Covid-19 | New Scientist

Introduction

Welcome to University of Bradford, here is a collection of information pertaining to infection prevention and control practices in relation to COVID-19. The information here has been collated from various reliable sources (World Health Organisation, Public health England, Infection Prevention Society and Health Education England) and is subject to change as the COVID-19 pandemic continues. Always follow the most current guidance, this document is for information purposes only.

What Is Coronavirus and COVID-19?

Coronavirus are a group of viruses that live in animals such as bats. Bats then have the ability to inoculate or infect other species of animals. In the case of COVID-19 experts believe this may have been Pangolins. Pangolin meat is considered a delicacy in some Asian countries and their scales are thought to have medicinal purposes. When humans eat infected meat they become infected with the Coronavirus and have the ability to infect other humans. This mode of infection is called Zoonotic transmission (WHO 2020). Once humans began to get sick with respiratory symptoms, virus typing will have been conducted and this 'Novel Coronavirus' was discovered. This new virus was first recognised in 2019, hence the name 'Novel Coronavirus-19', now COVID-19.

As this is a new virus in the human population we are all susceptable and it has the potential to spread due to a lack of immunity (IPS 2020). We have seen this global spread due to the mobility of the population with world wide travel.

What are the Symptoms of COVID-19?

IPS COVID-19_Page_03.jpg

Severity of COVID-19 illness.

It is thought that 30-40% of individuals will be asymptomatic (IPS 2020), this is an issue as these individuals will not know they are infected but may have the ability to infect other individuals. Most children if infected will be asymptomatic or suffer with mild symptoms, similar to the common cold. The most severe disease is seen in older people aged 60+ and individuals with a long term health condition (PHE 2020). These include individuals with;

Heart disease
Chronic respiratory disease
Diabetes
Comprimised immune systems

The case fatality rate is less than 2% and is highest in at risk groups.

Transmission, IPC at home and preventing the spread.

Standard Precautions.

When you are in the clinical environment please use the following standard precautions.

Hand Hygiene.

Performing effective hand hygiene is vital in preventing the spread of infection. If hands are visibly dirty you should wash your hands with soap and water. Alcohol gel is effective against COVID-19 but should only be used on visibly clean hands.

Remember to lookafter your skin. Invest in a good handcream that can be applied on breaks and after your shift. Most ICU's will have some kind of emolient for staff to use while they are on-duty.

LOOK AFTER YOUR HANDS!

5 Moments Of Patient Safety Complying to professional appearance has never been more important, ensure you are bare below the elbow.

This means;

Short sleaves
No wrist wear -watches or bracelets - religious bracelets must be fixed above the elbow or be removed for work.
Nails should be clean and short - no false nails, no polish or shellac.
One plain band may be worn - no stoned rings or engravings on the metal.

Non compliance to this is a patient safety issue.

REMEBER - Patients need clean hands too.

Personal Protective Equipment in ICU.

All staff must wear:

FFP3 mask
- Filters out very small particles
- Protects from inhalation of fine airborne particles
- Filtration effective only if sealed to contour of face (fit testing required)
Eye protection
- Ideally a visor that covers the full face
Waterproof long-sleved gown
Plastic apron
- Must be changed between procedures
Gloves:
- Must be changed and hands decontaminated between procedures.

REMEMBER - Pathogens are transfered between patients, surfaces and your own mucose membranes on your gloved hands. Avoid touching your mouth, nose and eyes.

There is extensive guidance from Public Health England (2020) regarding the use of and rationale for Personal Protective Equipment.

Here is a video demonstration of how to don PPE in ICU.

Here is a video demonstration on how to doff/remove and dispose of PPE in ICU.

Aerosol Generating Procedures.

The highest risk of transmission of respiratory viruses is during AGPs of the respiratory tract, and use of enhanced respiratory protective equipment is indicated for health and social care workers performing or assisting in such procedures. The evidence review will continue to be updated in light of emerging evidence for this new pathogen.

A long-sleeved disposable fluid repellent gown (covering the arms and body), a filtering face piece class 3 (FFP3) respirator, a full-face shield or visor and gloves are recommended during AGPs on possible and confirmed cases, regardless of the clinical setting. Subject to local risk assessment, the same precautions apply for all patients regardless of case status in contexts of sustained COVID-19 transmission. Where an AGP is a single procedure, PPE is subject to single use with disposal after each patient contact or procedure as appropriate.

The following procedures are currently considered to be potentially infectious AGPs for COVID-19:

intubation, extubation and related procedures, for example, manual ventilation and open suctioning of the respiratory tract (including the upper respiratory tract)
tracheotomy or tracheostomy procedures (insertion or open suctioning or removal)
bronchoscopy and upper ENT airway procedures that involve suctioning
upper gastro-intestinal endoscopy where there is open suctioning of the upper respiratory tract
surgery and post mortem procedures involving high-speed devices
some dental procedures (for example, high-speed drilling)
non-invasive ventilation (NIV); Bi-level Positive Airway Pressure Ventilation (BiPAP) and Continuous Positive Airway Pressure Ventilation (CPAP)
High Frequency Oscillatory Ventilation (HFOV)
induction of sputum
high flow nasal oxygen (HFNO)

For patients with possible or confirmed COVID-19, any of these potentially infectious AGPs should only be carried out when essential. Where possible, these procedures should be carried out in a single room with the doors shut. Only those healthcare staff who are needed to undertake the procedure should be present.

