INFECTION PREVENTION

AND CONTROL FOR COVID-

19 IN HEALTH-CARE AND
COMMUNTIY SETTINGS

Module 1b: Practical IPC

measures for COVID-19 in
health-care settings
DISCLAIMER

Prior to taking this course you should be familiar with Standard and Transmission -
based precautions.
Please go to the OpenWHO site, Infection Prevention and Control channel to
learn more about Standard and Transmission–based precautions.

Infection Prevention and Control (openwho.org)

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LEARNING OBJECTIVES
The purpose of this module is to provide an overview of WHO IPC guideline for
COVID-19 and highlight recommendations and implementation considerations
for health-care settings. At the end of this module participants will:
✓ Identify actions for implementing screening and triage of patients with signs
and symptoms of COVID-19.
✓ Describe the source control measures in a health facility to prevent
transmission of COVID-19 including the use of masks.
✓ Describe specific IPC measures applicable to the prevention and control of
COVID-19 transmission in health facilities.

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1. RISK ASSESSMENT, SCREENING AND TRIAGE
IDENTIFY AND IMPLEMENT MEASURES

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 RISK ASSESSMENT

Before each patient Assess the This informs

interaction, assess the likelihood of immediate IPC
following: exposure to measures and PPE or

infectious agents to minimize the risk

THE PATIENT of exposure or

THE TASK

THE ENVIRONMENT

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 SCREEN FOR EARLY RECOGNITION
Prompt identification of COVID-19 and other acute
Signs and symptoms of
respiratory infections (ARI) and swift implementation
COVID-19:
of IPC measures reduces transmission in health-care
facilities.
Cough, general
Immediate actions include: weakness/fatigue,
• Screening at the first point of contact headache, myalgia, sore
• Patient placement / isolation of patients where throat, coryza, dyspnoea,
applicable nausea, diarrhoea,
• Respiratory and hand-hygiene best practices anorexia
• Appropriate selection and use of PPE Source: WHO COVID-19 Case definition (2022).

• Maintain a physical distance of at least 1 metre

• Mask use as source control (universal and targeted
continuous masking)
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SCREENING
WHAT
Screening is a process by which an individual is evaluated to see if they meet a case definition. This
process can occur in many settings, including at the first point of contact with the health-care facility.
WHY
Screening is done to allow for early identification of suspect cases, followed by their immediate
triage and isolation. In the context of COVID-19, screening should be done at a distance (of at least 1
metre), or by a physical separation (such as a partition or barrier).
WHEN & WHERE
Screening can be performed in areas such as the emergency unit, outpatient department/primary
care clinic, in the community by a community health worker or by telemedicine.

HOW
Administering standardized questionnaires to every patient entering the health facility using either a
checklist or verbal questions.

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TRIAGE
WHAT
Timely and Admit
Triage is a process of sorting patients into categories effective
triage and
patients to
appropriate
based on their need for time-sensitive treatment. infection dedicated
area
control

WHY Safe Specific case

transport and and clinical
Triage identifies patients who require immediate discharge management
home protocols
medical intervention and those who can safely wait.

WHERE
TRIAGE
Once the patient is screened, triage should occur
inside the emergency department or similar area
close to the entrance of the health facility.

Source: https://www.who.int/publications/i/item/infection-prevention-and-control-of-epidemic-and-pandemic-prone-acute-respiratory-infections-in-health-care
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https://openwho.org/courses/clinical-management-COVID-19-initial-approach
 HOW TO SET UP SCREENING (AND TRIAGE) AREA
Ensure adequate space for safe screening and
1. medical triage (maintain at least 1 metre distance
between staff screening and patient/staff entering)
Have hand hygiene and masks available (also
2. gloves, eye protection and gowns to be used
according to risk assessment)
Waiting room chairs for patients should be at least
3.
1 metre apart
4. Maintain a one-way flow for patients and for staff
5. Clear signage posted for symptoms and directions
Family members should wait outside the triage area-
6.
prevent triage area from overcrowding
There is a clear referral pathway for patients who are suspected
7.
or confirmed to have COVID-19 including immediate isolation
Source: who.int/images/default-source/wpro/health-topic/covid-19/covid-19-022020-4.jpg?sfvrsn=9e14c7c4_2

