In 2014 the World Health Organization published an update to the 2007 “Infection Prevention and Control of Epidemic- and Pandemic-Prone Acute Respiratory Infections in Health Care.” This addition is an important one, and especially relevant today, because it includes information and guidelines that were gathered during the H1N1 2009 virus infection and influenza-like illnesses. The updated publication prescribes best practices and recommendations with emphasis on acute respiratory infections (ARI) that manifest as epidemics or a pandemic.
The information and prescriptions provided are thorough. Relevant to COVID-19 pandemic, the publication details what has been learned from the Severe Acute Respiratory Syndrome (SARS) in 2003 and Middle East Respiratory Syndrome (MERS) in 2012. Of high importance are the prescribed guidelines for isolation rooms and areas that are broken into three categories:
- Preparation of the isolation room or area
- Wearing and removing personal protective equipment
- Checklist for isolation room and isolation cart
Preparation of the Isolation Room or Area
- Ensure that appropriate hand-washing facilities and hand-hygiene supplies are available.
- Stock the sink area with suitable supplies for hand-washing, and with alcohol-based hand sanitizer, near the point of care and the room door.
- Ensure adequate room ventilation.
- Post signs on the door indicating that the space is an isolation area.
- Ensure that visitors consult the health-care worker in charge (who is also responsible for keeping a visitor record) before being allowed into the isolation areas. Keep a roster of all staff working in the isolation areas, for possible outbreak investigation and contact tracing.
- Remove all non-essential furniture and ensure that the remaining furniture is easy to clean and does not conceal or retain dirt or moisture within or around it.
- Stock the PPE supply and linen outside the isolation room or area (e.g. in the change room). Setup an isolation cart outside the door to hold PPE. A checklist may be useful to ensure that all equipment is available.
- Place appropriate waste bags in a bin. If possible, use a touch-free bin. Ensure that used (i.e. dirty) bins remain inside the isolation rooms.
- Place a puncture-proof container for sharps disposal inside the isolation room or area.
- Keep the patient's personal belongings to a minimum. Keep water pitchers and cups, tissue wipes, and all items necessary for attending to personal hygiene, within the patient's reach.
- Dedicate non-critical patient-care equipment (e.g. stethoscope, thermometer, blood pressure cuff and sphygmomanometer) to the patient, if possible. Thoroughly clean and disinfect patient-care equipment that is required for use by other patients before use.
- Place an appropriate container with a lid outside the door for equipment that requires disinfection or sterilization.
- Keep adequate equipment required for cleaning or disinfection inside the isolation room or area, and ensure scrupulous daily cleaning of the isolation room or area.
- Set up a telephone or other method of communication in the isolation room or area to enable patients, family members or visitors to communicate with health-care workers. This may reduce the number of times the workers need to don PPE to enter the room or area.
Wearing and Removing Personal Protective Equipment (PPE)
Before entering the isolation room or area:
- Collect all equipment needed;
- Perform hand hygiene with an alcohol-based hand sanitizer (preferably when hands are not visibly soiled) or soap and water;
- Put on PPE in the order that ensures adequate placement of PPE items and prevents self-contamination and self-inoculation while using and taking off PPE. Refer to this graphic.
Leaving the isolation room or area:
- Either remove PPE in the anteroom or, if there is no anteroom, make sure that the PPE will not contaminate either the environment outside the isolation room or area, or other people.
- Remove PPE in a manner that prevents self-contamination or self-inoculation with contaminated PPE or hands. General principles are:
- Remove the most contaminated PPE items first;
- Perform hand hygiene immediately after removing gloves;
- Remove the mask or particulate respirator last (by grasping the ties and discarding in a waste bin);
- Discard disposable items in a closed rubbish bin;
- Put reusable items in a dry (e.g. without any disinfectant solution) closed container;
- Perform hand hygiene with an alcohol-based hand sanitizer (preferably) or soap and water whenever ungloved hands touch contaminated PPE items.
Checklist for Isolation Room and Isolation Cart
The following items should be kept on the isolation cart at all times so that PPE is always available for health-care workers.
- Eye Protection (visor or goggles)
- Face shield (provides eye, nose and mouth protection
- Reusable vinyl or rubber gloves for environmental cleaning
- Latex single-use gloves for clinical care
- Hair covers (optional)
- Particulate respirators (N95, FFP2, or equivalent)
- Medical (surgical or procedure) masks
- Gowns and aprons
- Single-use long-sleeved fluid-resistant or reusable non-fluid-resistant gowns
- Plastic aprons (for use over non-fluid-resistant gowns if splashing is anticipated and if fluid-resistant gowns are not available)
- Alcohol-based hand sanitizer
- Plain soap (liquid if possible, for washing hands in clean water)
- Clean single-use towels (e.g. paper towels)
- Sharps containers
- Appropriate detergent for environmental cleaning and disinfectant for disinfection of surfaces, instruments or equipment
- Large plastic bags
- Appropriate clinical waste bags
- Linen bags
- Collection container for used equipment
For more information:
Infection Prevention and Control of Epidemic- and Pandemic- Prone Acute Respiratory Infections in Health Care
Geneva: World Health Organization; 2014.