美国CDC关于确诊为新冠状患者或在医疗机构中临时感染的预防和控制建议(中英文)

    

       

2020年2月3日更新


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背景

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感染控制程序包括行政规则和工程控制,环境卫生,正确的工作习惯以及适当使用个人防护设备(PPE),对于防止感染在医疗服务提供过程中传播都是必不可少的。及时检测、有效分类和隔离潜在感染性患者,对于防止患者,医护人员和机构访客不必要的接触至关重要。所有医疗机构必须确保其人员接受了正确的培训,并且能够执行感染控制程序;各个医疗人员应确保他们了解并可以遵守感染控制要求。

本指南基于当前有限的关于2019-nCoV病毒严重程度,传播效率和持续时间的信息。随着更多信息的获得以及美国需求的变化,这种谨慎的方法将得到完善和更新。本指南适用于所有美国医疗机构。本指南不适用于非医疗机构(例如学校)或医疗机构以外的人员。有关临床管理,空中、地面医疗运输或实验室设置的建议,请参阅CDC 2019-nCoV主网站。

医护人员(HCP)的定义–在本指南中,HCP指从事医护活动的所有有薪和无薪工作人员,其从事患者护理活动,包括:对患者进行分诊评估,进入检查室或患者室以提供护理,或清洁和消毒环境,获取临床标本,处理使用过的医疗用品或设备,并与可能受污染的环境表面接触。


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推荐建议

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1.最小化接触机会

确保机构政策和行动到位,以最大程度地减少对呼吸道病原体的暴露,包括2019-nCoV。应在患者到达之前,到达之后以及在受影响患者在医疗机构就诊的整个过程中采取措施。

抵达前
  • 安排预约时,指示患者和陪同人员在到达时有任何呼吸道感染的症状(例如,咳嗽,流鼻涕,发烧)提前打电话或通知HCP,并采取适当的预防措施(例如,戴上口罩,一旦出现咳嗽,遵循分诊程序)。
  • 如果患者是通过紧急医疗服务(EMS)运送到达的,驾驶员应与接收急诊部门(ED)或医疗机构联系,并遵循先前商定的本地或区域运输协议。这让医疗机构为接收患者做好准备。

抵达和就诊期间
  • 采取措施以确保在整个就诊期间所有患有疑似2019-nCoV症状或其他呼吸道感染(例如发烧,咳嗽)的人遵守呼吸道卫生和咳嗽礼仪,手部卫生和分流程序。考虑在入口处和重要地点(例如候车区,电梯,自助餐厅)张贴视觉警示(例如标志,海报),以向患者和HCP提供有关手部卫生,呼吸系统卫生和咳嗽礼仪的说明(使用适当的语言) 。说明应包括:咳嗽或打喷嚏时如何使用口罩(请参见附录中面罩的定义)或纸巾来遮盖口鼻,处置废物容器中的纸巾和受污染物品,如何以及何时进行手部清洁。
  • 确保患有可疑2019-nCoV症状或其他呼吸道感染(例如发烧,咳嗽)症状的患者不得与其他患者在一起候诊。确保有一个单独的,通风良好的空间,让候诊患者相隔6英尺或更远,并易于获得呼吸卫生用品。在某些情况下,病情稳定的患者可能会选择在私人交通工具中或医疗机构外等待,轮到评估时,可通过移动电话与他们联系。
  • 确保对患有疑似2019-nCoV或其他呼吸道感染(例如发烧,咳嗽)症状的患者进行快速分类和隔离:
  • 实施患者分类程序,在患者分类或登记之时或之前(例如,在接待患者时)检测2019-nCoV的被调查者(PUI),并确保向所有患者询问是否存在呼吸道感染症状以及是否到过2019-nCoV传播地区的旅行史或与2019-nCoV疑似患者接触。
  • 在患者到达医疗机构之前或刚到达时,就能明确患者是否具有2019-nCoV感染风险。
  • 实施呼吸卫生和咳嗽礼仪(即,在患者的鼻子和嘴处带上面罩),并在空气传播隔离室(AIIR)中隔离2019-nCoV的PUI。请参阅下面的“患者安置”建议。可在CDC 2019-nCoV网站上找到评估美国感染2019-nCoV患者的其他指南。
  • 告知感染预防和控制服务单位,地方和州公共卫生当局以及其他医疗机构人员2019-nCoV患者的调查情况。
  • 提供呼吸卫生和咳嗽礼仪用品,包括60%-95%的酒精类洗手液(ABHS),纸巾,无接触容器以供使用,并在医疗机构入口,候诊室,患者接待处提供口罩。


