COVID-19 Infection and

Prevention
CASE DEFINITIONS:
WHO (World Health Organization) periodically updates the Global Surveillance for
human infection with coronavirus disease (COVID-19) document which includes case
definitions. For easy reference, case definitions are included below:
Suspected case:
 Patient with acute respiratory illness (fever and at least one sign/symptom of
respiratory disease, e.g., cough, shortness of breath), a history of travel to or
residence in a location reporting community transmission of COVID-19 disease
during the 14 days prior to symptom onset.
 A patient with any acute respiratory illness AND having been in contact with a
confirmed or probable COVID-19 case (see definition of contact) in the last 14 days
prior to symptom onset;
 A patient with severe acute respiratory illness (fever and at least one sign/symptom of
respiratory disease, e.g., cough, shortness of breath; and requiring hospitalization) and
in the absence of an alternative diagnosis that fully explains the clinical presentation.
Probable case:
 A suspect case for whom testing for the COVID-19 virus is inconclusive.
Inconclusive being the result of the test reported by the laboratory.
OR
 A suspect case for whom testing could not be performed for any reason.

Confirmed case:
 A person with laboratory confirmation of COVID-19 infection,
irrespective of clinical signs and symptoms.
 Technical guidance for laboratory testing can be found here.
Contact case:
 A contact is a person who experienced any one of the following exposures
during the 2 days before and the 14 days after the onset of symptoms of a
probable or confirmed case:
i. Face-to-face contact with a probable or confirmed case within 1 meter and
for more than 15 minutes;
ii. Direct physical contact with a probable or confirmed case;
iii. Direct care for a patient with probable or confirmed COVID-19 disease
without using proper personal protective equipment;
iv. Other situations as indicated by local risk assessments. Note: for confirmed
asymptomatic cases, the period of contact is measured as the 2 days before
through the 14 days after the date on which the sample was taken which led
to confirmation
Definition of COVID-19 death.

 COVID-19 death is defined for surveillance purposes as a death resulting

from a clinically compatible illness in a probable or confirmed COVID-19
case, unless there is a clear alternative cause of death that cannot be related to
COVID disease (e.g. trauma).
 There should be no period of complete recovery between the illness and
death.
 
Infection, Prevention and Control of COVID-19

1. Limit human-to-human transmission

2. Reduce secondary infections
3. Prevent transmission through amplification and super-spreading events
Natural history of COVID- 19
Pathogen
COVID-
19

Susceptible
host Reservoir
Any individual Unknown
exposed to
virus

Portal of
exit
Portal of
Airway,
entry
others ?
Airway, Transmission
Others? Direct
contact,
Spillover, etc
 Study N Route / mechanism of Findings
transmission
Zhu N et al., NEJM 3 cases of Bronchoalveolar SARS-Cov-2 positive in BAL
“unusual SARI” lavage fluid (BAL)
2020
Fuk-Woo Chan J et al., A family of 6 Respiratory samples 3/6 (50%) patients SARS-Cov-2 ;
Lancet 2020 individuals (nasopharyngeal swab) none of them exposed to seafood
market
    Mother-to-child  
transmission SARS-CoV-2 negative in amniotic fluid,
Chen H et al., Lancet 9 infants cord blood,
(intrauterine neonatal throat swab, and breastmilk
2020 transmission)
  12 patients Saliva  
admitted to a
Kai-Wang To K et al., SARS-CoV-2 detected in 11/12 (91.7%)
healthcare
CID 2020 facility of patients
  138 patients Faeces  
admitted to a 17/138 (12.3%) referred diarrhea and
Wang D et al., JAMA
healthcare abdominal pain
2020 facility
    tears, semen, vaginal  
fluid, other body fluids,
? ? ?
viral sanctuaries?
 Standard Precautions
“(…) A set of practices that are applied to the care of patients,
regardless of the state of infection (suspicion or confirmation), in any
place where health services are provided. (…)”
Hand hygiene (water and soap or alcohol-based solutions)

