Extra Precautions while Caring for a Suspected COVID-19 Patient in an ICU beyond PPE and Hand Hygiene

Abstract

A bstract Since the diagnosis of the first case of COVID-19 in December 2019, there have been reports of several healthcare workers infected with COVID-19. It has changed the infection control practices of most ICUs all over the world. Prevention is better than cure is definitely proven true as there is no definite cure for COVID-19 yet. Personal protective equipment and hand hygiene are a must while handling any suspected COVID-19 patient. Apart from that, there are several other things, which should be followed in ICU and specifically while caring for a patient on ventilator. There are a large number of interventions done while treating any critically ill patient in ICU, which can generate aerosols and exaggerate spread of COVID-19, which include high-flow nasal cannula, NIV, nebulization, suctioning, bag and mask ventilation, endotracheal intubation, and bronchoscopy. We will be reviewing those things beyond PPE and hand hygiene along with the rationale of each of them, which can help to minimize the risk of exposure to healthcare workers and other patients in the surrounding. It will help not only to prevent COVID-19 transmission but also to reduce overall nosocomial infection rate. As per our knowledge, this will be the first paper reviewing innovative ideas to minimize the risk of infection in a comprehensive manner. How to cite this article: Shah V, Tyagi N, Trivedi D. Extra Precautions while Caring for a Suspected COVID-19 Patient in an ICU beyond PPE and Hand Hygiene. Indian J Crit Care Med 2021;25(3):331–336.

Aerosol Generating Procedures-How to Manage?

“…Following extra precautions should be taken while handling COVID-19 patients with aerosol generating procedures [2].…”

“…It has been found to be effective for contact time as short as 15 seconds and even in 0.5% concentration, but further clinical studies are needed to establish benefit. Now a days even 0.5% betadine oral and throay spray is also available which can be used prior to any aerosol generating procedures.Following extra precautions should be taken while handling COVID-19 patients with aerosol generating procedures [2].…”

Gestione del percorso per pazienti critici e raccomandazioni per il management assistenziale in caso di infezione da Sars-Cov 2: indagine sulle conoscenze e sulle competenze degli infermieri di Area Critica umbria

“…Durante la prima ondata pandemica, non sembrano essere state sufficientemente appropriate le conoscenze e le competenze di molti professionisti sanitari in tema di infezione respiratoria, tanto che in molti casi, corsi di formazione specifica in modalità telematica addizionati a corsi di addestramento sul campo hanno colmato quelle lacune conoscitive che molti operatori sanitari pensavano di non avere. Inoltre, è stata dimostrata la necessità di ricorrere a misure aggiuntive all'uso di dispositivi di protezione individuale e all'igiene del personale, per far fronte alle possibili fonti di contagio [9] .…”

“…Il ricorso a rigide procedure gestionali, dettagliate in ogni particolare, e il coinvolgimento di ogni professione sanitaria all'interno di esse, ha permesso di arginare non solo possibili focolai epidemici, ma di salvaguardare la salute di molti, tra chi presta assistenza e tra chi è assistito [9][10][11] .…”