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Re: Infection prevention recommendations for care of patients with nCoV

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  • #76249
    Avatar photoMichael Wishart
    Participant

    Author:
    Michael Wishart

    Email:
    michael.wishart@internode.on.net

    Organisation:
    St Vincent's Private Hospital Northside

    State:
    QLD

    Michael Wishart
    Infection Control Coordinator
    St Vincent's Private Hospital Northside & St Vincent's Private Hospital Brisbane
    Brisbane, QLD
    michael.wishart@svha.org.au

    #76251
    marjenes@OPTUSNET.COM.AU Subject: Re: Infection prevention recommendations for care of patients with nCoV In-Reply-To:
    Participant

    Author:
    marjenes@OPTUSNET.COM.AU Subject: Re: Infection prevention recommendations for care of patients with nCoV In-Reply-To:

    Email:
    e38ebb19-0219-614a-7e07-f14a91a10bda@internode.on.net

    Organisation:

    State:

    Sun

    Dear Michael/Phil,

    Many thanks

    As a professional assisting in GP staff education, please comment on order for putting on (not as critical admittedly) but order of removal as below happy to accept of course as long as this is what is meant

    RESPIRATORY SYMPTOMS/SPECIMEN COLLECTION FOR 2019-nCoV REQUIRED:

    o perform hand hygiene before donning gown, gloves, eye protection (goggles or face shield) and P2/N95 respirator (for specimen collection) which must be fit checked

    o at completion of consultation, remove gown and gloves, perform hand hygiene; remove eye protection and P2 respirator without touching the front of them; perform hand hygiene.

    Are you indicating gown and glove removal in one movement? Is it indicating gown before goggle removal? Yes understood that eyes are possible portal of entry

    Just comparing this with NSW health dept below which I understood is universal

    Fit in this order

    * Wash hands or use alcohol-based rub

    * Respirator

    * Goggles

    * Gown

    * Gloves

    Remove in this order

    * Gloves

    * Wash hands or use alcohol-based rub

    * Goggles

    * Gown

    * Respirator

    * Wash hands or use alcohol-based ru

    Regards,

    Margaret Jennings
    Marjen Education Services

    website. http://www.marjenes.com.au
    email. marjenes@optusnet.com.au

    mob. 0404 088 754

    [Posted on behalf of member – Moderator]

    Hi Phil

    Will these recommendations for type of precautions apply to inpatient management of suspected or confirmed cases? That is: manage the patient in a negative pressure room under contact and droplet precautions, using airborne precautions for AGP?

    Many thanks

    Rebecca Adams

    Rebecca Adams

    Clinical Nurse Consultant

    Communicable Diseases and Infection Management Unit

    Queensland Health

    On Sat, Feb 1, 2020, 2:16 PM Philip Russo <prusso@acipc.org.au > wrote:

    INFECTION PREVENTION AND CONTROL RECOMMENDATIONS WHEN CARING FOR SUSPECTED 2019-nCoV INFECTIONS

    AHPPC commissioned Lyn Gilbert to convene an advisory group to advise on infection control recommendations. This group has made some interim recommendations that are broadly consistent with the WHO and EU policy, but not the same as CDC policy.

    In summary

    *Contact and droplet precautions are recommended for routine care of patients with suspected and confirmed nCoV infection
    *Contact and airborne precautions are recommended when performing aerosol generating procedures (AGPs), including taking respiratory specimens (which may provoke sneezing/coughing).

    A few points about these recommendations

    *These are interim recommendations and may be updated
    *These are minimum standards that are designed to allow patients with suspected coronavirus to be assessed safely in any setting, including general practice and hospitals
    *A higher standard of protection (use of airborne precautions) should be used for high risk AGPs such as bronchoscopy and intubation. Where possible, AGPs (esp nebulisers) should be avoided if possible.
    *If hospitals choose to use PAPRs or other PPE, it is essential that staff have adequate training to use them safely. HCWs (esp RMOs starting this week!) should be be trained to use PPE.
    *This advice has been provided to the Chief Health Officers (AHPPC) but not yet endorsed.

    The more detailed recommendations are below

    USE OF PPE DURING CARE OF PATIENTS WITH SUSPECTED OR CONFIRMED nCoV INFECTION.

    A person who has been in Hubei province (or other region where the risk of human-to-human transmission is significant) in the previous 14 days OR has been in contact with a person with nCoV infection should be in quarantine (voluntary or supervised).

    If a quarantinable person needs to see a doctor for any reason (e.g. development of fever and respiratory symptoms or other illness/injury), they should be asked to phone GP or ED before presenting.

    o If the patient has symptoms consistent with nCoV case definition, local public health unit should be consulted about the most suitable venue for clinical assessment and specimen collection.

    On presentation (to GP or hospital ED), the patient should be given a surgical mask and immediately directed to a single room, ideally with negative pressure ventilation (whether or not respiratory symptoms) are present.

    For clinical examination of a quarantinable patient (as above) transmission-based precautions should be observed whether or not respiratory symptoms are present as follows:

    NO RESPIRATORY SYMPTOMS/RESPIRATORY SPECIMEN NOT REQUIRED:

    o perform hand hygiene before donning gown, gloves and surgical mask (for routine clinical care),

    o at completion of consultation, remove PPE and perform hand hygiene.

    RESPIRATORY SYMPTOMS/SPECIMEN COLLECTION FOR 2019-nCoV REQUIRED:

    o perform hand hygiene before donning gown, gloves, eye protection (goggles or face shield) and P2/N95 respirator (for specimen collection) which must be fit checked

    o at completion of consultation, remove gown and gloves, perform hand hygiene; remove eye protection and P2 respirator without touching the front of them; perform hand hygiene.

    At completion of the consultation, the room surfaces should be wiped clean with disinfectant wipes by a person wearing gloves, gown and surgical mask.

    NOTE: If respiratory specimen collection (or other aerosol-generating procedure) has been performed in a room without negative pressure ventilation, it should not be used for patient consultation for at least 30 minutes (cleaning can be performed, during this time)

    Philip Russo PhD MClinEpid BN, FACIPC

    ACIPC President

    P +61 3 6281 9239

    E admin@acipc.org.au

    W acipc.org.au

    A 228 Liverpool Street, Hobart TAS 7000, Australia

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    The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

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