Sign Up
For the best experience, choose your profession & state.
You are not currently logged in. Please log in to CEUfast to enable the course progress and auto resume features.

Course Library

Coronavirus Disease 2019 (COVID-19)

2 Contact Hours
This peer reviewed course is applicable for the following professions:
Advanced Registered Nurse Practitioner (ARNP), Athletic Trainer (AT/AL), Certified Nursing Assistant (CNA), Certified Registered Nurse Anesthetist (CRNA), Clinical Nurse Specialist (CNS), Home Health Aid (HHA), Licensed Practical Nurse (LPN), Licensed Vocational Nurses (LVN), Medical Assistant (MA), Midwife (MW), Nursing Student, Registered Nurse (RN), Respiratory Therapist (RT)
This course will be updated or discontinued on or before Thursday, August 18, 2022
BOC
Outcomes

≥90% of participants will know how to prevent, identify and treat COVID-19.

Objectives

After completing this continuing education course, the participant will be able to meet the following objectives:

  1. Discuss the clinical evaluation of a patient suspected of COVID-19 infection.
  2. Identify modes of transmission.
  3. Discuss methods to prevent transmission.
  4. Identify the treatment of COVID-19.
  5. Discuss preparedness recommendations for Healthcare facilities.
CEUFast Inc. did not endorse any product, or receive any commercial support or sponsorship for this course. The Planning Committee and Authors do not have any conflict of interest.

Last Updated:
CEUfast OwlGet one year unlimited nursing CEUs $39Sign up now
To earn of certificate of completion you have one of two options:
  1. Take test and pass with a score of at least 80%
  2. Reflect on practice impact by completing self-reflection, self-assessment and course evaluation.
    (NOTE: Some approval agencies and organizations require you to take a test and self reflection is NOT an option.)
Author:    Julia Tortorice (RN, MBA, MSN, NEA-BC, CPHQ)

Introduction

Update 8/18/20

Cases of Coronavirus Disease (COVID-19) in the U.S. is updated daily at 4 PM and found here. The Center for Disease Control (CDC) is closely monitoring the outbreak of the novel (new) coronavirus first discovered in China. Current quarantines will not be enough to stop the spread.1 The unknown nature of the virus implies that it is only a matter of time before the virus becomes established in the U.S.

On 1/31/20, President Trump signed a proclamation to suspend entry to those persons who pose a risk of transmitting the 2019 novel coronavirus.2 At this time, that is defined as people who were physically present within the People’s Republic of China, excluding the Special Administrative Regions of Hong Kong and Macau, during the 14-day period preceding their entry or attempted entry into the United States. In addition, medical screening and quarantine may be implemented.

Clinical Evaluation

The following are the most recent recommended testing for individuals with signs or symptoms consistent with COVID-193:

  • CDC recommends using authorized nucleic acid or antigen detection assays that have received an FDA EUA to test persons with symptoms when there is a concern of potential COVID-19. Tests should be used in accordance with the authorized labeling; providers should be familiar with the tests’ performance characteristics and limitations.
  • Clinicians should use their judgment to determine if a patient has signs or symptoms compatible with COVID-19 and whether the patient should be tested. Most patients with confirmed COVID-19 have developed  fever and/or symptoms of acute respiratory illness (e.g., cough), but some infected patients may present with other symptoms (e.g., altered smell or taste) as well. Clinicians are encouraged to consider testing for other causes of respiratory illness, for example influenza, in addition to testing for SARS-CoV-2 depending on patient age, season, or clinical setting; detection of one respiratory pathogen (e.g., influenza) does not exclude the potential for co-infection with SARS-CoV-2. Because symptoms and presentations may be different in children, consider referencing the CDC guidelines for COVID-19 in neonates and for Multisystem Inflammatory Syndrome in Children (MIS-C).
  • The severity of symptomatic illness due to infection with SARS-CoV-2 may vary from person to person. Among persons with extensive and close contact to vulnerable populations (e.g., healthcare personnel [HCP]), even mild signs and symptoms (e.g., sore throat) of a possible SARS-CoV-2 infection should prompt consideration for testing. Additional information is available in CDC’s Interim Guidance on Testing Healthcare Personnel for SARS-CoV-2.