Certain other procedures or equipment may generate an aerosol from material other than patient secretions but are not considered to represent a significant infectious risk. Procedures in this category include administration of pressurised humidified oxygen, entonox or medication via nebulisation.

NERVTAG advised that during nebulisation, the aerosol derives from a non-patient source (the fluid in the nebuliser chamber) and does not carry patient-derived viral particles. If a particle in the aerosol coalesces with a contaminated mucous membrane, it will cease to be airborne and therefore will not be part of an aerosol. Staff should use appropriate hand hygiene when helping patients to remove nebulisers and oxygen masks.

Chest compressions and defibrillation (as part of resuscitation) are not considered AGPs; first responders (any setting) can commence chest compressions and defibrillation without the need for AGP PPE while awaiting the arrival of other clinicians to undertake airway manoeuvres (PHE 2020)

Enironmental Decontamination.

IPS COVID-19_Page_23.jpg

Management of Waste and Linen.

All waste should be discarded in an infected waste stream, this is usually orange waste bags but check your local policy.

All linen is infected and should be placed in a water soluble bag then a red laundry bag. This policy may differ in your trust so please follow local guidance.

All blood or bodily fluid spills should be as per hospital policy, by an individual who is trained to manage the situation.

Uniforms must NOT be worn for traveling too and from work. If you wash your uniform at home ensure this is washed seperately at a temperature of 60 degrees.

Staff with COVID-19 symptoms.

If you develop symptoms of a flu-like illness then DO NOT come into work:

Acute onset fever >37.5oC and new persistent cough
Inform your manager
Self-isolate at home for 7 days from onset of symptoms
If your symptoms worsen contact NHS 111

Staff at high risk of complications from COVID-19

risk-assessment to manage their deployment

Infection Prevention in ICU.

Preventing Ventilator Associated Pneumonia.

This extract is from The Journal of the Intensive Care Society. The full artical can be found here:

"Ventilator-associated pneumonia (VAP) is a common healthcare-associated infection (HCAI) occurring in 10–20% of patients mechanically ventilated in the ICU.^1,2 Although the exact attributable mortality has proved difficult to define, it has significant consequences with increased mortality, the length of ICU stay and hospital stay and an increase in healthcare costs.^3–5 Furthermore, within a global setting of worsening antimicrobial resistance, the treatment of respiratory tract infections represents a significant burden of antimicrobials in the ICU.

VAP occurs because the obtunded, endotracheally intubated patient is at risk of inoculation of the lower respiratory tract with microorganisms. The source of the potential inoculate includes the oropharynx, subglottic area, sinuses and gastrointestinal (GI) tract. Access to the lower respiratory tract occurs around the endotracheal tube (ETT) cuff.⁶ Interventions to prevent VAP aim either to prevent repeated micro-aspiration, colonisation of upper airway and GI tract with potentially pathogenic organisms, or contamination of ventilator/respiratory equipment.

Bundles of care are evidenced-based practices that are grouped together to encourage the consistent delivery of these practices. These bundles are common in the ICU and have been developed for the prevention of VAP.^7,8 Recent evidence has challenged current widespread practice and so up to date recommendations on interventions for the prevention of VAP are needed" (Hellyer & Ewan et al 2016).

Care of Invasive Devices.

Arterial Lines.

Care of and sampling from an arterial line.jpg

Central Lines.

Care of a Central Line.jpg

Catheters.

Urinary catheterisation should be avoided if possible. If needed, then catheter should be reviewed
on a daily basis and removed as soon as clinically possible, preferably within 5 days
Urinary catheterisation should be performed using sterile equipment and aseptic technique should
always be maintained during insertion and aftercare procedures.
Hands must be properly washed before and after procedure and during daily management.
Catheters should not be changed routinely as this exposes the patient to increased risk of bladder
and urethral trauma.
Maintain a closed drainage system; open systems should be avoided if at all possible.
Bladder irrigation or washout and instillation of antiseptics or antimicrobial agents does not prevent
catheter-associated urinary tract infection and should not be used.
The drainage bag should be emptied at least once per nursing session into a clean receptacle
used only on one patient. (WHO 2019)

Useful Resources

Public Health England Campaign Resources
https://campaignresources.phe.gov.uk/resources/campaigns/101-coronavirus-
Public Health England Coronavirus (COVID-19) guidance
https://www.gov.uk/government/collections/coronavirus-covid-19-list-of-guidance
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attach
ment_data/file/872745/Infection_prevention_and_control_guidance_for_pandemic_
coronavirus.pdf
NHS England
https://www.england.nhs.uk/ourwork/eprr/coronavirus/
NHS website
https://www.nhs.uk/conditions/coronavirus-covid-19/
Healthcare Infection Society
https://his.org.uk/resources-guidelines/novel-coronavirus-resources/
World Health Organization
https://www.who.int/emergencies/diseases/novel-coronavirus-2019