COVID-19

Infection Prevention and

Control (IPC)

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
 2

Objectives

1. Understand the principles and practices for Infection Prevention

and Control (IPC), with a focus on preventing transmission at
the person, facility, and community levels.
2. Know how to correctly coordinate the use of IPC for patients
with possible COVID-19.
3. Attain understanding of IPC measures for healthcare providers
pertaining to Personal Protective Equipment (PPE), with a focus
on donning and doffing, and hand and respiratory hygiene.

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
 3

Objectives

4. Identify recommended IPC requirements for COVID-19 for

suspected and confirmed cases in community settings.
5. Understand how to interact with communities to optimize IPC
for COVID-19, using available resources.
6. Develop disinfection strategies for reusing PPE.

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
Outline of this Presentation
4

Infection Prevention and Control (IPC) Measures for COVID-19

● In Healthcare Settings
● Early recognition and source control
● Standard precautions
○ Hand hygiene & respiratory hygiene
● Contact and droplet precautions
● Managing COVID-19 patients, visitors, and healthcare workers (HCWs)
● In the Community
● Environmental Disinfection

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
 5

Importance of IPC
Hospital/Healthcare Facility Setting
● During an outbreak of any respiratory infection, a large proportion of infections can
be acquired in healthcare settings.

● Patients ill from other causes or with underlying health conditions are more at risk
for severe complications from COVID-19.

● Because (HCWs) are on the frontlines, protecting them must be prioritized.

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
 6

Importance of IPC
Community Setting
• Community spread of COVID-19 involves rapid person-to-person local
transmission.
• Slowing the outbreak at the community level is challenging and requires local,
national and international actions.
• Infection prevention and control procedures should be initiated in the community
just as they are initiated in healthcare facilities.
• There should be a clear lines of communication between healthcare facility
leadership, HCWs, and public health officials to manage community spread.

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
 7

IPC in Healthcare Facilities

1. Designate a COVID-19 response team at each facility and assign specific
COVID-19 roles and responsibilities to each team member
2. Create screening area for early recognition
3. Once there is community spread, assume every patient is potentially
COVID-19 positive.
4. Apply standard precautions (hand hygiene, respiratory hygiene) to all
patients
5. Implement additional droplet/contact precautions and other environmental
controls
6. Enforce rational use of PPE
7. Prepare for and manage patients coming to the facility with suspected,
probable, or confirmed COVID-19
8. Restrict visitors
9. Implement risk assessment and monitoring for exposed healthcare
personnel
Developed with a grant from Project HOPE. Copyright © Brown University,
2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
 8

Importance of IPC in Healthcare Settings

Goals of IPC
1. To reduce transmission of COVID-19 within a facility
2. To ensure safety of all staff, patients, visitors
3. To support the ability of health professionals to respond to an outbreak

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
 9

Core Principles of IPC

1. Focus screening prior to triage to achieve early recognition and isolation of patients with
suspected infection
2. Apply standards of precaution to all patients.
3. Implement droplet and contact precautions for patients with suspected COVID-19 infection.
4. Monitor contacts of patients with COVID-19 infection
5. Establish proper administrative controls and policies (training for HCWs, adequate staffing, and
capacity-building).
6. Modify existing structures of healthcare facilities to minimize spread

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
 10

Establish a COVID-19 IPC Team

At Each Healthcare Facility
• Establish a COVID-19 Infection Prevention and Control team at each healthcare facility.
• Assign specific titles and responsibilities to each member.
• Conduct training sessions so each individual understands their roles and responsibilities
• Schedule at least weekly meetings (or more often depending on the situation) to provide situational
updates, make adjustments to facility guidelines, and coordinate public messaging.
• Establish a clear line of communication and reporting within the team.
• Establish a clear line of communication from the rest of the HCWs at the facility to appropriate
members of the team based on their roles.

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
Healthcare Facility IPC 11

Important Points
• Review emergency/outbreak plans and procedures already in place
• Evaluate the available number of healthcare personnel and resources (PPE, sanitizing equipment,
etc.) at least daily
• Implement a chain of command for reporting and task assignment
• Adopt a specific risk assessment for HCWs
• Update all healthcare workers in the facility daily and when changes are made to the IPC plans.
• Provide list of contacts with titles and roles, reporting procedures and forms to all stakeholders

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
 12

IPC During Screening

Early Recognition
• Ensure staff maintain a high level of clinical suspicion for COVID-19 through
education on symptoms and risk factors.