Recommended testing for asymptomatic individuals with known or suspected exposure to SARS-CoV-2 to control transmission3:

Testing is recommended for all close contacts of persons with SARS-CoV-2 infection.  Because of the potential for asymptomatic and pre-symptomatic transmission, it is important that contacts of individuals with SARS-CoV-2 infection be quickly identified and tested.

In some settings, broader testing, beyond close contacts, is recommended as a part of a strategy to control transmission of SARS-CoV-2.  This includes high-risk settings that have potential for rapid and widespread dissemination of SARS-CoV-2 or in which populations at risk for severe disease could become exposed.  Expanded testing might include testing of individuals on the same unit or shift as someone with SARS-CoV-2 infection, or even testing all individuals within a shared setting (e.g., facility-wide testing).

Health care professionals (HCP) should obtain a detailed travel history for patients being evaluated with fever, and acute respiratory illness.4  CDC reasons that symptoms may appear between 2 and 14 days after exposure.5 In confirmed COVID-19 infections, symptoms range from mild to death. Symptoms can include5:

  • Fever or chills
  • Cough
  • Shortness of breath or difficulty breathing
  • Fatigue
  • Muscle or body aches
  • Headache
  • New loss of taste or smell
  • Sore throat
  • Congestion or runny nose
  • Nausea or vomiting
  • Diarrhea

This list does not include all possible symptoms. CDC will continue to update this list as we learn more about COVID-19.

Look for emergency warning signs for COVID-19. If someone is showing any of these signs, seek emergency medical care immediately5:

  • Trouble breathing
  • Persistent pain or pressure in the chest
  • New confusion
  • Inability to wake or stay awake
  • Bluish lips or face

Symptoms differ with severity of the disease.  For example, fever, cough, and shortness of breath are more commonly reported among people who are hospitalized with COVID-19 than among those with milder disease (non-hospitalized patients). Atypical presentations occur often, and older adults and persons with medical comorbidities may have delayed presentation of fever and respiratory symptoms. In one study of 1,099 hospitalized patients, fever was present in only 44% at hospital admission but eventually developed in 89% during hospitalization. Fatigue, headache, and muscle aches (myalgia) are among the most commonly reported symptoms in people who are not hospitalized, and sore throat and nasal congestion or runny nose (rhinorrhea) also may be prominent symptoms.  Many people with COVID-19  experience gastrointestinal symptoms such as nausea, vomiting or diarrhea, sometimes prior to developing fever and lower respiratory tract signs and symptoms. Loss of smell (anosmia) or taste (ageusia) preceding the onset of respiratory symptoms have been commonly reported in COVID-19 especially among women and young or middle-aged patients who do not require hospitalization. While many of the symptoms of COVID-19 are common to other respiratory or viral illnesses, anosmia appears to be more specific to COVID-19.6

The illness severity can range from mild to critical6:

  • Mild to moderate (mild symptoms up to mild pneumonia): 81%
  • Severe (dyspnea, hypoxia, or >50% lung involvement on imaging): 14%
  • Critical (respiratory failure, shock, or multiorgan system dysfunction): 5%

Laboratory Findings

Lymphopenia is the most common laboratory finding in COVID-19 and is found in as many as 83% of hospitalized patients. Lymphopenia, neutrophilia, elevated serum alanine aminotransferase and aspartate aminotransferase levels, elevated lactate dehydrogenase, high CRP, and high ferritin levels may be associated with greater illness severity. Elevated D-dimer and lymphopenia have been associated with mortality. Procalcitonin is typically normal on admission but may increase among those admitted to an ICU. Patients with critical illness had high plasma levels of inflammatory markers, suggesting potential immune dysregulation.6

Radiographic Findings

Chest radiographs of patients with COVID-19 typically demonstrate bilateral air-space consolidation, though patients may have unremarkable chest radiographs early in the disease. Chest CT images from patients with COVID-19 typically demonstrate bilateral, peripheral ground-glass opacities. Because this chest CT imaging pattern is non-specific and overlaps with other infections, the diagnostic value of chest CT imaging for COVID-19 may be low and dependent upon radiographic interpretation.

Transmission5

The virus is thought to spread mainly from person-to-person.

