Escalation of Standard Precautions during COVID-19 Pandemic : Review of Electronic Literature and Position Paper

Abstract

Introduction: It has been proven that COVID- 19 asymptomatic carriers and presymptomatic patients do transmit the virus and potentially infect their contacts and caregivers International medical and scientific societies, as well as governmental and public health bodies, from all over the globe, have issued recommendations about infection prevention and control measures that should be taken, in addition to the general standard precautions measures, while dealing with hospital patients during this pandemic In this article, we did an electronic review of the published and posted recommendations in different medical scenarios Accordingly, we put a position set of recommendations about the precautions that are needed to be taken with all patients when the virus is still circulating in the community from an Infectious Disease specialist perspective Methods: This is a narrative electronic review of the available and latest interim guidelines recommendations, position statements, expert commentaries and opinions issued by international scientific societies, international organizations, governmental bodies and public health authorities from different medical specialties in the United States of America, Canada, United Kingdom, Europe, France, Italy, China, Australia, and Asia Pacific region We searched PubMed and Google Scholar for articles and written material published in English and French between January 1, 2020, and April 25, 2020 Results: Recommendations were retrieved from around 50 documents We endorse the general recommendations that appear in all reviewed specialties From an infectious disease specialist perspective, the following should be applied to all patients in healthcare settings: • Triage based on a checklist with the timely updated case definition at the entrance and admission to any health facility ward or service • Aerosol generating procedures to all patients like tracheal intubation for medical reasons or anesthesia, gastrointestinal endoscopy is preferably done under airborne/contact precautions • Areas of the hospital where patients potentially would undergo aerosol generating procedures should be adequately ventilated and with negative pressure • All staff should be trained for donning and doffing personal protective equipment, and well trained regarding infection prevention measures in their respective departments • Face-to-face consultations especially in the vulnerable at risk population, like immunocompromised patients and pregnant women, should be reasonably minimized along with prioritization and deferral of care as much as possible •Workforce and personal protective equipment management should become a priority in the planning of care Conclusion: The COVID pandemic has become a turning point in the standard of care in healthcare settings At least, until the availability of universal vaccination or mortality-reducing therapies, healthcare settings will have to apply additional measures to the classical standard precautions, not only to those infected, but to asymptomatic patients, healthcare personnel and visitors