2.遵守规范,空气接触预防措施,包括使用护目镜

标准预防措施假定每个人都可能被医疗机构中传播的病原体感染。下面总结了适用于呼吸道感染患者(包括由2019-nCoV引起的感染)的标准预防措施的要点。应注意正确使用,正确穿戴(穿上)和落下(脱下)以及处置个人防护装备的培训。本文档未强调所有患者护理标准预防措施的所有方面(例如,注射安全性);完整描述参见《隔离预防措施指南:在医疗机构中防止传染性病原传播。进入已知或怀疑具有2019-nCoV的患者房间(即PUI)的所有HCP(针对非HCP访客的措施,请参阅第3节)应遵守规范,接触和空中预防措施,包括以下内容:

患者安置
  • 将具有已知或疑似2019-nCoV(即PUI)的患者安置在根据指南构建和维护的AIIR中。
  • AIIR是相对于周围区域负压的单人病房,每小时至少换气6次(对于新建或翻新,建议每小时换气12次)。这些房间的空气应直接排放到室外,或在再循环之前通过高效微粒空气过滤器(HEPA)进行过滤。除进入或离开房间外,房间的门应保持关闭状态,出入时应尽量减少。应有设施监视并记录这些房间的负压功能。
  • 如果没有AIIR,需要住院的患者应在可行的情况下尽快转移到有AIIR的设施中。如果患者不需要住院,可与州或地方公共卫生部门协商后出院。待转移或出院前,给患者戴上口罩,将他/她隔离在关闭的检查室中。理想情况下,不应将患者放置在未经HEPA过滤的室内并将空气排气再循环到其他房间。
  • 一旦进入AIIR,就可以取下患者的口罩。将患者在AIIR之外的运输和移动仅限于医疗中。当不在AIIR时(例如,在运输过程中或没有AIIR时),患者应戴上口罩以阻挡分泌物。
  • 进入房间的人员应使用PPE,包括呼吸防护,如下所述。
  • 只有重要人员才能进入房间。实施人员配备政策,尽量减少进入房间的HCP人数。
  • 机构应考虑用专用HCP照顾这些患者,以将这些患者的传播和暴露风险降至最低。
  • 机构应保存人员照顾或进入这些患者病房或护理区域的所有日志。
  • 使用专用或一次性的非关键性患者护理设备(例如血压袖带)。如果设备用于多名患者,请先按照制造商的说明对另一名患者进行清洁和消毒。
  • 病人离开病房后之后,HCP进入应使用呼吸防护装置。(请参阅下面的个人防护装备部分)通过空中传播的病原体(例如麻疹,结核病)的标准做法是限制未经防护的个人(包括HCP)进入空置的房间,需要等待足够的时间以清除空气中潜在的传染性颗粒之后才可进入。我们仍不知道2019-nCoV在空气中保持传染性的时间。在此期间,合理的做法是,进入房间之前,应采用与呼吸道传播的病原体(例如,麻疹,结核病)相同的时间。此外,病房恢复正常使用之前,应进行适当的清洁和表面消毒。

手部卫生
  • 与所有患者接触之前或之后,与潜在感染性物质接触之前或之后以及穿上和脱下PPE(包括手套)之前,HCP应使用ABHS进行手部清洁。在医疗机构中的手部卫生也可以用肥皂和至少20秒水清洗。如果明显弄脏了双手,请在返回ABHS之前先用肥皂和水清洗。
  • 医疗保构应确保在每个护理场所都能随时获得手部清洁用品。

个人防护设备
雇主应根据OSHA的PPE标准(29 CFR 1910 Subpart I)选择合适的PPE并提供给HCP 。HCP必须接受有关PPE的培训并正确理解:何时使用PPE;什么是个人防护装备;如何正确穿戴,使用和脱下个人防护装备;如何正确处置或消毒和维护个人防护装备;和个人防护装备的局限性。使用后和使用中必须妥善清洁,净化和维护任何可重复使用的PPE。机构应有政策和程序来描述安全穿戴和脱下PPE的推荐顺序:

手套
  • 进行手部清洁,然后在进入病房或护理区时戴上干净的,非无菌手套。如果手套破损或严重污染,请更换手套。
  • 离开患者室或护理区时,请脱掉手套并丢弃,并立即进行手部清洁。

防护服
  • 进入患者房间或区域时,穿上干净的隔离服。如果隔离服变脏,请更换它。离开病人房间或护理区域之前,将隔离服移至专用容器中以进行废物处理或丢弃。一次性隔离服在使用后应丢弃。

呼吸系统防护
  • 进入患者室或护理区之前,请使用呼吸防护装置(例如,呼吸器),其防护等级至少应与经NIOSH认证的一次性N95过滤式面罩呼吸器相同。有关呼吸器的定义,请参阅附录。
  • 离开患者房间或护理区域并关门后,应摘掉一次性呼吸器并丢弃。丢弃呼吸器后要进行手清洁。
  • 如果是可重复使用的呼吸器(例如,电动空气净化呼吸器/ PAPR),则在使用前必须根据制造商的处理说明对其进行清洁和消毒。
  • 必须根据美国职业安全与健康管理局(OSHA)呼吸防护标准,在完整的呼吸防护程序中使用呼吸器。如果使用带有紧密配合面罩的呼吸器(例如,经NIOSH认证的一次性N95),应对医务人员进行医学检查和适合性测试,对其进行培训,包括接受有关正确使用呼吸器,安全拆卸和处置以及使用呼吸器的医学禁忌的培训。

