ROI COVID-19 Guidance - Infection prevention in hospitals (02)

The information below is to be used as an update, please be aware that you should be following local guidance from the hospital where you are working.

Infection prevention and control practice supported by appropriate use of PPE is important to minimise risk to patients of healthcare-associated COVID-19. These measures are equally important in controlling exposure to occupational infections for healthcare workers.

Minimising exposure risk – actions for healthcare workers:
  • Implement standard precautions for infection prevention and control with all patients at all times
  • Maintain a physical distance of at least 2 metres from individuals with the respiratory symptoms (where possible)
  • Clean your hands regularly as per WHO 5 moments
  • Avoid touching your face
  • Promote respiratory hygiene and cough etiquette which involves covering mouth and nose with a tissue when coughing and sneezing, or coughing into the crook of an elbow, discarding used tissue into a waste bin and cleaning hands
PPE

It is important that you wear the appropriate PPE for the environment that you are working in which is outlined in the table below.

Types of PPE
  • Disposable plastic aprons: are recommended to protect staff uniform and clothes from contamination when providing direct patient care and when carrying out environmental and equipment decontamination
  • Fluid resistant gowns: are recommended when there is a risk of extensive splashing of blood and or other bodily fluids, and a disposable plastic apron does not provide adequate cover to protect the healthcare workers uniform or clothing
  • Non-Fluid resistant gowns: If these are used and there is a risk of splashing with blood or other bodily fluids a disposable apron should be worn underneath
  • Eye protection/Face visor: these should be worn when there is a risk of contamination to the eyes from splashing of blood, bodily fluids, excretions or secretions (including respiratory secretions). Types of eye protection include:
    • Surgical mask with integrated visor
    • Full face shield or visor
    • Goggles/safety spectacles
  • Surgical face masks: – Fluid resistant type 11R, consider the following tips when wearing a surgical mask:
    • It must cover the nose and mouth of the wearer
    • It must not be allowed to dangle around the wearers neck after or between each use
    • It must not be touched once in place
    • It must always be changed when wet or torn
    • It must be worn and then discarded as health care risk waste.

As of September 2020, healthcare workers are also required to wear a surgical mask when in busy public areas of healthcare facilities, even if they do not expect to be within a distance of 2m of another person for 15 minutes or more

FFP Respirators (flat or cone-shaped FFP2 or FFP3): These are disposable masks and are intended to protect the wearer against inhalation of infectious aerosols in addition to protection against droplet impact. Fit testing of respiratory masks and the fit checking of the mask each time is required to ensure that the masks fit properly to the wearers face shape, with no gaps between the mask and face for air to escape unfiltered.

The full guidance can be accessed here and here.

Care required and recommended PPE

1. Patients with respiratory symptoms/suspected/confirmed COVID-19 who require an AGP.

Recommended PPE:

    • Hand Hygiene
    • Disposable single-use Nitrile Gloves
    • Long-sleeved disposable gown
    • FFP2 respirator mask
    • Eye protection

2. Patients with respiratory symptoms/suspected/confirmed COVID-19 who do not require AGP but do require high contact patient care activities that provide increased risk of transfer of virus and other pathogens to the hands and clothing including:

  • Close contact for physical examination
  • Changing incontinence wear
  • Assisting with toileting
  • Device care or use
  • Wound care
  • Providing personal hygiene
  • Bath/showering
  • Transferring a patient
  • Care activities where splashes/sprays are anticipated

Recommended PPE:

    • Hand Hygiene
    • Disposable single-use Nitrile Gloves
    • Long-sleeved disposable gown
    • Surgical facemask
    • Eye protection if risk assessed as necessary

 

3. Patients with respiratory symptoms/suspected/confirmed COVID-19 where the tasks being performed are unlikely to provide opportunities for the transfer of virus/other pathogens to the hands and clothing, Low contact activities for example:

  • Initial clinical assessments
  • Taking a respiratory swab
  • Recording temperature
  • Checking drainage bag
  • Inserting a peripheral IV cannula
  • Administering IV fluids
  • Helping to feed a patient

Recommended PPE:

    • Hand Hygiene
    • Disposable single-use Nitrile Gloves
    • Disposable plastic apron
    • Surgical facemask
    • Eye protection if risk assessed as necessary
Aerosol Generating Procedures

The current AGPs are:

  • Intubation, extubation, manual ventilation and open suctioning
  • Tracheostomy procedures – insertion, removal or open suction
  • Bronchoscopy and upper ENT airway procedures
  • Upper Gastro endoscopy where there is open suction
  • Surgical and post-mortem procedures involving high-speed drills
  • Some dental procedures
  • Non-invasive ventilation – BiPAP or CPAP
  • High-frequency oscillation ventilation
  • Induction of sputum cough
  • High flow nasal oxygen
  • NB Nebulisers are no longer included

 

Hand Hygiene
  • Essential in the reduction of transmission
  • Staff should adhere to the WHO five moments for hand hygiene
  1. before touching a patient
  2. before clean/aseptic procedures
  3. after body fluid exposure/risk
  4. after touching a patient, and
  5. after touching patient surroundings.
Source: WHO

Follow the protocol below when washing hands – don’t forget to include your exposed forearms:

Hand hygiene guide

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, some people have been using pillow cases which goes straight into their washing machine.
  • Once you have returned home, take off your clothes, have a shower and then wash your uniform immediately at 90°c (Avoid shaking them out prior to putting them into the washing machine)

You can read the full guidance here.

Stay up to date with the latest HSE advice here.