• Set up a screening station at all entrances to assess patients for symptoms and/or
potential exposures.

• Screen using questionnaires for currently defined risk factors for COVID-19:
• Exposure to suspected cases
• Presence of classic symptoms – fever, cough, shortness of breath
• Travel history is no longer relevant once there is community spread!

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
Infection Control Precautions for Suspected/
13

Confirmed Cases of COVID-19

The World Health Organization recommends the following:
➔ Transmission-based precautions:
Contact precautions
to prevent virus transmission by hand or fomite to mucous membranes (eyes, nose, mouth)
Droplet precautions
to prevent transmission by inhalation of large droplets which can be in the air for a short
period of time and travel up to 2 meters from a patient with COVID-19
Airborne precautions ONLY during aerosol-generating procedures
to prevent transmission of small particles that remain infectious over long distances when
suspended in the air (such as during endotracheal intubation)

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
 14

Patient Placement for COVID-19

Within the Healthcare Facility

• Place a patient with known or suspected COVID-19 in an isolated area, as available.

Keep doors closed, and reduce entry and exit.
• If single rooms are not available for each patient, keep patients at least 2 meter apart
and all patients should wear masks.
• Aside from transfer or discharge, place a facemask on the patient and isolate
him/her in an examination room with the door closed.

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
 15

COVID-19 Examination Rooms/Areas

• Limit transport and movement of the patient unless medically needed.

• COVID-19 suspected or confirmed patients, (along with any patient with a fever or
respiratory symptoms), should wear facemasks during transport.
• Only essential personnel should enter the room.
• Assigning staff to only care for COVID patients can reduce risk of transmission to other
patients and healthcare workers, and save PPE.

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
Standard Precautions for ALL Patients
16

Hand Hygiene
WHO’s 5 MOMENTS FOR HAND HYGIENE
1. Before touching a patient
2. Before any clean or aseptic procedure is performed
3. After exposure to body fluid
4. After touching a patient
5. After touching a patient’s surroundings

Hand washing -- use at least one of the following -- for at least 20 seconds
• Soap and water
• (Sing Happy Birthday twice ~= 20 seconds)
• Alcohol-based hand rub (at least 60% alcohol) for at least 30 seconds
• If these are not readily available, 0.05% chlorine solutions from diluted
bleach can be used.
Developed with a grant from Project HOPE. Copyright © Brown University,
2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
Standard Precautions for All Patients
17

Respiratory Hygiene
● Everyone should cover their nose and mouth with a
tissue or upper sleeve when coughing or sneezing.
● Wash hands after coughing and sneezing.
● If upper respiratory symptoms, offer face masks to
patients while they are in waiting or public areas.
● Perform hand hygiene after any contact with respiratory
secretions.
● Avoid touching eyes, nose, or mouth. How a Sneeze Travels

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
 18

Contact and Droplet Precautions: When and Where

● Dedicate a team of trained staff to care for suspected/confirmed COVID-19 cases to reduce the risk of
transmission and the number of people exposed.
● Patients should be placed in adequately ventilated, single rooms whenever possible.
● When single rooms are not available, suspected patients can be grouped together with beds > 2
meter apart
● Use single-use or dedicated equipment when possible. Clean and disinfect any equipment before re-use
on a different patient.
● Disinfect objects and surfaces in patients’ environment.
● Transport of patients outside their room should ONLY be for medically-necessary purposes.
● For transport, instruct patient to wear a mask and follow Respiratory Hygiene/Cough Etiquette.

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
 19

Airborne Precautions During Aerosol-Generating

Procedures
Aerosol-generating procedures include endotracheal intubation, noninvasive ventilation
(BiPAP or CPAP), nebulizer treatments, high flow O2 > 6L, tracheotomy,
cardiopulmonary resuscitation, bag-valve mask ventilation before intubation, and
bronchoscopy.

● An airborne infection isolation room (AIIR) with special ventilation and air
handling capabilities is recommended, if available.
● If not available, place the patient in a private room with the door closed, and provide
N95 masks (or higher level respirators) for healthcare personnel to reduce airborne
transmission.