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Source: who.int/images/default-source/wpro/health-topic/covid-19/covid-19-022020-4.jpg?sfvrsn=9e14c7c4_2
 SUPPLIES REQUIRED FOR SCREENING & TRIAGE
Screening questionnaire​
Algorithm for medical triage​ (such as the
WHO/ICRC/MSF/IFRC integrated interagency
triage tool pictured here)
Documentation papers​
Personal protective equipment (PPE)​
Hand hygiene equipment and posters​
Non- contact thermometer​
Waste bins and access to cleaning/disinfection​​
Signage for public areas with syndromic screening
questions to instruct patients to alert HWs For additional details on the Interagency Integrated Triage Tool see,
https://www.who.int/publications/m/item/IITT
Source: who.int/images/default-source/wpro/health-topic/covid-19/covid-19-022020-4.jpg?sfvrsn=9e14c7c4_2

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Source: who.int/images/default-source/wpro/health-topic/covid-19/covid-19-022020-4.jpg?sfvrsn=9e14c7c4_2
SOURCE CONTROL FOR COVID-19
Source control keeps infectious agents from spreading by
stopping them at the source. It is an important tool to reduce the
spread of COVID-19 and other respiratory infections.
Examples of source control measures for COVID-19 include:
o The design and layout of a healthcare facility (e.g. entrances,
signage, one-way flow for patients and for staff)
o Physical barriers and distancing
o Patient placement (isolation and cohorting) to separate
patients with suspect and confirmed COVID-19

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VENTILATION
• Adequate ventilation in all patient care areas plays a key role in helping to
prevent and reduce infections.
• Check with the facility maintenance to ensure there is adequate ventilation
where needed and that strategies to improve ventilation in units/wards are
implemented.
• The recommend ventilation rates are as follows:
o 160 l/s/patient for airborne precaution rooms; and
o 60 l/s/patient for general wards and outpatient departments

For additional ventilation requirements and strategies, see Roadmap to improve

and ensure good indoor ventilation in the context of COVID-19
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PHYSICAL DISTANCING

• Transmission of SARS-CoV-2 can occur when one or

more individuals are in close contact with an infected
person.
• Maintain a physical distance of at least 1 metre
between patients, increasing that distance where
possible.
• A physical distance of at least 1 metre should be
maintained between any two individuals in health
facilities whenever possible (e.g. between health and
care workers while on breaks).

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PHYSICAL BARRIERS
Consider installing physical barriers in places where
patients present first as an additional measure to
protect health and care workers as well as patients.
• Examples of barriers include glass or plastic windows.
• Consider consulting with a Heating, Ventilation, and Air-
Conditioning (HVAC) professional to ensure the use of
barriers are protective and does not adversely affect the
ventilation patterns where they are installed.

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WEARING MASKS IN THE HEALTH FACILITY

Depending upon the COVID-19 situation, some facilities

may require masks to be worn outside of performing
patient care to protect the health and care worker.
There are 2 different scenarios:
A. Targeted mask wearing
• Targeted continuous masking is the practice of wearing
a medical mask by all health and care workers
and caregivers in clinical areas during all routine
activities throughout the entire shift.
• In non-patient areas, health and care workers are not
required to wear a medical mask during routine
activities if they have no patient contact.

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Wearing masks in the health facility
B. Universal mask wearing
• Universal masking is the practice of all health and care
workers and other staff, caregivers, visitors, outpatients
and service providers wearing a well-fitted medical mask
at all times within the health facility and in any
common area (e.g. cafeteria, staff rooms).
• Inpatients are not required to wear a medical mask
unless physical distancing of at least 1 metre cannot be
maintained (e.g. during examinations or bedside visits)
or when outside of their care area (e.g. when being
transported), provided the patient is able to tolerate the
mask and there are no contraindications.

If caring for COVID-19 patients, please see the recommendation

on mask type for health and care workers when caring for a
suspected or confirmed COVID-19 patient.

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MASK OR RESPIRATOR
• Heath and care workers may wear a respirator or a medical
mask in addition to the other PPE (gown, gloves, eye
protection) when caring for patients with suspected or
confirmed COVID -19
When choosing your mask:
• Conduct a risk assessment and consider the following factors:
the activity (procedure), the setting (patient care
environment) and the patient
• Consider your personal preferences
• Respirators are to be used in care settings where ventilation
is known to be poor or cannot be assessed, or the ventilation
system is not properly maintained

For further information on technical specifications of PPE see:

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https://www.who.int/publications/i/item/WHO-2019-nCoV-PPE_specifications-2020.1
MASK FIT

Appropriate mask fitting should always be

ensured (for respirators, through fit testing and
a user seal check when a filtering facepiece
respirator is put on; and for medical masks,
through methods to reduce air leakage around
the mask) as well as compliance with
appropriate use of PPE and other standard and
transmission-based precautions.