保护眼睛
  • 进入病房或护理区时,戴上眼罩(例如护目镜,覆盖面部正面和侧面的一次性面部防护罩)。离开患者室或护理区之前,请脱掉护目镜。在重复使用之前,必须根据制造商的处理说明清洁和消毒可重复使用的护目镜。使用后应丢弃一次性护目镜。

执行气雾生成程序时要谨慎
  • 对2019-nCoV患者执行的某些程序可能会产生传染性气溶胶。特别是,应谨慎执行可能引起咳嗽的操作(例如,吸痰,开放气道抽吸),应尽量避免这些操作。
  • 如果执行了这些程序,则应在AIIR中进行,并且人员应如上所述使用呼吸保护装置。此外:
  • 将执行过程中的HCP数量降到最低,限制为仅对患者护理和程序支持至关重要的HCP数量。
  • 如下面有关环境感染控制的部分所述,及时清洁和消毒手术室表面。

检测呼吸道的标本采集
  • 收集诊断呼吸道的标本(例如鼻咽拭子)可能会引起咳嗽或打喷嚏。理想情况下,房间内的人员应仅限于患者和获取标本的医护人员。
  • 从已知或怀疑具有2019-nCoV的患者(即PUI)采集的用于检测2019-nCoV的标本时,HCP应遵守规范,接触和空中预防措施,包括使用眼部防护装置。
  • 这些程序应在AIIR或关闭的检查室中进行。理想情况下,不应将患者放置在未经HEPA过滤的、空气排放会再循环至其他房间的室内。

PUI和确诊的2019-nCoV患者隔离预防措施的持续时间
  • 在获得有关临床改善后病毒脱落的信息之前,应与当地,州和联邦卫生当局结合具体情况确定是否终止隔离措施。
  • 应考虑的因素包括:与2019-nCoV有关症状的存在,症状缓解的日期,需要采取特殊预防措施的其他状况(例如结核,艰难梭菌),其他反映临床状况的实验室信息,替代住院的方法,例如在家中安全恢复的可能性。

3.机构内访客进入和移动

  • 建立监视,管理和培训来访者的程序。
  • 限制访客进入已知或疑似2019-nCoV患者(即PUI)的房间。应探索患者和访客交流的替代机制,例如手机或平板电脑视频通话应用程序。根据临终情况或当探访者关怀对于患者的情感健康至关重要时,机构可以考虑例外情况。
  • 应当安排预约并控制对2019-nCoV已知或疑似患者(即PUI)患者的探访者,应当:
  • 在进入医疗机构之前,对访客进行急性呼吸道疾病症状筛查。
  • 机构应评估对访客健康的风险(例如,访客可能患有潜在疾病,使访客在2019-nCoV中处于较高风险中)和遵守预防措施的能力。
  • 在访客进入患者房间之前,机构应向访客提供指导:保持手部清洁,限制接触表面以及使用PPE。
  • 机构应保存所有进入病房的访客的记录(例如,日志)。
  • 在气雾生成过程中,不应出现访客。
  • 应该指示访客限制其在机构内移动。
  • 应建议暴露的访客(例如,入院前与2019-nCoV患者接触)应在其最后一次已知的与患者接触后14天内,向其医疗服务提供者报告任何急性疾病的体征和症状。
  • 在机构的公共区域内,所有访客均应遵守呼吸道卫生和咳嗽礼仪预防措施。

4. 实施控制工程

考虑设计和安装工程控件,通过保护HCP和其他患者免受感染,减少或消除暴露。控制工程的示例包括引导病人通过分诊区的物理屏障或隔板,共用区中病人之间的窗帘,密闭抽吸系统以及合适的空气处理系统(具有适当的方向性,过滤,交换率等等)进行安装和正确维护。

5. 监控和管理患病人员和医务人员

  • 对接触2019-nCoV的HCP的监测决策应与公共卫生当局协商。
  • 医疗机构和组织应实施非惩罚性的、灵活且符合公共卫生指导方针的HCP 病假政策。

6. 培训和教育医护人员

  • 为HCP提供针对工作或任务的教育和培训,以防止传染源传播,包括进修培训。
  • 必须对HCP进行医学体检,培训和密封度测试来使用呼吸防护设备(例如,N95过滤式面罩呼吸器),或进行医学体检和培训,以使用其他呼吸防护设备(例如,动力式呼吸防护具,PAPR)。OSHA网站有许多呼吸训练视频。
  • 在照顾患者之前,请确保对HCP进行了教育,培训和适当使用PPE,包括拆卸此类设备的过程中注意正确使用PPE并防止污染衣服,皮肤和环境。