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
 20

Basics of Personal Protective Equipment (PPE)

● Eye protection and facemasks to prevent droplet (and contact)
transmission
● Long-sleeved gowns (clean, non-sterile) and gloves to prevent
contact transmission
● Appropriate hand hygiene (even when PPE is used)
● Avoid touching eyes, nose, mouth or mask
● Use a new set of PPE when care is given to a different patient
(though this may not be possible)
● Focus on saving and reusing PPE

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
 21

Appropriate Use of Personal Protective Equipment

● Reduce need for PPE to save supply.
○ Limit access to COVID-19 patients to essential
healthcare personnel.
○ Combine activities to reduce entry into patient area (i.e.
obtain vital signs at the same time as delivering food).
● Use technology (telephone, WhatsApp, internet) for
evaluation of possible cases for testing and/or clinical
evaluation.
● Use physical barriers to reduce exposure to COVID-19
(glass/plastic windows)

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
 23

Appropriate PPE for Routine Patient Care

● Eye protection
● Surgical mask
● Gloves

● REMEMBER: Always practice appropriate hand hygiene

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
 24

PPE for Suspected or Confirmed COVID-19

● Eye protection
● Surgical mask
● Gloves
● Long-sleeved gowns (clean, non-sterile)

● REMEMBER: Always practice appropriate hand hygiene

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
 25

PPE for Aerosolizing Generating Procedures

● Eye protection
● N95 respirator
● Gloves
● Long-sleeved gowns (clean, non-sterile)
● Cap/hair cover
● Shoe or leg covers

● REMEMBER: Always practice appropriate hand hygiene

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
Alternative PPE for Aerosolizing Generating 26

Procedures
● Use a PAPR (Powered air-purifying respirator)
● No other PPE EXCEPT gloves is needed when a
PAPR is available

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
 27

Copyright 2020 © Project HOPE and Brown University. All rights reserved
28
 29

Copyright 2020 © Project HOPE and Brown University. All rights reserved
 30

Source: WHO
“Don” or Put on PPE for Suspected or Confirmed 31

COVID-19

***CRITICAL:
Perform hand Hand hygiene
hygiene should be performed
before and after
each step!

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
 32

Donning PPE

***CRITICAL:
Hand hygiene
should be performed
before and after
each step!

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
“Doff” or Take Off PPE 33

***CRITICAL:
Hand hygiene
should be performed
before and after
each step!

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
 34

Doffing PPE for Suspected or Confirmed COVID-19

***CRITICAL:
Hand hygiene
should be performed
before and after
each step!

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
Doffing PPE 35

***CRITICAL:
Hand hygiene
should be performed
before and after
each step!

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
 36

Waste Disposal of PPE

Multiple bucket approach:
Separate disposable items from reusable items. (See example below.)
Maintain compulsive hand hygiene

Disposable waste Glasses/Eye Shields Gowns

(Laundry items)
Developed with a grant from Project HOPE. Copyright © Brown University,
2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
 37

Reusing PPE In Case of Low Supply

Gowns
• Can be washed with hot water and detergent for re-use. Store used gowns in a closed container
in patient rooms. Staff handling dirty gowns should wear PPE.
Gloves
• Disposable gloves preferred.

Masks
• Masks can be reused up to 2-3 days or longer. Avoid touching the mask when you have it on.
Apply and remove by touching only the straps.
• After removal, masks can be stored in a labeled bag for re-use.

Eye protection
• Eye protection such as goggles or face shields can be re-used. Clean after each use by using
disinfectant wipes and store in a labelled bag.

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
Conservation of Masks and Respirators
38

Masks and respirators should be limited to essential healthcare workers and conserved according to
WHO “Rational Use of PPE” guidelines.

Masks and respirators can be reused if appropriate precautions are taken

Designate a storage area or keep masks in a clean, breathable container (i.e. paper bag) between uses

Store masks in a way that they do not touch each other

Avoid touching face or any part of the mask while wearing

• Do not pull mask down onto chin

• Avoid touching the inside of the mask during doffing procedures

Perform hand hygiene before and after touching or adjusting the mask (if necessary for comfort or to maintain fit).
or hard to breathe through

Developed with a grant from Project HOPE. Copyright © Brown

University, 2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
Indications to Replace Masks and Respirators
39

Discard masks if:

They are used during aerosol generating procedures (intubation, etc.)