  • Between people who are in close contact with one another (within about 6 feet)
  • Through respiratory droplets produced when an infected person coughs, sneezes, or talks
  • These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs
  • COVID-19 may be spread by people who are not showing symptoms

How easily a virus spreads from person-to-person can vary. Some viruses are highly contagious, like measles, while other viruses do not spread as easily. Another factor is whether the spread is sustained, which means it goes from person-to-person without stopping.

The virus that causes COVID-19 is spreading very easily and sustainably between people. Information from the ongoing COVID-19 pandemic suggests that this virus is spreading more efficiently than influenza, but not as efficiently as measles, which is highly contagious. In general, the more closely a person interacts with others, and the longer that interaction, the higher the risk of COVID-19 spread.

It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their mouth, nose, or possibly their eyes. This is not thought to be the main way the virus spreads, but we are still learning more about how this virus spreads.

Spread between animals and people

  • At this time, the risk of COVID-19 spreading from animals to people is considered to be of low risk. Learn more about COVID-19 and pets, and other animals here.
  • It appears that the virus that causes COVID-19 can spread from people to animals in some situations. CDC is aware of a small number of pets worldwide, including cats and dogs, reported being infected with the virus that causes COVID-19, mostly after close contact with people with COVID-19. Learn what you should do if you have pets here.

Prevention

There is no vaccine to prevent COVID-19. The best way to prevent infection is to avoid exposure to this virus. The CDC always recommends everyday preventive actions to help prevent the spread of respiratory viruses, including5:

  • Avoid close contact with people who are sick.
  • Maintain six feet of social distancing when possible.
  • Avoid touching your eyes, nose, and mouth with unwashed hands.
  • Stay home when you are sick.
  • Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
  • Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe.
  • Follow CDC’s recommendations for using a facemask:
    • CDC recommends that people who are well to wear a facemask to protect themselves from respiratory viruses when social distancing cannot be maintained. This is recommended because asymptomatic people may transmit Covid-19.
    • A facemask should be used by people who show symptoms of 2019 novel coronavirus, in order to protect others from the risk of getting infected. The use of facemasks is also crucial for health workers and people who are taking care of someone in close settings.
  • Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing.
    • If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol. Always wash hands with soap and water if hands are visibly dirty.

Treatment

Treatment guidelines are evolving so quickly, that CDC  is maintaining an electronic guideline available at www.covid19treatmentguidelines.nih.gov/. As of August 18, 2020, below are the treatment guidelines recommended by CDC.9

  • The Coronavirus Disease 2019 (COVID-19) Treatment Guidelines are published in an electronic format that can be updated in step with the rapid pace and growing volume of information regarding the treatment of COVID-19.
  • The COVID-19 Treatment Guidelines Panel (the Panel) is committed to updating this document to ensure that health care providers, patients, and policy experts have the most recent information regarding the optimal management of COVID-19 (see the Panel Roster for a list of Panel members).
  • New Guidelines sections and recommendations, and updates to existing Guidelines sections are developed by working groups of Panel members. All recommendations included in the Guidelines are endorsed by a majority of Panel members (see the Introduction for additional details on the Guidelines development process).

Major revisions to the Guidelines within the last month are as follows:

July 30, 2020
Corticosteroids
The recommendations in this section have been updated to allow the use of alternative corticosteroids (i.e., hydrocortisone, methylprednisolone, prednisone) in situations where dexamethasone may not be available. In addition, the results of the RECOVERY trial were updated based on data reported in a recently published paper.

General Considerations (Care of Critically Ill Patients with COVID-19)
The Goals of Care subsection has been expanded to include information on advance care planning, with emphasis on the importance of identifying surrogate decision-makers for critically ill patients with COVID-19.

July 24, 2020
Key Updates to the Guidelines
Remdesivir
The recommendations for using remdesivir to treat COVID-19 have been revised to account for the patient’s supplemental oxygen requirements and the mode of oxygen delivery. In this revision, patients who require supplemental oxygen are divided into two groups:

  • Those who require supplemental oxygen but not high-flow oxygen, noninvasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO); and
  • Those who require high-flow oxygen, noninvasive or invasive mechanical ventilation, or ECMO.