Use of personal protective equipment (PPE) according to risk

Respiratory hygiene (or cough etiquette)

Safe injection practices

Sterilization / disinfection of medical devices

Environmental cleaning
PPE (Personal Protective Equipment) includes:

Face Shield
Transmission-based precautions

Contact precaution

Droplet precaution

Airborne precaution
As a reminder, transmission of
C O V ID -1 9
Transmission-based precautions and
C O V ID -1 9
Scenario Precaution
For any suspected or
confirmed case of Standard + contact + droplet precautions
COVID-19
For any suspected or
confirmed case of
COVID-19 and Standard + contact + airborne precautions
aerosol- generating
procedure
(AGP)
 Type of
interaction
with the
patient

Amount of Mode of
body fluid transmission
that will be of the
generated disease

PAHO. Prevention and Control of Healthcare associated infections – Basic Recommendations”- PAHO, 2017 (adapted)
 Hand hygiene should always be performed
despite PPE use.

Remove and replace if necessary any

General
damaged or broken pieces of re-usable PPE
as soon as you become aware that they are
not in full working order.

p r in c ip le s
of PPE
Remove all PPE as soon as possible after
completing the care and avoid
contaminating the environment outside the
isolation room; any other patient or worker;
and yourself.

Discard all items of PPE carefully and

perform hand hygiene immediately
afterwards.
Gloves are an essential item of
PPE and are used to prevent
the healthcare worker from
being exposed to direct contact
with the blood or body fluid of
an infected patient.

Gloves DO NOT replace

hand hygiene.
Gowns are used in addition to
gloves if there is risk of fluids
or blood from the patient
splashing onto the healthcare
worker’s body.
The same gown can be used
when providing care to more
than one patient but only those
patients in a cohort area and
only if the gown does not have
direct contact with a patient.
Plastic aprons should be used
in addition to gowns if the
material of the gown is not fluid
repellent and the task to be
performed may result in
splashes onto the healthcare
worker’s body.
Facial mucosa protection (face
shield, eye visor, goggles)
Masks, and eye protection, such
as eyewear and goggles, are also
important pieces of PPE and
are used to protect the eyes,
nose or mouth mucosa of the
health- care worker from any
risk of
contact with a patient’s
respiratory secretions or
splashes of blood, body
fluids, secretions or
excretions.
Wear a medical mask when
within a 1 metre range of
the patient.
Put the patient in a single
room or in a room that
contains only other patients
with the same diagnosis, or
with similar risk factors, and
ensure that every patient is
separated by at least one
metre.
Ensure that the transportation
of a patient to areas outside of
the designated room is kept to
a minimum.
Perform hand hygiene
immediately after removing
the medical mask.
Respirator [N95]
(airborne precaution)
Use a respirator
whenever entering and
providing care within the
patient isolation facilities
ensuring that the seal of
the respirator is checked
before every use.
Perform hand hygiene
immediately after
removing the
respirator.
Aerosol-generating
procedures (AGP) .
..
Perform a particulate respirator
seal check
Donning Steps:

1. Perform hand hygiene

 Alcohol based hand rub: Rub hands for 20–30 seconds.
 Water and soap: Wash hands for 40–60 seconds.

2. Put on the gown

3. Put on the mask Medical mask.
4. Put on eye protection
5. Put on face shield or goggles
6. Put on gloves. (Ensure glove is placed over the cuff of the gown)
Removing PPE as per WHO guidelines (Doffing)
Remove gloves .

Remove the gown Ensure gown is pulled away from the body during removal and that clothing does not
become contaminated and dispose of them safely

Perform hand hygiene

Remove eye protection Remove face shield or goggles.

Remove the mask Ensure you are taking the mask o from the straps, avoid touching the mask.

Perform hand hygiene Alcohol based handrub Rub hands for 20–30 seconds. Water and soap Wash hands
for 40–60 seconds.