They become contaminated with blood, respiratory or nasal secretions, or other bodily fluids
from patients (consider using a reusable face shield to prevent this)

They become soiled, damaged or hard to breathe through

Developed with a grant from Project HOPE. Copyright ©

Brown University, 2020. Released under Creative
Commons license Attribution-NonCommercial-
NoDerivatives 4.0 International (CC BY-NC-ND 4.0
Reuse and Disinfection of PPE 40

PPE Recommendations
Respirator masks • Guidelines for reuse described in the previous slide.
(i.e. N95) • Some studies show that sustained heat in an oven (70 degrees C for 30 minutes) may be effective in
disinfecting the mask while maintaining integrity of N95 mask. However, this disinfecting procedure is not
an official WHO recommendation. Alcohol and chlorine-based disinfectants are NOT recommended as they
degrade the filtering capacity of the mask.
• Other methods for disinfecting and sanitizing N95s are in development.
Surgical masks • Reuse guidelines should be followed as described in the previous slide.
Face shield • Can be reused after wiping down with a disinfectant wipe or solution.
• Use proper hand hygiene and gloves when disinfecting face shields between uses.
Gloves • The reuse of single-use gloves is not recommended by WHO.
• In some situations, extended use of gloves can be used by Healthcare Workers while caring for multiple
COVID+ patients. Gloved hands can be washed with soap and water in between patients (note that
alcohol-based hand sanitizer as may degrade vinyl gloves). Gloves that become damaged or contaminated
should be discarded right away.
Gowns • Gowns (cloth or disposable) can be worn by the same health care worker while caring for multiple COVID+
patients (should be changed before seeing a non-COVID patient).
• Any gown that becomes visibly soiled or contaminated with bodily fluids should be disposed of or
laundered (in a standard washing machine on the hottest setting) before reuse.

Developed with a grant from Project HOPE. Copyright ©

Brown University, 2020. Released under Creative
Commons license Attribution-NonCommercial-
NoDerivatives 4.0 International (CC BY-NC-ND 4.0
 41

Environmental Considerations
For Hospitalized Patients
Environmental survival of coronaviruses on surfaces: review of 22 studies
• Can persist on environmental surfaces (metal, glass, plastic) for up to 9 days
• Duration of transmissibility is believed shorter, but not known
• Can be removed with surface disinfection using:
• 62-71% ethanol
• 0.5% hydrogen peroxide
• 0.5% sodium hypochlorite
• Less effective disinfectants for coronaviruses:
• .05 - 2% benzalkonium chloride
• .02% chlorhexidine digluconate

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
 42

Environmental Considerations

N Engl J Med DOI: 10.1056/NEJMc2004973

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
 43

Environmental Considerations
For Hospitalized Patients
• Use disposable equipment for patient room wherever possible
• Daily cleaning of high touch surfaces in the room
• If done by environmental staff, they should wear same PPE as clinical staff
• After discharge, do not allow another patient into the room until cleaning is done and waiting
at least 1-2 hours (to allow air exchange)
• Personnel should at least wear gown and gloves and face mask and eye protection if
splash or sprays are used

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
Environmental considerations 44

For Hospitalized Patients

Developed with a grant from Project

HOPE. Copyright © Brown University,
2020. Released under Creative
Commons license Attribution-
NonCommercial-NoDerivatives 4.0
International (CC BY-NC-ND 4.0
 45

Environmental Considerations
For Hospitalized Patients

• Use gloves when handling patient clothing and linens

• Do not shake items
• Launder as per manufacturer’s instructions
• Use hottest temperature for the material

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
 46

Dilute Chlorine Solutions as Disinfectants

● In many places, alcohol-based disinfectants are prohibitively expensive or not available.
● Dilute chlorine solutions have been shown to be effective in eliminating a broad range of
viruses .
● The chlorine concentration needed to be effective differs by its anticipated use:
● For environmental surface disinfection, 0.5% (5000 ppm) of available chlorine is
needed
● For hand hygiene, 0.05% (500 ppm) of available chlorine is needed.
● Bleach (sodium hypochlorite, NaOCl) products are made in different concentrations in
different parts of the world (2% - 12%).
○ How much dilution is needed depends on the product that is available.

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
 48

Dilutions for Chlorine-Based Disinfectants

Dilution from Liquid Bleach:
[% hypochlorite in liquid bleach as indicated on the label/% hypochlorite in the
desired solution] – 1 = total parts of water for each part of liquid bleach

Making Solution from Powder:

[% hypochlorite in use solution/% hypochlorite in the granules or powder as
indicated on product label] x 1000 = amount in grams of granules to add to each
liter of water.

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
 49

Managing Visitors

• Limit and consider prohibiting all visits to the hospital.