7. 实施环境感染控制

  • 应使用专用的医疗设备进行患者护理。
  • 用于患者护理的所有非专用,非一次性医疗设备应根据制造商的说明和机构政策进行清洁和消毒。
  • 确保始终如一地正确执行环境清洁和消毒程序。
  • 常规清洁和消毒程序适用于2019-nCoV的医疗机构中,包括执行气雾产生程序的病人护理区域。建议将具有EPA批准的有新兴病毒病原体要求的产品用于2019-nCoV。这些产品按照以下要求进行标识:
  • “ [产品名称]已证明对类似于2019-nCoV的病毒有效。因此,针对[病毒的名称]的使用说明也可用于针对2019-nCoV的使用。”
  • 只能通过以下渠道提出此主张或类似的主张:仅向医疗机构,医生,护士和公共卫生官员分发的技术文献,“ 1-800”消费者信息服务,社交媒体网站和公司网站。“ 2019-nCoV”的特定声明将不会出现在产品或主标签上。
  • 查看有关EPA批准的新兴病毒病原体声明的附加信息。
  • 如果没有可用的EPA注册产品,则应根据标签说明使用带有针对人类冠状病毒的标签声明的产品。
  • 衣物清洁,食品餐具和医疗废物的管理也应按照常规程序进行。
  • 有关在医疗机构中进行环境感染控制的详细信息,请参见CDC的《在医疗机构中进行环境感染控制的指南》和《隔离注意事项指南:防止医疗机构中传染源的传播》 [第IV.F章节]。

8. 在医疗机构内和向公共卫生当局建立报告

  • 实施机制和政策,迅速提醒关键机构人员有关已知或疑似2019-nCoV患者(即PUI)的信息,包括感染控制,医疗流行病学,机构领导,职业健康,临床实验室和前线人员。
  • 与公共卫生部门进行沟通和合作。
  • 立即将已知或疑似2019-nCoV的患者(即PUI)通知州或地方公共卫生部门。机构应指定医疗机构中特定人员负责与公共卫生官员沟通并向HCP传播信息。


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附录:

有关呼吸器和口罩的其他信息:

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有关呼吸器的信息:
  • 呼吸器是一种戴在脸上,至少覆盖鼻子和嘴巴的个人防护设备,用于降低佩戴者吸入有害的空气传播颗粒(包括灰尘颗粒和传染剂),气体或蒸气的风险。呼吸器已通过CDC / NIOSH认证,包括用于医疗保健的呼吸器。
  • 必须在符合OSHA呼吸防护标准(29 CFR 1910.134 )的完整呼吸防护程序中使用呼吸器。如果使用带有紧密配合面罩的呼吸器(例如,经NIOSH批准的N95呼吸器),应对HCP进行医学检查并进行密封测试,并接受有关正确使用呼吸器,安全拆卸和处置以及使用呼吸器的医学禁忌的培训。
  • NIOSH关于呼吸器的信息网站
  • OSHA呼吸防护eTool 网站

过滤面罩呼吸器(FFR),包括N95呼吸器
  • 常用的呼吸器是过滤式面罩呼吸器(通常称为N95)。过滤式面罩呼吸器是可过滤掉颗粒的一次性半面罩呼吸器。
  • FFR必须在整个暴露期间都佩戴,并适合每个佩戴者(这称为“密封测试”,通常在使用呼吸器的工作场所进行)。
  • 网站:N95呼吸器有效的三个关键因素
  • FFR用户还应执行用户密封检查,以确保每次使用FFR时都密合。
  • 网站:有关如何执行用户密封度检查的更多信息

动力空气滤净式呼吸器(PAPR)
  • 动力空气滤净式呼吸器(PAPR)具使用电池驱动的自动呼吸器,可通过连接过滤器,滤罐或滤筒吸入空气。当配备了适当的滤筒,滤毒罐或过滤器时,它们可阻挡气体,蒸气或颗粒。
  • 非密合型的PAPR不需要进行密封测试,可与毛发一起使用。
  • NIOSH认证的设备清单上有NIOSH批准的PAPR 列表(网站)。

有关面罩的信息:
  • 如果佩戴正确,则面罩有助于阻止佩戴者产生的呼吸道分泌物污染他人和表面(通常称为源控制)。
  • 面罩已被美国食品药品监督管理局(FDA)批准成为医疗设备。面罩应使用一次后丢弃到垃圾桶。


以下为英文版


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


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Background

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Infection control procedures including administrative rules and engineering controls, environmental hygiene, correct work practices, and appropriate use of personal protective equipment (PPE) are all necessary to prevent infections from spreading during healthcare delivery. Prompt detection and effective triage and isolation of potentially infectious patients are essential to prevent unnecessary exposures among patients, healthcare personnel, and visitors at the facility. All healthcare facilities must ensure that their personnel are correctly trained and capable of implementing infection control procedures; individual healthcare personnel should ensure they understand and can adhere to infection control requirements.