Previously, the COVID-19 Treatment Guidelines Panel (the Panel) recommended using remdesivir for patients who were on high-flow oxygen, mechanical ventilation, or ECMO. This recommendation has been revised due to uncertainty regarding whether starting remdesivir confers clinical benefit in these patients.

The revised recommendations are as follows:

  • Recommendation for Prioritizing Limited Supplies of Remdesivir
    • Because remdesivir supplies are limited, the Panel recommends that remdesivir be prioritized for use in hospitalized patients with COVID-19 who require supplemental oxygen but who are not on high-flow oxygen, noninvasive ventilation, mechanical ventilation, or ECMO (BI).
  • Recommendation for Patients with COVID-19 Who Are on Supplemental Oxygen but Who Do Not Require High-Flow Oxygen, Noninvasive or Invasive Mechanical Ventilation, or ECMO
    • The Panel recommends using remdesivir for 5 days or until hospital discharge, whichever comes first (AI).
    • If a patient who is on supplemental oxygen while receiving remdesivir progresses to requiring high-flow oxygen, noninvasive or invasive mechanical ventilation, or ECMO, the course of remdesivir should be completed.
  • Recommendation for Patients with COVID-19 Who Require High-Flow Oxygen, Noninvasive Ventilation, Mechanical Ventilation, or ECMO
    • Because there is uncertainty regarding whether starting remdesivir confers clinical benefit in these groups of patients, the Panel cannot make a recommendation either for or against starting remdesivir.

July 17, 2020
Key Updates to the Guidelines
Remdesivir

In situations where remdesivir supplies are limited, the Panel recommends prioritizing remdesivir for use in hospitalized patients with COVID-19 who require supplemental oxygen but who are not mechanically ventilated or on extracorporeal membrane oxygenation (BI). The overall recommendations for the use of remdesivir are being revised and will be updated soon.

Corticosteroids (Including Dexamethasone)

The Corticosteroids (Including Dexamethasone) section is a new subsection of Immunomodulators Under Evaluation for Treatment of COVID-19. This new section is based on the Recommendations for Dexamethasone in Patients with COVID-19 section that was released on June 25, 2020. The Panel continues to recommend the use of dexamethasone in patients who are mechanically ventilated (AI) and in patients who require supplemental oxygen but who are not mechanically ventilated (BI). The new Corticosteroids (Including Dexamethasone) section also discusses the clinical data on the use of other corticosteroids in patients with COVID-19, the potential adverse effects of corticosteroids, other considerations when using corticosteroids, and recommendations for the use of dexamethasone in pregnant patients.

New Sections of the Guidelines

Mesenchymal Stem Cells

  • A new subsection on mesenchymal stem cells was added to Immune-Based Therapy in the Blood-Derived Products Under Evaluation for the Treatment of COVID-19 section. The Panel recommends against the use of mesenchymal stem cells for the treatment of COVID-19, except in a clinical trial (AII).

Adjunctive Therapy: Vitamin C, Vitamin D, and Zinc Supplementation

  • Vitamin and mineral supplements have been promoted for the treatment and prevention of respiratory viral infections; however, their roles in treating COVID-19 are yet unproven. Three new sections were added to the guidelines to discuss the proposed rationale for the use of vitamin C, vitamin D, and zinc supplements.

Special Considerations in Solid Organ Transplant, Hematopoietic Stem Cell Transplant, and Cellular Therapy Candidates, Donors, and Recipients

  • Solid organ transplant, hematopoietic stem cell transplant, and cellular therapy donors and recipients are at risk of complications associated with COVID-19. This new section provides recommendations for screening transplant candidates and donors for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection before donation and transplant. Clinicians should follow the guidelines for evaluating and managing COVID-19 in nontransplant patients when treating transplant and cellular therapy recipients (AIII). In this section, the Panel also emphasizes the importance of consulting a transplant specialist and reviewing concomitant medications for drug-drug interactions and overlapping toxicities.

Other Updates to the Guidelines

Introduction

  • The Panel has expanded the explanation of the types of recommendation statements used in the guidelines.