• The only exception may be end-of-life care with a short visit
with visitors in appropriate PPE (mask, gloves, eye protection,
gown).
• Encourage use of technology for family to keep in touch with the
patient if possible (FaceTime, Skype, What’sApp) or to contact
medical staff for updates.

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
 50

Post-Mortem Management
• Transmission from respiratory droplets is not a concern, but it is
important to prevent contact with infectious body fluids
• Use standard PPE, including gloves, fluid-resistant gown, and eye
shield, both when interacting with the deceased patient and when
handling any chemicals
• Doff PPE using standard procedures, ensuring excellent hand hygiene
• Body may be moved to a regular cemetery for burial, or crematorium,
based on family wishes and local cultural practice

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
 51

Key Definitions
Healthcare Workers and Close Contacts
Healthcare Personnel:
• All paid and unpaid persons working in the healthcare facility who may have direct or indirect
exposure to patients or infectious materials and surfaces (medical supplies, devices, and
equipment, surrounding surfaces, or contaminated air.
Close contact:
• Being within 2 meters of a person with COVID-19 for 15 minutes or longer without proper PPE
(whether caring for a patient or being in a waiting area).
• Having direct contact with infectious secretions or excretions of the patient (for example, being
coughed on or touching used tissues with hand) without proper PPE.

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
 52

Monitoring and Managing Exposed Healthcare Personnel

General Guidelines
• Each facility needs clear guidelines for risk assessment, exposed healthcare worker monitoring, and criteria
for return to work.
• These should be communicated to all healthcare workers in the facility and written guidelines
made available for reference.
• WHO has developed assessment tools:
https://apps.who.int/iris/bitstream/handle/10665/331340/WHO-2019-nCov-HCW_risk_assessment-2
020.1-eng.pdf
• Individual or department names and contact information for exposure reporting and monitoring should be
made clear.
• Facilities should have sick leave policies for personnel.
• Policies and guidelines need to adjust as demand for personnel and resources changes.

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
 53

Monitoring and Managing Exposed Healthcare Personnel

Defining Exposure Risk
Low-risk exposures
• Short contacts with COVID-19 patients or prolonged close contact when both the patient and the
healthcare worker were wearing a facemask.
High-risk exposures
• Healthcare personnel who had prolonged close contact with COVID-19 patients while the patient or the
healthcare provider did not wear PPE and their nose and mouth were exposed.
• Being present in the room for procedures that generate aerosols or during which respiratory secretions
may be poorly controlled (for example, cardiopulmonary resuscitation, intubation, extubation,
bronchoscopy, nebulizer therapy, sputum induction) on a COVID-19 patient when the healthcare
provider did not wear PPE.

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
Monitoring Exposed Healthcare Personnel
54

Self-Monitoring
• Healthcare personnel monitor themselves for fever and respiratory symptoms (cough, shortness of breath, sore
throat).
• It should be made clear who they need to contact if they have fever or respiratory symptoms.
Active Monitoring
• Other healthcare personnel or public health officials communicate by phone, text message or electronic format to
assess the exposed worker for fever or respiratory symptoms.
Self-Monitoring with Supervision (for situations where there is a shortage of healthcare workers at the facility)
• On days the exposed healthcare provider is scheduled to work, other healthcare personnel may measure the
exposed worker’s temperature and assess symptoms before starting work.
• Or, the exposed healthcare worker may report their own temperature and symptoms before starting work by direct
contact, telephone calls, or any electronic or internet-based methods.

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
Healthcare Workers Who Have Had Potential Exposure to 55

COVID-19
The WHO has provided guidance on categorizing and managing the risk to healthcare workers
during the COVID-19 outbreak
Recommendations for healthcare workers at HIGH risk Recommendations for healthcare workers at LOW risk
of COVID-19 of COVID-19

● Stop all health care contact with patients for a ● Self-monitor temperature and respiratory
period of 14 days after the last day of exposure to symptoms daily for 14 days after the last day of
a confirmed COVID-19 patient. exposure to a COVID-19 patient.
● Be tested for COVID-19 virus infection ● Healthcare workers should call health care facility
● Quarantine for 14 days. if he/she develop any symptoms suggestive
● Healthcare facilities should provide psychosocial of COVID-19.
support while in quarantine as well as continued ● Place contact/droplet precautions when caring for
compensation as possible. all patients with acute respiratory illness and
standard precautions to take care of all patients.