This guidance is based on the currently limited information available about 2019-nCoV related to disease severity, transmission efficiency, and shedding duration. This cautious approach will be refined and updated as more information becomes available and as response needs change in the United States. This guidance is applicable to all U.S. healthcare settings. This guidance is not intended for non-healthcare settings (e.g., schools) OR to persons outside of healthcare settings. For recommendations regarding clinical management, air or ground medical transport, or laboratory settings, refer to the main CDC 2019-nCoV website.

Definition of Healthcare Personnel (HCP) – For the purposes of this guidance, HCP refers to all persons, paid and unpaid, working in healthcare settings engaged in patient care activities, including: patient assessment for triage, entering examination rooms or patient rooms to provide care or clean and disinfect the environment, obtaining clinical specimens, handling soiled medical supplies or equipment, and coming in contact with potentially contaminated environmental surfaces.


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Recommendations

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1. Minimize Chance for Exposures

Ensure facility policies and practices are in place to minimize exposures to respiratory pathogens including 2019-nCoV. Measures should be implemented before patient arrival, upon arrival, and throughout the duration of the affected patient’s presence in the healthcare setting.

Before Arrival
  • When scheduling appointments, instruct patients and persons who accompany them to call ahead or inform HCP upon arrival if they have symptoms of any respiratory infection (e.g., cough, runny nose, fever1) and to take appropriate preventive actions (e.g., wear a facemask upon entry to contain cough, follow triage procedures).
  • If a patient is arriving via transport by emergency medical services (EMS), the driver should contact the receiving emergency department (ED) or healthcare facility and follow previously agreed upon local or regional transport protocols. This will allow the healthcare facility to prepare for receipt of the patient.

Upon Arrival and During the Visit
  • Identify patients at risk for having 2019-nCoV infection before or immediately upon arrival to the healthcare facility.
  • Implement respiratory hygiene and cough etiquette (i.e., placing a facemask over the patient’s nose and mouth if that has not already been done) and isolate the PUI for 2019-nCoV in an Airborne Infection Isolation Room (AIIR), if available. See recommendations for “Patient Placement” below. Additional guidance for evaluating patients in U.S. for 2019-nCoV infection can be found on the CDC 2019-nCoV website.
  • Inform infection prevention and control services, local and state public health authorities, and other healthcare facility staff as appropriate about the presence of a person under investigation for 2019-nCoV.
  • Implement triage procedures to detect persons under investigation (PUI) for 2019-nCoV  during or before patient triage or registration (e.g., at the time of patient check-in) and ensure that all patients are asked about the presence of symptoms of a respiratory infection and history of travel to areas experiencing transmission of 2019-nCoV or contact with possible 2019-nCoV patients.
  • Take steps to ensure all persons with symptoms of suspected 2019-nCoV or other respiratory infection (e.g., fever, cough) adhere to respiratory hygiene and cough etiquette, hand hygiene, and triage procedures throughout the duration of the visit. Consider posting visual alerts (e.g., signs, posters) at the entrance and in strategic places (e.g., waiting areas, elevators, cafeterias) to provide patients and HCP with instructions (in appropriate languages) about hand hygiene, respiratory hygiene, and cough etiquette. Instructions should include how to use facemasks (See definition of facemask in Appendix) or tissues to cover nose and mouth when coughing or sneezing, to dispose of tissues and contaminated items in waste receptacles, and how and when to perform hand hygiene.
  • Ensure that patients with symptoms of suspected 2019-nCoV or other respiratory infection (e.g., fever, cough) are not allowed to wait among other patients seeking care.  Identify a separate, well-ventilated space that allows waiting patients to be separated by 6 or more feet, with easy access to respiratory hygiene supplies. In some settings, medically-stable patients might opt to wait in a personal vehicle or outside the healthcare facility where they can be contacted by mobile phone when it is their turn to be evaluated.
  • Ensure rapid triage and isolation of patients with symptoms of suspected 2019-nCoV or other respiratory infection (e.g., fever, cough):
  • Provide supplies for respiratory hygiene and cough etiquette, including 60%-95% alcohol-based hand sanitizer (ABHS), tissues, no touch receptacles for disposal, and facemasks at healthcare facility entrances, waiting rooms, patient check-ins, etc.