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MASK FIT
• A well-constructed and well-fitted and
properly worn mask can prevent from being
exposed to COVID-19.

• Improving the fit of medical masks with

techniques such as the “knot-and-tuck” and
“linking-ear-loops-behind-the-head”
reduces gaps on the sides of medical
masks with ear loops. Such gaps allow air
leakage (potentially containing infectious
particles) to bypass the filtration layers of
the medical mask when the wearer inhales
or exhales.

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CARING FOR PATIENTS WITH SUSPECTED OR CONFIRMED
COVID-19 PERFORM HAND HYGIENE

PERSONAL PROTECTIVE EQUIPMENT (PPE)

✓Use contact and droplet precautions for all 1.
Alcohol based
handrub or
Water and
soap

patients with suspected or confirmed COVID-19 Rub hands for

20-30 seconds
Wash hands for
40-60 seconds

✓Required PPE: a respirator or medical mask, eye 2. PUT ON THE GOWN

protection (goggles or face shield), gown, and
gloves 3. PUT ON THE MASK or
Medical mask OR Respirator
✓Airborne and contact precautions are
recommended in circumstances and settings in 4. EYE PROTECTION or

Put on goggles or face shield.

which AGPs and support treatment are
performed PUT ON GLOVES
5. Ensure gloves are placed over the
cuff of the gown.
✓Hand hygiene should be done any time the
WHO “5 Moments” apply, and before PPE and 6. COMPLETE PPE
(gown, mask, eye protection, gloves)
after removing PPE

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CARING FOR PATIENTS WITH SUSPECTED OR CONFIRMED
COVID-19 PERFORM HAND HYGIENE

PERSONAL PROTECTIVE EQUIPMENT (PPE)

✓Equipment should be single use when 1.
Alcohol based
handrub or
Water and
soap
possible, dedicated to the patient and Rub hands for Wash hands for
disinfected between uses 20-30 seconds 40-60 seconds

✓Avoid transporting suspected or confirmed 2. PUT ON THE GOWN

cases – if necessary, have patients wear
masks. Health and care workers should wear PUT ON THE MASK
appropriate PPE 3. Medical mask OR Respirator
or

✓Limit the number of health and care workers,

visitors, and family members who are in 4. EYE PROTECTION or

Put on goggles or face shield.

contact with the patient. If necessary,
everyone must wear PPE 5.
PUT ON GLOVES
Ensure gloves are placed over the
✓All persons entering the patient’s room cuff of the gown.

(including visitors) should be recorded (for

contact tracing purposes) 6. COMPLETE PPE
(gown, mask, eye protection, gloves)

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RESPIRATOR FITTING (1)
DO A SEAL CHECK BEFORE YOU ENTER THE ROOM!
RESPIRATOR FITTING
Do a seal check before
Positive seal check
you enter the room! 1. Exhale sharply.
• If there is no air/leakage felt

around the mask this indicates a

positive pressure inside the
respirator.
• If there is air/leakage, adjust the

mask position and/or straps.

2. Retest the seal until there is no
air around the mask when you
exhale.

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Source: WHO OpenWHO IPC Channel https://openwho.org/courses/COVID-19-mask-use
RESPIRATOR FITTING (2)
DO A SEAL CHECK BEFORE YOU ENTER THE ROOM!
RESPIRATOR FITTING
Do a seal check before
you enter the room! Negative seal check
1. Inhale deeply.
• If no air/leakage is felt around the

mask, the negative pressure will

make the respirator cling to your
face.
• Leakage will result in loss of

negative pressure in the respirator

due to air entering through gaps.

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Source: WHO OpenWHO IPC Channel https://openwho.org/courses/COVID-19-mask-use
AEROSOL GENERATING PROCEDURES (AGPs)

• A respirator should always be worn along with other

PPE by health and care workers performing aerosol-
generating procedures (AGPs)
• A respirator should be worn by health and care
workers on duty in settings where AGPs are regularly
performed on patients with suspected or confirmed
COVID-19, such as intensive care units (ICU), semi-
intensive care units or emergency departments

For further information on airborne precautions: see Transmission-based

precautions for the prevention and control of infections: aide-memoire (2022)

