Infection from new coronavirus SARS-CoV-2 (COVID-19) – Guidance for Healthcare settings
All healthcare personnel working in the Accident & Emergency Dept (A&E) must wear a STANDARD SURGICAL MASK while at the A&E, according to NPHO’s guidelines (www.eody.gov.gr). Moreover, healthcare personnel outside the A&E, who may potentially handle a patient with a respiratory infection, regardless of its cause, must wear a STANDARD SURGICAL MASK. Doctors and all healthcare personnel must be up-to-date with the new coronavirus case definition, as provided in NPHO’s website (www.eody.gov.gr).
- Triage, recognition and isolation of suspected cases of COVID-19 infection
Triage aims at the early recognition of cases that fall into the definition of COVID-19 case, the assessment of infection severity and the restriction of virus spread to other patients, visitors and healthcare workers. Triage also safeguards health services provided to citizens.
Triage must be carried out before entrance to A&E, and specifically, at the hospital’s main gate office (container). A suitable poster with information to incoming individuals must be placed at the triage area. Trained personnel shall ask questions based on the definition of COVID-19 case. Patients who meet the suspected case criteria will be given a standard surgical mask and will be transferred to a separate waiting and examination area (isolation) with available infrastructure and materials for hand hygiene and respiratory hygiene practice, and, if possible, without going through A&E, while adhering to all necessary measures against virus spreading. Moreover, for best triage and early identification of suspected cases, we advice hospitals to keep only one entrance open for incoming patients.
- Handling of suspected case of new coronavirus SARS-CoV-2 infection
If a suspected case is identified, the following measures should be adopted:
- offer the patient a standard surgical mask to wear
- examine and treat the patient in a separate room
- personnel involved in patient management must implement standard precautions, contact precautions and droplet precautions
- the Hospital Infections Control Committee must be informed immediately
- the case must be immediately reported to the National Public Health Organization (tel. 210-5212054)
- Measures for prevention and control of SARS-CoV-2 infection
3.1. Standard precautions
Standard precautions include hand hygiene and respiratory hygiene, the use of personal protective equipment according to risk assessment, good handling of sharp objects, safe contaminated waste management, cleaning and disinfection of surfaces as well as sterilization of medical equipment and linen used by the patient.
Implementation of the following measures of respiratory hygiene is particularly important:
- offer a standard surgical mask to the patient
- ensure that everyone uses a tissue to cover their nose and mouth when coughing or sneezing
- perform hand hygiene after contact with respiratory secretions.
Of note, good and systematic use of the appropriate personal protective equipment along with hand hygiene practice is critical for reducing the spread of pathogens.
Furthermore, cleaning and disinfecting all surfaces with detergent and water as well as common disinfectants (e.g. sodium hypochlorite solution) is sufficient. Handling of linen, tableware and contaminated waste must be carried out according to standard, established safety procedures.
3.2 Additional precautions for handling a suspected case of SARS-CoV-2 infection
Contact and droplet precautions
- In addition to standard precautions, all persons coming in contact with the patient (family members, visitors and healthcare personnel) must also use contact and droplet precautions.
- Patients must be placed in a adequately ventilated single rooms and, if this is not possible, they may be placed together with other patients with suspected SARS-CoV-2 infection
- All beds in hospitalization rooms must be placed at least 1 meter apart
- Specific healthcare professionals should be appointed for the treatment of patients.
- All persons who come in close contact with the patient must:
- use a FFP2 mask
- use eye protection/ face protection (face shield or wide-spectrum protective glasses)
- wear a clean, non-sterile long-sleeve waterproof gown
- wear disposable gloves (sterile, when necessary)
- practice hand hygiene
- avoid touching their eyes, nose or mouth with potentially contaminated hands
- Medical equipment (stethoscope, thermometer, blood pressure gauge) should be dedicated to each patient. If this is not feasible, all medical equipment must be cleaned and sterilized before use in a different patient.
- Patient movement shall only be limited to medically necessary transport and the shortest route must always be selected.
- The patient admissions department must be up-to-date as to the measures for control and prevention of virus spread.
- Personnel who are transporting patients must use personal protective equipment and perform hand hygiene.
- Designated portable X-ray equipment or other diagnostic equipment must be used
- All surfaces with which the patient is in contact must be cleaned and disinfected.
- The number of family members and visitors must be limited to the minimum possible
- All persons entering the patient’s room must be recorded, including all staff and visitors.
Certain aerosol-generating procedures (e.g. tracheal intubation, non-invasive ventilation, tracheotomy, cardiopulmonary resuscitation, bronchoscopy, AMBU bag use) have been associated with an increased risk of transmission of coronaviruses.
Healthcare professionals performing aerosol-generating procedures must:
- Use a high-protection mask (FFP3)
- Use eye protection/ face protection (face shield or wide-spectrum protective glasses)
- Wear a clean, non-sterile, waterproof long-sleeved gown, and, if such item is not available, a waterproof apron for procedures expected to create high volumes of body fluid.
- Wear disposable gloves (sterile, when necessary)
- Practice hand hygiene
All procedures above must be carried out in an adequately ventilated room or in a negative-pressure room, if feasible. The number of persons present in the room must be limited to the absolute minimum.
Duration of spread control and prevention measures
Standard precautions must be applied systematically and in all cases. Additional contact and droplet precautions should continue until the patient is symptomatic.
Note: This guidance may be revised based on new epidemiological and clinical data on the new coronavirus infection.
- World Health Organization (WHO). Infection prevention and control during health care when novel coronavirus (nCoV) infection is suspected. Interim guidance 25 January 2020 (12 February 2020)
- Centers for Disease Control and Prevention. Interim infection prevention and control recommendations for patients with confirmed 2019 novel coronavirus (2019-nCoV) or persons under investigation for 2019-nCoV in healthcare settings – updated February 3, 2020 (12 February 2020)
- European Centre for Disease Prevention and Control (ECDC). Personal protective equipment (PPE) needs in healthcare settings for the care of patients with suspected or confirmed novel coronavirus (2019-nCoV) (12 February 2020)