2. Adherence to Standard, Contact, and Airborne Precautions, Including the Use of Eye Protection

Standard Precautions assume that every person is potentially infected or colonized with a pathogen that could be transmitted in the healthcare setting. Elements of Standard Precautions that apply to patients with respiratory infections, including those caused by 2019-nCoV, are summarized below. Attention should be paid to training on correct use, proper donning (putting on) and doffing (taking off), and disposal of any PPE. This document does not emphasize all aspects of Standard Precautions (e.g., injection safety) that are required for all patient care; the full description is provided in the Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. All HCP (see section 3 for measures for non-HCP visitors) who enter the room of a patient with known or suspected 2019-nCoV (i.e., PUI) should adhere to Standard, Contact, and Airborne Precautions, including the following:

Patient Placement
  • Place a patient with known or suspected 2019-nCoV (i.e., PUI) in an AIIR that has been constructed and maintained in accordance with current guidelines.
  • AIIRs are single patient rooms at negative pressure relative to the surrounding areas, and with a minimum of 6 air changes per hour (12 air changes per hour are recommended for new construction or renovation). Air from these rooms should be exhausted directly to the outside or be filtered through a high-efficiency particulate air (HEPA) filter before recirculation. Room doors should be kept closed except when entering or leaving the room, and entry and exit should be minimized. Facilities should monitor and document the proper negative-pressure function of these rooms.
  • If an AIIR is not available, patients who require hospitalization should be transferred as soon as is feasible to a facility where an AIIR is available. If the patient does not require hospitalization they can be discharged to home (in consultation with state or local public health authorities) if deemed medically and socially appropriate. Pending transfer or discharge, place a facemask on the patient and isolate him/her in an examination room with the door closed. Ideally, the patient should not be placed in any room where room exhaust is recirculated within the building without HEPA filtration.
  • Once in an AIIR, the patient’s facemask may be removed. Limit transport and movement of the patient outside of the AIIR to medically-essential purposes. When not in an AIIR (e.g., during transport or if an AIIR is not available), patients should wear a facemask to contain secretions.
  • Personnel entering the room should use PPE, including respiratory protection, as described below.
  • Only essential personnel should enter the room. Implement staffing policies to minimize the number of HCP who enter the room.
  • Facilities should consider caring for these patients with dedicated HCP to minimize risk of transmission and exposure to other patients and other HCP.
  • Facilities should keep a log of all persons who care for or enter the rooms or care area of these patients.
  • Use dedicated or disposable noncritical patient-care equipment (e.g., blood pressure cuffs). If equipment will be used for more than one patient, clean and disinfect such equipment before use on another patient according to manufacturer’s instructions.
  • HCP entering the room soon after a patient vacates the room should use respiratory protection. (See personal protective equipment section below) Standard practice for pathogens spread by the airborne route (e.g., measles, tuberculosis) is to restrict unprotected individuals, including HCP, from entering a vacated room until sufficient time has elapsed for enough air changes to remove potentially infectious particles (more information on clearance rates under differing ventilation conditions is available). We do not yet know how long 2019-nCoV remains infectious in the air. In the interim, it is reasonable to apply a similar time period before entering the room without respiratory protection as used for pathogens spread by the airborne route (e.g., measles, tuberculosis). In addition, the room should undergo appropriate cleaning and surface disinfection before it is returned to routine use.

Hand Hygiene
  • HCP should perform hand hygiene using ABHS before and after all patient contact, contact with potentially infectious material, and before putting on and upon removal of PPE, including gloves. Hand hygiene in healthcare settings also can be performed by washing with soap and water for at least 20 seconds. If hands are visibly soiled, use soap and water before returning to ABHS.
  • Healthcare facilities should ensure that hand hygiene supplies are readily available in every care location.

Personal Protective Equipment
Employers should select appropriate PPE and provide it to HCP in accordance with OSHA’s PPE standards (29 CFR 1910 Subpart I)external icon. HCP must receive training on and demonstrate an understanding of when to use PPE; what PPE is necessary; how to properly don, use, and doffpdf icon PPE in a manner to prevent self-contamination; how to properly dispose of or disinfect and maintain PPE; and the limitations of PPE. Any reusable PPE must be properly cleaned, decontaminated, and maintained after and between uses. Facilities should have policies and procedures describing a recommended sequence for safely donning and doffing PPE:

Gloves
  • Perform hand hygiene, then put on clean, non-sterile gloves upon entry into the patient room or care area. Change gloves if they become torn or heavily contaminated.
  • Remove and discard gloves when leaving the patient room or care area, and immediately perform hand hygiene.

Gowns
  • Put on a clean isolation gown upon entry into the patient room or area. Change the gown if it becomes soiled. Remove and discard the gown in a dedicated container for waste or linen before leaving the patient room or care area. Disposable gowns should be discarded after use. Cloth gowns should be laundered after each use.

Respiratory Protection
  • Use respiratory protection (i.e., a respirator) that is at least as protective as a fit-tested NIOSH-certified disposable N95 filtering facepiece respirator before entry into the patient room or care area. See appendix for respirator definition.
  • Disposable respirators should be removed and discarded after exiting the patient’s room or care area and closing the door. Perform hand hygiene after discarding the respirator.
  • If reusable respirators (e.g., powered air purifying respirator/PAPR) are used, they must be cleaned and disinfected according to manufacturer’s reprocessing instructions prior to re-use.
  • Respirator use must be in the context of a complete respiratory protection program in accordance with Occupational Safety and Health Administration (OSHA) Respiratory Protection standard (29 CFR 1910.134external icon). Staff should be medically cleared and fit-tested if using respirators with tight-fitting facepieces (e.g., a NIOSH-certified disposable N95) and trained in the proper use of respirators, safe removal and disposal, and medical contraindications to respirator use.

