, and then put on clean, ïîï-sterile gloves when entering the room or treatment area of the patient. If they get ripped or become highly polluted, change gloves. Before entering the patient's room or treatment area, remove and discard the gloves and practice hand hygiene immediately.

Gowns: put on a clean gown of insulation upon entering the room or region of the patient. If it gets soiled remove the robe. Remove and dispose of the gown in a designated waste or linen tub before leaving the room or treatment area for the patient. You will remove the disposable gowns after use. After each use cloth gowns should be laundered.

Respiratory Protection : Using respiratory protection (i.e., respiratory protection) that is at least as safe as a fit-tested disposable N95 NIOSH-Certified respiratory face piece filter when entering the patient room or treatment area. See appendix for interpretation of respirator. Upon leaving the room or treatment area of the patient, and closing the door, remove and discard disposable respirators. Perform cleaning by hand after the respirator has been removed. When reusable respirators (e.g., powered air purifying respirator ∕ PAPR) are used, they must be washed and disinfected prior to re-use in compliance with manufacturer's reprocessing instructions. Respiratory use must be in compliance with the Occupational Safety and Health Administration (OSHA) Respiratory Protection Code (29 CFR 1910.134 external icon) in the form of a full respiratory protection programme. Staff should be properly washed and fit- tested when using respirators with tight-fitting face parts (e.g., a NIOSH-Certified disposable N95) and qualified in proper respiratory usage, safe removal and disposal, and medical
contraindications for respiratory use.

Eye Protection: Using eye protection (e.g. goggles, face mask that protects the front and side of the face) when entering the patient room or treatment area. Disable the eye protection before leaving the room or area of treatment for the patient. Reusable eye protection (e.g., goggles) must be washed and disinfected according to the reprocessing instructions given by the manufacturer before re-use. Upon use, the eye cover should be removed.

Use caution to produce infectious aerosols while conducting aerosol-generating procedures Some of the procedures performed on Covid-19 patients. In particular, procedures which are likely to induce coughing (e.g., induction of sputum, open suction of airways) should be performed with caution and avoided where possible.

Such procedures should take place in an AIIR if performed and staff should use respiratory protection as mentioned above.

Additionally:

Restrict the number of HCP present during the procedure to only those required for patient care and procedural assistance.

Clean and disinfect surfaces of the procedure room promptly as defined in the section below on the control Ofenvironmental infections.

Respiratory Diagnostic Specimen Collection

Collection of diagnostic respiratory specimens (e.g., nasopharyngeal swab) can cause coughing or sneezing. Ideally, people in the room during the treatment should be confined to the specimen being collected by the patient and by the health care provider.

HCP collecting Covid-19 test specimens from patients with known or suspected Covid-19 (i.e., PUI) will adhere to Normal, Contact and Airborne Precautions, including the use of eye care. Such tests should be performed in an AIIR or in a closed-door exam room. Ideally, the patient should not be put in any space within the building where exhaust is re-circulated without HEPA filtration.

Length of Isolation Precautions for PUIs and confirmed Covid-19 patient's

Before information on viral shedding following clinical progress is available, discontinuation of isolation precautions should be decided on a case-by-case basis, in accordance with local, state and federal health authorities.

Factors to be considered include: the occurrence of Covid-19 symptoms, the date symptoms resolved, other conditions requiring specific precautions (e.g., tuberculosis, Clostridioides diffici), other clinical-related laboratory details, alternatives to inpatient isolation, such as the likelihood of safe recovery at home.

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Scientific source Sidney Osler. Coronavirus outbreak. All the secrets revealed about the Covid-19 pandemic. A complete rational guide of its Evolution, Expansion, Symptoms and First Defense. 2019

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