Day 1 - IPC

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.

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.

4
Outline of this Presentation

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

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.

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.

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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
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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

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

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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.

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

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!

Infection Control Precautions for Suspected/
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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)

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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.

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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.

Standard Precautions for ALL Patients
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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.
Standard Precautions for All Patients
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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

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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.

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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.

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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

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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)

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Appropriate PPE for Routine Patient Care

● Eye protection
● Surgical mask
● Gloves
● REMEMBER: Always practice appropriate hand hygiene

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PPE for Suspected or Confirmed COVID-19

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

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PPE for Aerosolizing Generating Procedures

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

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Alternative PPE for Aerosolizing Generating Procedures

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

“Don” or Put on PPE for Suspected or Confirmed 27
COVID-19
***CRITICAL:
Perform hand Hand hygiene
hygiene should be
performed before
and after each step!

28
Donning PPE
***CRITICAL:
Hand hygiene
should be
performed before

“Doff” or Take Off PPE 29
***CRITICAL:
Hand hygiene
should be
performed before

30
Doffing PPE for Suspected or Confirmed COVID-19

***CRITICAL:
Hand hygiene
should be
performed before

Doffing PPE 31
***CRITICAL:
Hand hygiene
should be
performed before

32
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)
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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.
Conservation of Masks and Respirators 34
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
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University, 2020. Released under Creative Commons license Attribution-
Indications to Replace Masks and Respirators
35
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
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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 36
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.
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Brown University, 2020. Released under Creative
Commons license Attribution-NonCommercial-
NoDerivatives 4.0 International (CC BY-NC-ND 4.0
37
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
• .5% hydrogen peroxide
• .1% sodium hypochlorite
• Less effective disinfectants for coronaviruses:
• .05 - 2% benzalkonium chloride
• .02% chlorhexidine digluconate
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Stability of COVID-19 Virus
N Engl J Med DOI: 10.1056/NEJMc2004973

39
• 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

Environmental considerations 40
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
• Use gloves when handling patient clothing and linens
• Do not shake items

• Launder as per manufacturer’s instructions
• Use hottest temperature for the material

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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.

44
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.

45
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.

46
Post-Mortem Management
• Prevent Contact with Infectious Body Fluids:
Frequent handwashing
Transmission from respiratory droplets is not a concern
Use standard PPE
gloves, fluid-resistant gown, and eye shield
• Disinfect all equipment and potentially contaminated surfaces
Wear appropriate PPE when handling all chemicals
• Move body to cemetery for burial, or crematorium based on family wishes

47
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.

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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-
2020.1-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.

49
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.

Monitoring Exposed Healthcare Personnel 50
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.

Healthcare Workers Who Have Had Potential Exposure to 51
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
compensation as possible. for all patients with acute respiratory illness and
standard precautions to take care of all patients.

52
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.

53
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.

54
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

55
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.

Recommendations for Home Care: Review of 56
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.

57
Who Should be Quarantined? – Review of Concepts

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.

Considerations for Quarantine: Review 58
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

59
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.

60
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

61
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.

62
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.

References 63
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-suspected-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

References 64
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)
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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
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26. World Health Organization, https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/risk-communication-and-
community-engagement


Day 1 - IPC

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Day 1 - IPC

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COVID-19

Infection Prevention and

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

1. Understand the principles and practices for Infection Prevention

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

4. Identify recommended IPC requirements for COVID-19 for

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

Outline of this Presentation

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

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

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

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

IPC in Healthcare Facilities

Importance of IPC in Healthcare Settings

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

Core Principles of IPC

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

Establish a COVID-19 IPC Team

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

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

IPC During Screening

• Set up a screening station at all entrances to assess patients for symptoms

• Exposure to suspected cases

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

Confirmed Cases of COVID-19

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

Patient Placement for COVID-19

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

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

COVID-19 Examination Rooms/Areas

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

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

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

Contact and Droplet Precautions: When and Where

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

Airborne Precautions During Aerosol-Generating

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

Basics of Personal Protective Equipment (PPE)

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Appropriate Use of Personal Protective Equipment

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

Appropriate PPE for Routine Patient Care

● REMEMBER: Always practice appropriate hand hygiene

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

PPE for Suspected or Confirmed COVID-19

● REMEMBER: Always practice appropriate hand hygiene

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

PPE for Aerosolizing Generating Procedures

● REMEMBER: Always practice appropriate hand hygiene

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

Alternative PPE for Aerosolizing Generating Procedures

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

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

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

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

Doffing PPE for Suspected or Confirmed COVID-19

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

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

Waste Disposal of PPE

Disposable waste Glasses/Eye Shields Gowns

Reusing PPE In Case of Low Supply

Masks and respirators can be reused if appropriate precautions are taken

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