Eye Protection
  • Put on eye protection (e.g., goggles, a disposable face shield that covers the front and sides of the face) upon entry to the patient room or care area. Remove eye protection before leaving the patient room or care area. Reusable eye protection (e.g., goggles) must be cleaned and disinfected according to manufacturer’s reprocessing instructions prior to re-use.  Disposable eye protection should be discarded after use.

Use Caution When Performing Aerosol-Generating Procedures
  • Some procedures performed on 2019-nCoV patients could generate infectious aerosols. In particular, procedures that are likely to induce coughing (e.g., sputum induction, open suctioning of airways) should be performed cautiously and avoided if possible.
  • If performed, these procedures should take place in an AIIR and personnel should use respiratory protection as described above. In addition:
  • Limit the number of HCP present during the procedure to only those essential for patient care and procedural support.
  • Clean and disinfect procedure room surfaces promptly as described in the section on environmental infection control below.

Diagnostic Respiratory Specimen Collection
  • Collecting diagnostic respiratory specimens (e.g., nasopharyngeal swab) are likely to induce coughing or sneezing. Individuals in the room during the procedure should, ideally, be limited to the patient and the healthcare provider obtaining the specimen.
  • HCP collecting specimens for testing for 2019-nCoV from patients with known or suspected 2019-nCoV (i.e., PUI) should adhere to Standard, Contact, and Airborne Precautions, including the use of eye protection.
  • These procedures should take place in an AIIR or in an examination room with the door closed.  Ideally, the patient should not be placed in any room where room exhaust is recirculated within the building without HEPA filtration.

Duration of Isolation Precautions for PUIs and confirmed 2019-nCoV patients
  • Until information is available regarding viral shedding after clinical improvement, discontinuation of isolation precautions should be determined on a case-by-case basis, in conjunction with local, state, and federal health authorities.
  • Factors that should be considered include: presence of symptoms related to 2019-nCoV, date symptoms resolved, other conditions that would require specific precautions (e.g., tuberculosis, Clostridioides difficile), other laboratory information reflecting clinical status, alternatives to inpatient isolation, such as the possibility of safe recovery at home.

3. Manage Visitor Access and Movement Within the Facility

  • Establish procedures for monitoring, managing and training visitors.
  • Restrict visitors from entering the room of known or suspected 2019-nCoV patients (i.e., PUI). Alternative mechanisms for patient and visitor interactions, such as video-call applications on cell phones or tablets should be explored. Facilities can consider exceptions based on end-of-life situations or when a visitor is essential for the patient’s emotional well-being and care.
  • Visitors to patients with known or suspected 2019-nCoV (i.e., PUI) should be scheduled and controlled to allow for:
  • Screening visitors for symptoms of acute respiratory illness before entering the healthcare facility.
  • Facilities should evaluate risk to the health of the visitor (e.g., visitor might have underlying illness putting them at higher risk for 2019-nCoV) and ability to comply with precautions.
  • Facilities should provide instruction, before visitors enter patients’ rooms, on hand hygiene, limiting surfaces touched, and use of PPE according to current facility policy while in the patient’s room.
  • Facilities should maintain a record (e.g., log book) of all visitors who enter patient rooms.
  • Visitors should not be present during aerosol-generating procedures.
  • Visitors should be instructed to limit their movement within the facility.
  • Exposed visitors (e.g., contact with 2019-nCoV patient prior to admission) should be advised to report any signs and symptoms of acute illness to their health care provider for a period of at least 14 days after the last known exposure to the sick patient.
  • All visitors should follow respiratory hygiene and cough etiquette precautions while in the common areas of the facility.

4. Implement Engineering Controls

Consider designing and installing engineering controls to reduce or eliminate exposures by shielding HCP and other patients from infected individuals. Examples of engineering controls include physical barriers or partitions to guide patients through triage areas, curtains between patients in shared areas, closed suctioning systems for airway suctioning for intubated patients, as well as appropriate air-handling systems (with appropriate directionality, filtration, exchange rate, etc.) that are installed and properly maintained.

5. Monitor and Manage Ill and Exposed Healthcare Personnel

  • Movement and monitoring decisions for HCP with exposure to 2019-nCoV should be made in consultation with public health authorities.
  • Facilities and organizations providing healthcare should implement sick leave policies for HCP that are non-punitive, flexible, and consistent with public health guidance.

6. Train and Educate Healthcare Personnel

  • Provide HCP with job- or task-specific education and training on preventing transmission of infectious agents, including refresher training.
  • HCP must be medically cleared, trained, and fit tested for respiratory protection device use (e.g., N95 filtering facepiece respirators), or medically cleared and trained in the use of an alternative respiratory protection device (e.g., Powered Air-Purifying Respirator, PAPR) whenever respirators are required. OSHA has a number of respiratory training videosexternal icon.
  • Ensure that HCP are educated, trained, and have practiced the appropriate use of PPE prior to caring for a patient, including attention to correct use of PPE and prevention of contamination of clothing, skin, and environment during the process of removing such equipment.

