COVID-19: infection control in acute settings

With COVID-19, it is more important than ever to ensure that we maintain effective infection control. COVID-19 is not thought to be completely airborne but can be transmitted through droplets, direct contact people’s secretions, and touching surfaces that have been infected through human transmission.

It is important that you follow local guidelines but below is some general guidance released by the UK government.

Standard Infection Control Precautions (SICPs)

  • Acts as the basic infection prevention & control measure necessary to reduce risk of transmission of infectious agents
  • Interrupts the transmission of COVID-19 by stopping the route of transmission via contact & droplets

Hand Hygiene

  • Essential in the reduction of transmission
  • Follow the protocol below when washing hands
The use of alcohol hand rub/gel
  • Should not be used in replacement of hand washing
  • Is used during donning and doffing
Source: GOV.UK

Personal Protective Equipment (PPE)

  • Assess the likelihood of exposure & adequateness of PPE for risks associated with the procedure that is to be undertaken.
  • Stay in line with the local policy and procedures of the hospital.

You can read more here.

Masks

Please use local guidance. For more general information on using masks please click here.

Sessional use

The use of masks for one worker to use in one work area. This is currently recommended in the UK Infection Prevention and Control Guidance:

  • It should be disposed of if it becomes moist, damaged, visibly soiled
  • The duration of sessional use is dependent on local and individual factors (e.g. heat, activity length, shift length). In practice, this may vary from 2-6hrs
  • If masks are touched or adjusted, hand hygiene should be performed immediately
  • If the mask is removed for any reason (e.g. upon exiting the ward area, taking a break or completing a shift), they are disposed of as clinical waste, unless they can be safely reused
Reuse

Important requirements are:

  • The mask should be removed and discarded if soiled, damaged or hard to breathe through
  • Masks with elastic ear hooks should be re-used (tie-on face masks are less suitable because they are more difficult to remove)
  • Hand hygiene should be performed before removing the face mask
  • Face masks should be carefully folded so the outer surface is held inward and against itself to reduce likely contact with the outer surface during storage
  • The folded mask should be stored between uses in a clean sealable bag/box which is marked with the person’s name and is then properly stored in a well-defined place
  • Hand hygiene should be performed after removing the face mask
  • Some models of PPE cannot be physically reused as they deform once being donned and do not go back to original condition (meaning it would be difficult to redon and achieve fit check – fit checks should be performed each time a respirator is donned if it is reused.)

Gowns and coveralls

Fluid repellent hospital gowns or coveralls are indicated for use for the care of patients in high-risk areas, where AGPs are performed. There are 3 main options that can be considered as alternatives if gowns are not available:

  • Reserve disposable, fluid repellent gown or coveralls for AGPs and surgical procedures
  • Disposable, non-fluid repellent gowns or coveralls with a disposable plastic apron for high-risk settings and AGPs with forearm washing once gown or coverall is removed
  • Reusable (washable) surgical gowns or coveralls or similar suitable clothing with a disposable plastic apron for AGPs and high-risk settings with forearm washing once gown or coverall is removed. These would need to be washed in a hospital laundry
Sessional use

If the gown or coverall becomes visibly soiled, it must be disposed of as infectious waste, followed by hand hygiene, donning of a new gown and appropriate donning of new gloves.

Reuse

Consider shifting disposable gowns or coveralls to reusable options, retaining disposable downs only for high-risk AGPs. If there are no available disposable gowns of coveralls, consider the use of gown alternatives including:

  • Reusable gowns
  • Reusable (washable) lab coats
  • Reusable (washable) long-sleeved patient gowns
  • Reusable coveralls

Eye and face protection

Eye and face protection provides protection against contamination to their eyes from respiratory droplets, aerosols arising from AGPs and from splashing of secretions, blood, body fluids or excretions.

Eye and face protection can be achieved by the use of anyone of the following:

  • Surgical mask with integrated visor
  • Full face shield or visor
  • Polycarbonate safety spectacles or equivalent.

Visors

Visors provide barrier protection to the facial area and related mucous membranes (eyes nose lips) and are considered an alternative to goggles. Visors should be used if AGPs are performed. They should cover the forehead and extend below the chin and wrap around the side of the face. Visors are available both disposable and reusable options.

Sessional use

Visors should be removed upon exiting the ward area as per standard practice.

Reuse

This is currently recommended in the UK guidance, where the eye protection is not relabelled as single-use only. If in extremely short supply, single-use only items can be re-used in a similar way as re-usable items. The standard method of cleaning is to use a detergent product, they should be rinsed thoroughly to remove any residual detergent and left to dry. Products will degrade over time with repeated cleaning, particularly the anti-fog component.

Gloves and aprons

These remain single-use, DO NOT use double gloves for the care of suspected or confirmed COVID-19

Aerosol Generating procedures (AGP) create a higher risk of respiratory infection transmission. For more information, click here.

Use of clothing at work

  • Do not travel to work in your uniform that you will be wearing during your shift
  • If possible, change into your uniform on commencement of shift
  • Use different footwear when at work – this prevents the spreading of the virus outside of the working environment
  • Prior to leaving the shift, change back into travelling clothes, place your uniform and footwear into a plastic bag
  • Once you have returned home, wash your uniform immediately at 90°c (Avoid shaking them out prior to putting them into the washing machine)