Practical strategies to reduce nosocomial transmission to healthcare professionals providing respiratory care to patient
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REVIEW
Open Access
Practical strategies to reduce nosocomial transmission to healthcare professionals providing respiratory care to patients with COVID-19 Ramandeep Kaur1, Tyler T. Weiss1, Andrew Perez1, James B. Fink1, Rongchang Chen2, Fengming Luo3, Zongan Liang3, Sara Mirza1 and Jie Li1*
Abstract Coronavirus disease (COVID-19) is an emerging viral infection that is rapidly spreading across the globe. SARS-CoV-2 belongs to the same coronavirus class that caused respiratory illnesses such as severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). During the SARS and MERS outbreaks, many frontline healthcare workers were infected when performing high-risk aerosol-generating medical procedures as well as when providing basic patient care. Similarly, COVID-19 disease has been reported to infect healthcare workers at a rate of ~ 3% of cases treated in the USA. In this review, we conducted an extensive literature search to develop practical strategies that can be implemented when providing respiratory treatments to COVID-19 patients, with the aim to help prevent nosocomial transmission to the frontline workers. Keywords: Nosocomial infection, Respiratory care, Aerosol-generating procedures
Introduction Coronavirus disease (COVID-19) cases were first reported to the World Health Organization on December 31, 2019 [1]. Since then, this illness has spread exponentially in over 200 countries. As of June 9, 2020, there were 7,039,918 confirmed cases of the COVID-19 disease globally [2]. Even though the exact mode of COVID-19 transmission has been debatable, the route of COVID-19 transmission is reported to be from personto-person contact and exposure to respiratory droplets (> 5–10 μm) [3], whereas airborne transmission (< 5 μm) * Correspondence: [email protected] Prior abstract publication/presentation: JL presented partial content in the special COVID-19 webinar invited by the International Society for Aerosols in Medicine on March 19, 2020. 1 Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University Medical Center, 1620 W Harrison St, Tower LL1202, Chicago, IL 60612, USA Full list of author information is available at the end of the article
during aerosol-generating procedures remains under investigation [4, 5]. Based on the initial data reported [6– 12], around 5–30% of COVID-19 patients develop signs of severe respiratory distress requiring intensive care unit (ICU) admission to receive advanced respiratory support in terms of oxygen therapy, non-invasive and invasive ventilatory support with prone positioning (Table 1). Standard droplet and contact precautions (gowns, gloves, mask) are known to reduce the risk of contracting severe acute respiratory syndrome (SARS) [13] but not under all circumstances, especially when performing high-risk procedures such as intubation [14]. A recent systematic meta-analysis showed that a physical distance of 1 m or more and wearing a mask is optimum to reduce person-to-person virus transmission and to keep healthcare workers
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