7. Implement Environmental Infection Control

  • Dedicated medical equipment should be used for patient care.
  • All non-dedicated, non-disposable medical equipment used for patient care should be cleaned and disinfected according to manufacturer’s instructions and facility policies.
  • Ensure that environmental cleaning and disinfection procedures are followed consistently and correctly.
  • Routine cleaning and disinfection procedures (e.g., using cleaners and water to pre-clean surfaces prior to applying an EPA-registered, hospital-grade disinfectant to frequently touched surfaces or objects for appropriate contact times as indicated on the product’s label) are appropriate for 2019-nCoV in healthcare settings, including those patient-care areas in which aerosol-generating procedures are performed. Products with EPA-approved emerging viral pathogens claims are recommended for use against 2019-nCoV. These products can be identified by the following claim:
  • “[Product name] has demonstrated effectiveness against viruses similar to 2019-nCoV on hard non-porous surfaces. Therefore, this product can be used against 2019-nCoV when used in accordance with the directions for use against [name of supporting virus] on hard, non-porous surfaces.”
  • This claim or a similar claim, will be made only through the following communications outlets: technical literature distributed exclusively to health care facilities, physicians, nurses and public health officials, “1-800” consumer information services, social media sites and company websites (non-label related). Specific claims for “2019-nCoV” will not appear on the product or master label.
  • See additional information about EPA-approved emerging viral pathogens claimsexternal icon.
  • If there are no available EPA-registered products that have an approved emerging viral pathogen claim for 2019-nCoV, products with label claims against human coronaviruses should be used according to label instructions.
  • Management of laundry, food service utensils, and medical waste should also be performed in accordance with routine procedures.
  • Detailed information on environmental infection control in healthcare settings can be found in CDC’s Guidelines for Environmental Infection Control in Health-Care Facilities and Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings [section IV.F. Care of the environment].

8. Establish Reporting within Healthcare Facilities and to Public Health Authorities

  • Implement mechanisms and policies that promptly alert key facility staff including infection control, healthcare epidemiology, facility leadership, occupational health, clinical laboratory, and frontline staff about known or suspected 2019-nCoV patients (i.e., PUI).
  • Communicate and collaborate with public health authorities.
  • Promptly notify state or local public health authorities of patients with known or suspected 2019-nCoV (i.e., PUI). Facilities should designate specific persons within the healthcare facility who are responsible for communication with public health officials and dissemination of information to HCP.


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Appendix: Additional Information about Respirators and Facemasks:

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Information about Respirators:
  • A respirator is a personal protective device that is worn on the face, covers at least the nose and mouth, and is used to reduce the wearer’s risk of inhaling hazardous airborne particles (including dust particles and infectious agents), gases, or vapors. Respirators are certified by the CDC/NIOSH, including those intended for use in healthcare.
  • Respirator use must be in the context of a complete respiratory protection program in accordance with OSHA Respiratory Protection standard (29 CFR 1910.134external icon). HCP should be medically cleared and fit-tested if using respirators with tight-fitting facepieces (e.g., a NIOSH-approved N95 respirator) and trained in the proper use of respirators, safe removal and disposal, and medical contraindications to respirator use.
  • NIOSH information about respirators
  • OSHA Respiratory Protection eToolexternal icon

Filtering Facepiece Respirators (FFR) including N95 Respirators
  • A commonly used respirator is a filtering facepiece respirator (commonly referred to as an N95). Filtering facepiece respirators are disposable half facepiece respirators that filter out particles.
  • To work properly, FFRs must be worn throughout the period of exposure and be specially fitted for each person who wears one (this is called “fit-testing” and is usually done in a workplace where respirators are used).
  • Three key factors for an N95 respirator to be effectivepdf icon
  • FFR users should also perform a user seal check to ensure proper fit each time an FFR is used.
  • More information on how to perform a user seal checkpdf icon

Powered Air-Purifying Respirators (PAPRs)
  • Powered air-purifying respirators (PAPRs) have a battery-powered blower that pulls air through attached filters, canisters, or cartridges. They provide protection against gases, vapors, or particles, when equipped with the appropriate cartridge, canister, or filter.
  • Loose-fitting PAPRs do not require fit testing and can be used with facial hair.
  • A list of NIOSH-approved PAPRs is located on the NIOSH Certified Equipment List

Information about Facemasks:
  • If worn properly, a facemask helps block respiratory secretions produced by the wearer from contaminating other persons and surfaces (often called source control).
  • Facemasks are cleared by the U.S. Food and Drug Administration (FDA) for use as medical devices. Facemasks should be used once and then thrown away in the trash.



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