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 • Recommended for AGPs:
AIRBORNE PRECAUTIONS • bronchoscopy,
• tracheal intubation,
• pressure on the chest during
cardiopulmonary
PERSONAL PROTECTIVE EQUIPMENT (PPE) resuscitation may induce
production of aerosol
PERFORM HAND HYGIENE • and other procedures that are
1.
Alcohol-based
handrub
Water and soap
Wash hands for 40-60
aerosol producing.
Rub hands for
20-30 seconds
seconds
Ensure the following
• single room
• adequate ventilation
PUT ON THE RESPIRATOR
2. (N95, FFP2, FFP3, or equivalent) • PPE
• airborne: N95, FFP2 or equivalent
• contact: gown, gloves
• eye protection: goggles, face
shield

Sources: https://www.who.int/publications/i/item/advice-on-the-use-of-masks-in-the-community-during-home-care-and-in-healthcare-settings-in-the-context-of-the-
novel-coronavirus-(2019-ncov)-outbreak
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https://www.who.int/publications/i/item/infection-prevention-and-control-of-epidemic-and-pandemic-prone-acute-respiratory-infections-in-health-care
 ENVIRONMENTAL CLEANING AND DISINFECTION

• Contaminated environmental surfaces play a role in

transmitting the virus and must be properly cleaned and
disinfected to remove pathogens or significantly reduce
their load on contaminated surfaces and prevent further
transmission.
• All surfaces in health-care facilities should be routinely
cleaned and disinfected, especially high-touch surfaces,
and whenever visibly soiled or if contaminated by body
fluids.
• Spraying of disinfectants is not recommended.

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WASTE MANAGEMENT
• Health-care waste is divided into two main categories: hazardous and non-
hazardous. If waste is not segregated correctly, hazardous waste can
contaminate non-hazardous waste. This can make collection, transport,
treatment, and disposal of waste difficult and hazardous.
• If waste from patients with acute respiratory infections is classified as infectious,
then consider all waste from the patient-care area as infectious waste, and treat
and dispose of it according to the health care facility’s policy, and in accordance
with national regulations pertaining to such waste.
• Waste should be treated, preferably on-site, and then safely disposed.
• Waste disposal should be safe for those handling the waste and for the
environment.

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HANDLING OF LINENS AND LAUNDRY
Follow standard precautions when handling soiled linen and laundry:
• Wear PPE according to the risk when handling used or soiled linen
• Handle soiled linen with minimum agitation to avoid contamination
• Place soiled linen into bags/containers at point of care
• If linen is grossly soiled:
• remove gross soil (e.g. feces, vomit) with a gloved hand and using a flat, firm object
• discard solid material into flush toilet and dispose of towel into waste
• Place soiled linen into a clearly labelled, leak-proof container (e.g. bag and closed bin) in
the patient care area
• Clean linen must be sorted and transported in a way to prevent contamination (i.e. closed
bins)
• Linen on the patient care wards should be stored in a designated area (i.e. a closet or
room) or closed containers away from public access.

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 SAFE DEAD BODY MANAGEMENT
• When preparing and packing the body for transfer from a patient room in a health
facility to an autopsy unit, mortuary, crematorium, or burial site, ensure that staff
who interact with the body (health-care or mortuary staff, or the team preparing
the body for burial or cremation) apply standard precautions, including hand
hygiene, before and after interaction with the body and the patient environment;
and use of the appropriate PPE, based on a risk assessment and considering the
level of interaction.
• Before attending to a dead body, health and care workers should ensure that
necessary hand-hygiene supplies, PPE and cleaning and disinfection supplies are
readily available.

The dignity of the dead, their cultural and religious traditions and their families
should be respected and protected throughout, balancing the rights of the family,
the need to investigate the cause of death and the risks of exposure to infection.
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SUMMARY
Upon completion of Module 1b learners will have increased knowledge of:
✓ Implementing screening and triage of patients with signs and symptoms of COVID-19.
✓ Use of source control measures in a health facility to prevent transmission of COVID-19
including the use of masks.
✓ The specific IPC measures applicable to the prevention and control of COVID-19 transmission
in health facilities.

For further information on COVID-19:

• Infection prevention and control in the context of COVID-19: a guideline (2023)
• Infection prevention and control guideline for coronavirus disease 2019 (COVID-19):
Executive summary (2023)
• Dunn, K., Hurwitz, H.H., Toledo, J.P., Schwaber, M.J., Chu, M., Chou, R., Ford, N., Allegranzi, B.
and Baller, A., 2024. Summary of WHO infection prevention and control guideline for covid-19:
striving for evidence based practice in infection prevention and control. bmj, 385

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