Overview of COVID-19: Epidemiology, Clinical Presentation, and Transmission

  • The section has been updated with recent epidemiologic data on COVID-19 in the United States. Emerging evidence suggests that racial and ethnic minorities in the United States experience higher rates of COVID-19 and subsequent hospitalization and death.

Prevention and Prophylaxis of SARS-CoV-2 Infection

  • This section discusses general prevention measures for reducing the risk of acquisition and transmission of SARS-CoV-2, the types of vaccines that are currently being studied, and the drug therapies that are being investigated for pre-exposure and post-exposure prophylaxis.

Hydroxychloroquine Plus Azithromycin

  • New clinical data from a large, retrospective, observational study have been added to this section and Table 2A. There is no change to the Panel’s recommendation.

Lopinavir/Ritonavir and Other HIV Protease Inhibitors

  • New data on lopinavir/ritonavir pharmacokinetics in patients with COVID-19 and new data on combination therapy with lopinavir/ritonavir plus interferon beta-1b plus ribavirin for the treatment of COVID-19 have been added to this section and Table 2A. There is no change to the Panel’s recommendation.

Blood-Derived Products Under Evaluation for the Treatment of COVID-19

  • New clinical data have been added to the Convalescent Plasma section. A new section has been created for SARS-CoV-2-specific immunoglobulins. There are no changes to the Panel’s recommendations.

Immunomodulators Under Evaluation for the Treatment of COVID-19

  • New clinical data for interferon beta-1b were added to the Interferons (Alfa, Beta) section, and the Panel changed the recommendation for interferons: The Panel recommends against the use of interferons for the treatment of severe and critically ill COVID-19 patients, except in a clinical trial (AIII). There are insufficient data to recommend either for or against the use of interferon-beta for the treatment of early (<7 days from symptom onset) mild and moderate COVID-19.
  • The Kinase Inhibitors section was expanded to include additional Janus kinase (JAK) inhibitors and to include Bruton’s tyrosine kinase (BTK) inhibitors. The Panel recommends against the use of BTK inhibitors and JAK inhibitors for the treatment of COVID-19, except in a clinical trial (AIII). 

Preparedness Recommendations for Healthcare Facilities

Minimize Chance for Exposures7

Ensure facility policies and practices are in place to minimize exposures to respiratory pathogens, including COVID-19. Measures should be implemented before patient arrival, upon arrival, and throughout the duration of the affected patient’s presence in the healthcare setting.

Instruct patients and persons who accompany them to call ahead or inform HCP upon arrival if they have symptoms of any respiratory infection (e.g., cough, runny nose, fever) and to take appropriate preventive actions (e.g., wear a facemask upon entry to contain cough, follow triage procedures).7

Provide supplies for respiratory hygiene and cough etiquette, including 60%-95% ABHS, tissues, no-touch receptacles for disposal, and facemasks at healthcare facility entrances, waiting rooms, patient check-ins, etc.7 Consider posting visual alerts (e.g., signs, posters) at the entrance and in strategic places (e.g., waiting areas, elevators, cafeterias) to provide patients and HCP with instructions (in appropriate languages) about hand hygiene, respiratory hygiene, and cough etiquette. Instructions should include how to use facemasks or tissues to cover nose and mouth when coughing or sneezing, to dispose of tissues and contaminated items in waste receptacles, and how and when to perform hand hygiene.

Ensure that patients with symptoms of suspected COVID-19 or other respiratory infection (e.g., fever, cough) are not allowed to wait among other patients seeking care. Identify a separate, well-ventilated space that allows waiting patients to be separated by 6 or more feet, with easy access to respiratory hygiene supplies.7

Ensure rapid triage and isolation of patients with symptoms of suspected COVID-19 or other respiratory infection (e.g., fever, cough).7 Implement respiratory hygiene and cough etiquette (i.e., placing a facemask over the patient’s nose and mouth if that has not already been done) and isolate a PUI for COVID-19 in an Airborne Infection Isolation Room (AIIR), if available.

Inform infection prevention and control services, local and state public health authorities and other healthcare facility staff as appropriate about the presence of a person under investigation for COVID-19.