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
 56

Healthcare Worker Exposure to COVID-19 in The Community

Community or Travel-Related Exposure
• Healthcare personnel should inform their facility’s assigned individual/team of any
community or travel-related exposure.

• They should undergo monitoring as outlined on the previous slide.

• Those in the high-risk category should be removed from working for 14 days after their
exposure.

• Healthcare personnel who develop signs or symptoms of COVID-19 should contact the
assigned contact person at their workplace for medical check-up before returning to work.

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
 57

Communication and Reporting

Healthcare Facilities
A person or team should be assigned to keep a record of all healthcare associated
exposures for these reasons:
• To monitor types of exposures (worker was not wearing appropriate PPE, COVID-19
patient did not have a mask, exposure happened during a procedure, etc.) so that
education can be given.
• To track dates of healthcare workers on quarantine to see when they could return to
work.
• To share reports with other authorities within the healthcare facility for giving updates
and to make changes to guidelines as needed.

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
 58

IPC in the Community

1. Recall case definitions
COVID-19 2. Assess for home care
3. Criteria for quarantining
4. Community prevention strategies
5. Communications

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
 59

IPC in the Community - Screening for Home Care:

Review of Concepts
Patients being sent home should be screened as follows
1. Can the patient and the family follow recommendations as part of home care
isolation (hand hygiene, respiratory hygiene, etc.)?
2. Is the patient’s home a safe place for them to stay in quarantine?
Collect contact information for the patient (correct phone number or other means)
Monitoring of symptoms (fever, cough, SOB) should continue in the home.

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
Recommendations for Home Care: Review 60

of Concepts
● Place the patient in a well-ventilated single room (with open windows and an open door) if
possible.
● Limit contact of patient with others:
○ Limit the movement of the patient in the house
○ Limit the number of caregivers
○ All household members should remain at least 1 m away at all times
● Perform hand hygiene after any contact with the patient.
● Personal Protective Equipment
○ Surgical mask should be worn by patient if available
○ Caregivers should wear gloves and a tightly fitted medical mask when in close contact
(bathing, dressing) with the patient.

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
Who Should be Quarantined? – Review of Concepts
61

Definition of COVID-19 contacts

● Provided direct care to COVID-19 patients without proper PPE

● Were in the same close space of a COVID-19 patient (including workplace, classroom,
household, gatherings).
● Travelled in close distance (within 1 meter) to a COVID-19 patient within a 14‐day period
after the symptoms for the COVID-19 patient started.
WHO Recommendations
● Contacts of confirmed cases should be quarantined for 14 days from the last exposure to
the patient.
● More groups may be recommended to self-quarantine based on travel history or other
exposure.

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
Considerations for Quarantine: Review 62

of Concepts
Quarantine = “restriction of activities or separation of persons who are not ill, but who may have been exposed
to an infectious agent or disease, with the objective of monitoring symptoms and early detection of cases”

• Various factors (cultural, geographic, economic) affect how well quarantine work.
If a decision to start quarantine is taken, the authorities should make sure:
● Appropriate physical setting and supplies for the quarantine period
● Appropriate infection prevention and control measures
● Health monitoring of quarantined persons

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
 63

Quarantines
Reliable and up-to-date information must be available to
communities and individuals in quarantine
● Persons who are quarantined need to be given resources including:
○ Health care services
○ Financial, social and psychosocial support
○ Basic needs including as food, water and other essentials
● Vulnerable populations should be prioritized and carefully considered.

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
 64

Preventing Community Spread

Case isolation and management
• Identify suspected COVID-19 cases, isolate patients at home or in the healthcare facility based on
severity of symptoms, test the patients for COVID-19, and treat symptoms.
Close contact quarantine
• Close contacts of suspected, probable, and confirmed COVID-19 cases should be quarantined in their
homes and monitored for up to 14 days after the last day of exposure.
Suspension of public gatherings
• If increasing number of cases are identified, local authorities can close or ban areas public
areas (theaters, sports events, religious services, restaurants, bars, etc).
• Local authorities can set a limit to any group gathering (examples, no more than 10 or 25 people).
Closure of schools, workplaces, etc.
Movement restriction
• Recommend only leaving home to get food, basic supplies, or care for a family member
• Ban non-essential travel

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
 65

Prevention Efforts in the Community

● Community steps to prevent infection and limit spread of disease.

