Prevent & Control Infection

#### Contact

Contact: Spreads via direct contact with an infected patient or contaminated surface. Contact precautions reduce method of transmission.

Note: Covid-19 may survive on surfaces for 96 hours or longer. Decontaminate surfaces frequently using a diluted bleach solution by mixing 5 tablespoons (1/3 cup) bleach per gallon of water. Clean and disinfect high-touch surfaces frequently medical such as equipment, floors, tables, hard-backed chairs, doorknobs, light switches, phones, tablets, touch screens, keyboards, handles, desks, toilets, sinks. If a separate, designated bathroom is not available, bathrooms should be cleaned and disinfected after each use by personnel wearing best possible PPE, and waste considered hazardous, disposed according to theater hazardous waste policy.

#### Droplet

Droplet: Spreads via relatively large liquid particles that settle from the air quickly (within a few feet). Droplet precautions reduce transmission.

#### Airborne

Airborne: Spreads of via small liquid particles (aerosols) that remain suspended in the air for prolonged periods of time, traveling longer distances. Airborne precautions reduce transmission.

- Wash hands with warm, soapy water (for at least 20 seconds), or use alcohol hand sanitizer (allowing to dry) before and after patient care, after touching PPE, especially facemask, goggles.
- Healthcare personnel should use best available PPE and remove PPE with assistant when available to avoid cross contamination
- Decontaminate goggles, glasses, face shield with diluted bleach solution between uses
- Place the monitor, ventilator, and IV pumps upwind and as far away as possible from the patient to minimize exposure to medical personnel.
- For chest tube management, water seal closed chest drainage system preferable over dry seal/Heimlich valve due to aerosolization.

#### High-risk aerosolization procedures

- Sputum specimen obtained via cough, nasal or orotracheal suction, tracheal intubation, tracheal extubation (accidental or planned)
- Bag-valve mask ventilation, ventilator circuit disconnection, non in-line tracheal suctioning, tracheostomy, cricothyroidotomy, cardiopulmonary resuscitation (before intubation and connection to ventilator circuit)
- Surgical procedures involving the face, neck, or thorax

#### Personal Protective Equipment (PPE)

- Minimum: face covering, eye protection glasses, gloves, and makeshift gown. Note: for patients with low probability of disease and where direct contact with the patient, their secretions, or other bodily fluids is low, gowns may not be required (mirroring conventional droplet precautions).
- Routine Care: surgical mask or N95 mask, face shield (either standalone or with mask) and eye protection, gloves, gown (surgical or contact), head covering.

#### Aerosol Generating Procedures

- N95 mask (with or without surgical mask covering) with face shield or hood/face shield (e.g. CBRNE pro-mask) along with gown and gloves. Disposable head covering is also highly recommended.
- Eye protection glasses and face shields should be cleaned with a diluted bleach solution between uses.
- NIOSH recommends the following for extended use and re-use of N95 respirators:
- N95 masks should be discarded following aerosol generating procedures (e.g. intubation) or when visibly contaminated with bodily fluids.
- Consider using a large face shield that sits in front of the mask, wear a surgical mask over-top of the N95, and masking the patient to minimize contamination.