COVID-19 Infection Control Measures

Personal Protective Equipment Recommendations

The American College of Intensive Care Medicine recommends that healthcare workers performing aerosol-generating procedures on COVID-19 patients use fitted respirator masks (N95, FFP2, or equivalent) along with other personal protective equipment (gloves, gown, and eye protection) to minimize transmission risk 1
Complete PPE should include gloves, gown, and eye protection (face shield or safety goggles) in addition to respirator masks, as suggested by the Intensive Care Medicine guidelines 1
Aerosol-generating procedures should be performed in negative pressure rooms, according to the Intensive Care Medicine recommendations 2
Common aerosol-generating procedures include endotracheal intubation, bronchoscopy, and cardiopulmonary resuscitation, as identified by the Intensive Care Medicine guidelines 1
For non-aerosol-generating procedures on non-ventilated COVID-19 patients, surgical/medical masks are suggested along with other PPE (gloves, gown, eye protection), as recommended by the Intensive Care Medicine guidelines 3
Patients should wear surgical masks to prevent droplet transmission, as suggested by the Anaesthesia guidelines 4

N95 respirators conform to US FDA standards while FFP2 conforms to European standards, both designed to block 95-99% of aerosol particles, according to the Intensive Care Medicine guidelines 1
Staff should be fit-tested for each different type of respirator to ensure proper protection, as recommended by the Intensive Care Medicine guidelines 1
Surgical masks are less effective than respirators in blocking small particle aerosols, as noted by the Intensive Care Medicine guidelines 1
Powered air purifying respirators (PAPRs) can be used by healthcare workers who failed N95 mask fit testing or when N95s are in limited supply, according to the Intensive Care Medicine guidelines 1

Aerosol-generating procedures should be performed in negative pressure rooms, as recommended by the Intensive Care Medicine guidelines 2
Negative pressure prevents accidental release of pathogens into larger spaces and open facilities, according to the Intensive Care Medicine guidelines 5
When negative pressure rooms are unavailable, operating rooms with high air exchange rates can be used, which remove 99% of airborne contaminants in 18 minutes, as suggested by the Anaesthesia guidelines 4

For endotracheal intubation, video-guided laryngoscopy is preferred over direct laryngoscopy when available, as recommended by the Intensive Care Medicine guidelines 6
Intubation should be performed by the most experienced healthcare worker to minimize attempts and transmission risk, according to the Intensive Care Medicine guidelines 6
General anesthesia is recommended for patients with suspected or confirmed COVID-19 to reduce the risk of coughing and bucking, as suggested by the Anesthesiology (ASA) guidelines 7
Rapid sequence induction should be used after complete PPE checks for all personnel in the operating room, according to the Anesthesiology (ASA) guidelines 7

For cardiac arrest management, minimize the number of personnel in the room and ensure proper PPE for all team members, as recommended by the Mayo Clinic Proceedings guidelines 8
Consider the potential need for conversion to general anesthesia when selecting PPE for procedures initially planned under regional anesthesia, as suggested by the Anaesthesia guidelines 4

Airborne precautions should be maintained for the appropriate duration based on room air exchanges after aerosol-generating procedures are completed, as recommended by the Mayo Clinic Proceedings guidelines 8
The most experienced personnel should perform high-risk procedures to minimize duration and number of attempts, according to the Intensive Care Medicine guidelines 6

For routine care of COVID-19 patients without aerosol-generating procedures, droplet precautions are recommended as a minimum, including surgical/medical mask, eye protection, gown, and gloves, according to Anaesthesia guidelines 9
Patients should wear surgical facemasks to prevent droplet transmission, as recommended by Anaesthesia 10
For regional anesthesia procedures, which are not considered aerosol-generating, droplet precautions are recommended as a minimum, but higher-level precautions may be appropriate in certain situations, according to Anaesthesia guidelines 9, 10

Oxygen therapy should be administered with caution, as the flow rate and delivery method can affect aerosol generation, as noted in Anaesthesia 11
The flow of oxygen should be kept to a minimum while maintaining adequate saturation, as recommended by Anaesthesia 11