TRANSMISSION, INFECTION PREVENTION & CONTROL-COVID-19 KNOWN TO DATE
- Prof. (Dr) Usha
- Jun 9, 2020
- 4 min read
Updated: Jun 27, 2020
Incubation period: Current estimates of the incubation period range from 1-14 days with median estimates of 5-6 days between infection and the onset of clinical symptoms of the disease.
Transmission: Asymptomatic transmission refers to transmission of the virus from a person, who does not develop symptoms. Transmission can happen from animals and human-to-human. Asymptomatic cases have been reported as part of contact tracing efforts in some countries. WHO regularly monitors all emerging evidence and provides updates.
Modes of transmission: Droplets sprayed by affected individuals, contact with patient respiratory secretions, contaminated surfaces and equipment.
Currently no sure treatment or vaccination, supportive measures only. Many companies and universities globally are rushing to create coronavirus vaccines, and human trials have already started for several manufacturers, including Pfizer, BioNTech etc.
Primary modes of transmission:
Droplet: Respiratory droplets (particles >5-10 μm in diameter) are generated when an infected person coughs or sneezes. Any person who is in close contact (within 1 m) with someone who has respiratory symptoms (coughing, sneezing) is at risk of having his/her mucosae (mouth and nose) or conjunctiva (eyes) exposed to potentially infective respiratory droplets.
Contact: direct contact with infected people and indirect contact with surfaces in the immediate environment of or with objects used on the infected person (e.g., stethoscope or thermometer) (droplets may land on surfaces where the virus could remain viable).
Airborne transmission: Mainly limited to circumstances and settings in which aerosol generating procedures (AGPs): tracheal intubation, non-invasive ventilation, tracheotomy, CPR, manual ventilation before intubation, bronchoscopy.
Additional measures/precautions are based on modes of transmission:
Direct modes:
Direct contact
Direct contact occurs through touching; an individual may transmit microorganisms to others by skin-skin contact or contact with infected surfaces, soil or vegetation.
Droplet spread
Droplet spread refers to spray with relatively large, short-range aerosols produced by sneezing or coughing.
Indirect modes:
Indirect contact:
Indirect transmission refers to the transfer of an infectious agent from a reservoir to a host.
Airborne transmission occurs when infectious agents are carried by dust or droplet nuclei suspended in air.
Vehicles may indirectly transmit an infectious agent.
Vectors may carry an infectious agent or may support growth or changes in the agent.
Patients suspected or confirmed of COVID-19: WHO & health authority guidelines
Contact and droplet precautions for all patients with suspected or confirmed COVID-19. Airborne precautions are recommended only in circumstances and settings in which AGPs and support treatment are performed (i.e. open suctioning of respiratory tract, intubation, bronchoscopy, cardiopulmonary resuscitation).
All patients with respiratory illness should be in a single room, or minimum 1m away from other patients when waiting for a room. A team of Healthcare workers(HCW) should be dedicated to care exclusively for suspected patients.
HCW to wear PPE: a medical mask, goggles or face shield, gown, and gloves.
Hand hygiene - as per routine practices/additional measures practices and before PPE and after removing PPE.
Contact precautions-
• Single room
• Hand hygiene- according to the “5 Moments of hand hygiene”, in particular before and after contact with the patient and after removing PPE.
• Avoiding touching eyes, nose or mouth with contaminated gloved or ungloved hands.
• PPE: gown + gloves
Other measures:
• Equipment- cleaning, disinfection, and sterilization
• Environmental Cleaning-Avoiding contaminating surfaces not involved with direct patient care (e.g., doorknobs, light switches, mobile phones)
“5 Moments of hand hygiene”
Droplet precautions
• Single room
• if single rooms are not available, separating patients from others by at least 1meter
PPE
• Medical mask
• Eye protection (goggles or face shield)
• Gown
Limit movement: Patient to stay in the room.
• If transport/movement is required, require the patient using a medical mask and use
predetermined transport routes to minimize exposure for staff, other patients and visitors.
Airborne precautions
Recommended ONLY for aerosol generating procedures:
• bronchoscopy,
• tracheal intubation,
• pressure on the chest during cardiopulmonary resuscitation (CPR) may induce production
of aerosol
• and others that are aerosol producing.
The following is required:
• Single room
• Adequate ventilation
• PPE: gown, gloves, N-95, or FFP2(94% filtration percentage and maximum 8% leakage to the inside) or equivalent masks, eye protection (goggles or face shield).
Face mask Protocol: A face mask is meant to help prevent large-particle droplets, sprays, splashes or splatter that may contain germs. It filters bodily fluids such as saliva, blood, and/or small particles from other people. However, it should not be used beyond 8-10 hours of wearing.
Airborne: N95 Mask Fitting- Do a seal check before you enter the room.
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