Patient Placement

Place a patient with known or suspected COVID-19 in an AIIR that has been constructed and maintained in accordance with current guidelines.7 AIIRs are single-patient rooms at negative pressure relative to the surrounding areas and with a minimum of 6 air changes per hour (12 air changes per hour are recommended for new construction or renovation). Air from these rooms should be exhausted directly to the outside or be filtered through a high-efficiency particulate air (HEPA) filter before recirculation. Room doors should be kept closed except when entering or leaving the room, and entry and exit should be minimized. Facilities should monitor and document the proper negative-pressure function of these rooms.

If an AIIR is not available, patients who require hospitalization should be transferred as soon as is feasible to a facility where an AIIR is available.7 If the patient does not require hospitalization they can be discharged to home (in consultation with state or local public health authorities) if deemed medically and socially appropriate. Pending transfer or discharge, place a facemask on the patient and isolate him/her in an examination room with the door closed.7 Ideally, the patient should not be placed in any room where room exhaust is recirculated within the building without HEPA filtration.

Once in an AIIR, the patient’s facemask may be removed. Limit transport and movement of the patient outside of the AIIR to medically-essential purposes. When not in an AIIR (e.g., during transport or if an AIIR is not available), patients should wear a facemask to contain secretions.7

Personnel entering the room should use PPE, including respiratory protection. Only essential personnel should enter the room. Implement staffing policies to minimize the number of HCP who enter the room. Facilities should consider caring for these patients with dedicated HCP to reduce the risk of transmission and exposure to other patients and other HCP.

Use dedicated or disposable noncritical patient-care equipment (e.g., blood pressure cuffs). If equipment will be used for more than one patient, clean and disinfect such equipment before use on another patient according to manufacturer’s instructions.7

HCP entering the room soon after a patient vacates the room should use respiratory protection. Standard practice for pathogens spread by the airborne route (e.g., measles, tuberculosis) is to restrict unprotected individuals, including HCP, from entering a vacated room until sufficient time has elapsed for enough air changes to remove potentially infectious particles.7

PPE

Follow contact and airborne PPE requirements. Respiratory protection should be, at a minimum, a fit-tested NIOSH-certified disposable N95 filtering facepiece respirator.7

If reusable respirators are used, they must be cleaned and disinfected according to the manufacturer’s reprocessing instructions prior to re-use.

Use Caution When Performing Aerosol-Generating Procedures7

  • Some procedures performed on COVID-19 patients could generate infectious aerosols. In particular, procedures that are likely to induce coughing (e.g., sputum induction, open suctioning of airways) should be performed cautiously and avoided if possible.
    • If performed, these procedures should take place in an AIIR, and personnel should use respiratory protection as described above. In addition:
      • Limit the number of HCP present during the procedure to only those essential for patient care and procedural support.
  • Clean and disinfect procedure room surfaces promptly, as described in the section on environmental infection control below.
    • Diagnostic Respiratory Specimen Collection:
      • Collecting diagnostic respiratory specimens (e.g., nasopharyngeal swab) is likely to induce coughing or sneezing. Individuals in the room during the procedure should, ideally, be limited to the patient and the healthcare provider obtaining the specimen.
      • HCP collecting specimens for testing for COVID-19 from patients with known or suspected COVID-19 (i.e., PUI) should adhere to Standard, Contact, and Airborne Precautions, including the use of eye protection.
      • These procedures should take place in an AIIR or in an examination room with the door closed. Ideally, the patient should not be placed in any room where room exhaust is recirculated within the building without HEPA filtration.

Until information is available regarding viral shedding after clinical improvement, discontinuation of isolation precautions should be determined on a case-by-case basis, in conjunction with local, state, and federal health authorities.7 Things to consider include7:

  • presence of symptoms related to COVID-19
  • date symptoms resolved
  • other conditions that would require specific precautions
  • other laboratory information reflecting the clinical status
  • alternatives to inpatient isolation, such as the possibility of safe recovery at home

Manage Visitor Access and Movement Within the Facility

Establish procedures for monitoring, managing, and training visitors. Restrict visitors from entering the room of known or suspected COVID-19 patients.7

Consider alternative mechanisms for patient and visitor interactions, such as video-call applications on cell phones or tablets. Facilities can consider exceptions based on end-of-life situations or when a visitor is essential for the patient’s emotional well-being and care.