○ Social distancing (staying an “arm’s length away” from other people)
○ Staying home if sick (fever, cough, other respiratory symptoms)
○ Regular hand washing and good respiratory hygiene
○ Avoiding touching the face (especially eyes, nose, and mouth)
● Wearing a mask in the community is not recommended.

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
66
 67

Summary
Infection Prevention and Control: COVID-19
• Good, understandable infection prevention and control strategies allows responsible use of
available resources to protect healthcare workers, patients, and community members.
• IPC starts with a unified team within each healthcare facility. Each team member should have a
clear understanding of their assigned roles and responsibilities.
• Staying up to date on guidelines from WHO and national health authorities is important as things
change day to day during the outbreak.
• IPC efforts within each hospital/healthcare facility should align with local community and
national response.
• Good communication and reporting are key for a successful IPC and to maintain public trust.

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
References 68

1. World Health Organization, https://openwho.org/courses/COVID-19-IPC-EN/items/5ZMmyYO6KlmIVXm7Ep4MwE

2. Medscape, https://www.medscape.com/viewarticle/926275
3. Wang et al. JAMA; 2020. https://www.ncbi.nlm.nih.gov/pubmed?term=32031570
4. World Health Organization Interim Technical Guidance,
https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/infection-prevention-and-control
5. World Health Organization, https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf
6. World Health Organization Case Definition,
https://apps.who.int/iris/bitstream/handle/10665/331340/WHO-2019-nCov-HCW_risk_assessment-2020.1-eng.pdf
7. World Health Organization Situation Report,
https://apps.who.int/iris/bitstream/handle/10665/331340/WHO-2019-nCov-HCW_risk_assessment-2020.1-eng.pdf
8. World Health Organization,
https://www.who.int/publications-detail/infection-prevention-and-control-during-health-care-when-novel-coronavirus-(ncov)-infection-is-suspec
ted-20200125
9. World Health Organization, Clean Hands is Safer Care, https://www.who.int/gpsc/clean_hands_protection/en/
10. World Health Organization 5 Moments to Wash Hands, https://www.who.int/gpsc/5may/background/5moments/en/
11. World Health Organization, How to Hand Wash, https://www.who.int/gpsc/5may/How_To_HandWash_Poster.pdf?ua=1
12. Bourouiba L, et al. J Fluid Mechanics; 2014.
13. Centers for Disease Control and Prevention, Transmission-Based Precautions,
https://www.cdc.gov/infectioncontrol/basics/transmission-based-precautions.html
14. Centers for Disease Control and Prevention, Precautions Guidelines, https://www.cdc.gov/infectioncontrol/guidelines/isolation/precautions.html

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0
References 69

15. World Health Organization, Rational Use of PPE,

https://apps.who.int/iris/bitstream/handle/10665/331215/WHO-2019-nCov-IPCPPE_use-2020.1-eng.pdf
16. Centers for Disease Control and Prevention, https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html
17. Centers for Disease Control and Prevention, https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html
18. World Health Organization HCW Risk Assessment,
https://apps.who.int/iris/bitstream/handle/10665/331340/WHO-2019-nCov-HCW_risk_assessment-2020.1-eng.pdf
19. World Health Organization, Surveillance Guidance,
https://www.who.int/publications-detail/global-surveillance-for-human-infection-with-novel-coronavirus-(2019-ncov)
20. World Health Organization, Home care,
https://www.who.int/publications-detail/home-care-for-patients-with-suspected-novel-coronavirus-(ncov)-infection-presenting-with-mild-sympto
ms-and-management-of-contacts
21. World Health Organization, Considerations for Quarantine,
https://www.who.int/publications-detail/considerations-for-quarantine-of-individuals-in-the-context-of-containment-for-coronavirus-disease-(cov
id-19)
22. Centers for Disease Control and Prevention, https://www.cdc.gov/coronavirus/2019-ncov/community/index.html
23. World Health Organization, https://www.who.int/publications-detail/water-sanitation-hygiene-and-waste-management-for-covid-19
24. Centers for Disease Control and Prevention, https://www.cdc.gov/vhf/ebola/clinicians/non-us-healthcare-settings/chlorine-use.html
25. Centers for Disease Control and Prevention,
https://www.cdc.gov/coronavirus/2019-ncov/php/public-health-communicators-get-your-community-ready.html
26. World Health Organization,
https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/risk-communication-and-community-engagement

Developed with a grant from Project HOPE. Copyright © Brown University,

2020. Released under Creative Commons license Attribution-
NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0