  • Visitors to patients with known or suspected COVID-19 (i.e., PUI) should be scheduled and controlled to allow for7:
    • Screening visitors for symptoms of acute respiratory illness before entering the healthcare facility.
    • Facilities should evaluate the risk to the health of the visitor (e.g., a visitor might have an underlying illness, putting them at higher risk for COVID-19).
    • Evaluate the risk of visitors' ability to comply with precautions.
    • Facilities should provide instruction, before visitors enter patients’ rooms, on hand hygiene, limiting surfaces touched, and use of PPE according to current facility policy while in the patient’s room.
    • Facilities should maintain a record (e.g., logbook) of all visitors who enter patient rooms.
    • Visitors should not be present during aerosol-generating procedures.
    • Visitors should be instructed to limit their movement within the facility.
    • Exposed visitors (e.g., contact with COVID-19 patient prior to admission) should be advised to report any signs and symptoms of acute illness to their health care provider for a period of at least 14 days after the last known exposure to the sick patient.

Implement Engineering Controls

Consider designing and installing engineering controls to reduce or eliminate exposures by shielding HCP and other patients from infected individuals.7 Examples of engineering controls include7:

  • physical barriers or partitions to guide patients through triage areas
  • curtains between patients in shared areas
  • closed suctioning systems for airway suctioning for intubated patients
  • appropriate air-handling systems (with appropriate directionality, filtration, exchange rate, etc.) that are installed and properly maintained

Monitor and Manage Ill and Exposed Healthcare Personnel

Facilities and organizations providing healthcare should implement sick leave policies for HCP that are non-punitive, flexible, and consistent with public health guidance.

Train and Educate Healthcare Personnel

Provide HCP with job- or task-specific education and training on preventing transmission of infectious agents, including refresher training.7

HCP must be medically cleared, trained, and fit-tested for respiratory protection device use (e.g., N95 filtering facepiece respirators), or medically cleared and trained in the use of an alternative respiratory protection device (e.g., Powered Air-Purifying Respirator, PAPR) whenever respirators are required.

Ensure that HCP are educated, trained, and have practiced the appropriate use of PPE prior to caring for a patient, including attention to the correct use of PPE and prevention of contamination of clothing, skin, and environment during the process of removing such equipment.

Implement Environmental Infection Control

Dedicated medical equipment should be used for patient care. All non-dedicated, non-disposable medical equipment used for patient care should be cleaned and disinfected according to the manufacturer’s instructions and facility policies.

Ensure that environmental cleaning and disinfection procedures are followed consistently and correctly. Routine cleaning and disinfection procedures (e.g., using cleaners and water to pre-clean surfaces prior to applying an EPA-registered, hospital-grade disinfectant to frequently touched surfaces or objects for appropriate contact times as indicated on the product’s label) are necessary for COVID-19 in healthcare settings. Products with EPA-approved emerging viral pathogens claims are recommended for use against COVID-19.7 If there are no available EPA-registered products that have an approved emerging viral pathogen claim for COVID-19, products with label claims against human coronaviruses should be used according to label instructions.7

Establish Reporting within Healthcare Facilities and to Public Health Authorities

Implement mechanisms and policies that promptly alert key facility staff, including infection control, healthcare epidemiology, facility leadership, occupational health, clinical laboratory, and frontline staff about known or suspected COVID-19 patients.

Promptly notify state or local public health authorities of patients with known or suspected COVID-19. Facilities should designate specific persons within the healthcare facility who are responsible for communication with public health officials and dissemination of information to HCP.7

Homecare Guidance

Below are the most recent guidance for Implementing Home Care of People Not Requiring Hospitalization for Coronavirus Disease 2019 (COVID-19)8

This interim guidance is for staff at local and state health departments, infection prevention and control professionals, and healthcare personnel who are coordinating the home care and isolation of people with confirmed or suspected COVID-19 infection, including persons under investigation (see Criteria to Guide Evaluation of Persons Under Investigation (PUI) for COVID-19)

This guidance includes patients evaluated in an outpatient setting who do not require hospitalization (i.e., patients who are medically stable and can receive care at home) or patients who are discharged home following hospitalization with confirmed COVID-19 infection.

In general, people should adhere to home isolation until the risk of secondary transmission is thought to be of low risk. Visit the Preventing the Spread of Coronavirus Disease 2019 in Homes and Residential Communities page for more information.

Preventing COVID-19 from Spreading in Homes and Communities: Interim guidance that may help prevent COVID-19 from spreading among people in homes and communities.

For interim healthcare infection prevention and control recommendations, see Interim Infection Prevention and Control Recommendations for Patients with Known or Persons Under Investigation for Coronavirus Disease 2019 (COVID-19) in a Healthcare Setting. CDC will update this interim guidance as needed and as more information becomes available.

Assess the Suitability of the Residential Setting for Home Care

In consultation with state or local health department staff, a healthcare professional should assess whether the residential setting is appropriate for home care. Considerations for care at home include whether:

  • The patient is stable enough to receive care at home.
  • Appropriate caregivers are available at home.
  • There is a separate bedroom where the patient can recover without sharing immediate space with others.
  • Resources for access to food and other necessities are available.
  • The patient and other household members are capable of adhering to precautions recommended as part of home care or isolation. A caregiver may wear a cloth face covering when caring for a person who is sick; however, the protective effects (how well the cloth face-covering protects healthy people from breathing in the virus) are unknown. Note: During the COVID-19 pandemic, medical-grade facemasks are reserved for healthcare workers and some first responders. A cloth face covering may need to be improvised using a scarf or bandana. Learn more here.
  • There are household members who may be at increased risk of severe illness from COVID-19 infection. See People Who Are at Increased Risk for Severe Illness to find out who is at increased risk.

Provide Guidance for Precautions to Implement during Home Care

A healthcare professional should:

Case Study

John enters the ER with a complaint of cough and fever for four days. The clerk asks John to put on a mask and set in the waiting room alcove. The clerk notifies the triage nurse, who immediately triages John. John traveled to mainland China last week. The triage nurse puts John in a private room and implements contact and airborne precautions.

Had the clerk not identified John as someone needing a mask and location in the alcove instead of the main waiting room, people in the ER waiting room would have been exposed. Had the triage nurse not immediately triaged and isolated John, more people would have been exposed.

After diagnosis, John was found to have the flu. He was discharged home. The actions to prevent exposure of people and staff were time-consuming but warranted. The actions prevented the spread of the flu and possibly something more serious.

References

  1. Western Journal. CDC Director Warns Outbreak is Coming to US, Containment only Buying Time. Published February 14, 2020. Retrieved February 15, 2020 (Visit Source).
  2. Proclamation by President Trump. 1/31/20. Suspension of Entry as Immigrants and Nonimmigrants of Persons who Pose a Risk of Transmitting 2019 Novel Coronavirus.Published January 31, 2020. Retrieved February 15, 2020 (Visit Source).
  3. CDC. Assess Covid 19. Published July 17, 2020. Retrieved Retrieved August 18/2020 (Visit Source).
  4. CDC. 2/12/20 Evaluating and Reporting Persons Under Investigation (PUI). Published February 12, 2020. Retrieved February 15, 2020 (Visit Source).
  5. CDC.Coronavirus Disease 2019 (COVID-19). Published February 6, 2020. Retrieved August 18, 2018 (Visit Source).
  6. CDC. Interim Clinical Guidance for Management of Patients with Confirmed 2019 Novel Coronavirus (COVID-19) Infection. Retrieved August 18, 2018 (Visit Source).
  7. CDC. 2/12/20. Interim Infection Prevention and Control Recommendations for Patients with Confirmed 2019 Novel Coronavirus (COVID-19) or Persons Under Investigation for COVID-19 in Healthcare Settings. Published February 12, 2020. Retrieved February 15, 2020 (Visit Source).
  8. CDC. 2/12/20. Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus (COVID-19). Published June 20, 2020. Retrieved August 18, 2020 (Visit Source).
  9. NIH COVID 19 Treatment Guidelines. Published July 30, 2020. Retrieved August 18, 20320 (Visit Source).

Select one of the following methods to complete this course.

Take TestPass an exam testing your knowledge of the course material.
OR
Reflect on Practice ImpactDescribe how this course will impact your practice.   (No Test)