New Infection Prevention Guidelines Highlight Lessons Learned From COVID-19

By Jay Kumar, PSQH

A new set of guidelines was released this week to provide healthcare facilities and personnel with infection prevention and control best practices when caring for COVID-19 patients. The guidelines were released by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America, and the Pediatric Infectious Diseases Society.

“There is still much to learn about this virus, but these recommendations give hospitals an evidence-based reference,” said Judith Guzman-Cottrill, DO, the SHEA representative on the author panel, in a release. “This guideline can assist in creating policies to prevent the transmission of COVID-19 and to help keep healthcare personnel and patients safe.”

The societies quickly developed the guidelines to respond to the pandemic, a process that usually takes more than a year. The guidelines were developed by a committee of frontline clinicians, healthcare epidemiologists, and other infectious disease specialists.

The eight recommendations released include:

1. Masks: Healthcare personnel caring for patients with suspected or known COVID-19 should use either a surgical mask or N95 (or N99 or PAPR) respirator as part of appropriate personal protective equipment (PPE).
2. Masks in shortage scenarios: In contingency or crisis settings with a shortage of respirators, healthcare personnel caring for patients with suspected or known COVID-19 should use a surgical mask or reprocessed respirator as part of appropriate PPE.
3. Gloves: Citing a lack of evidence, the panel did not make a recommendation to support the use of double gloves vs. single gloves.
4. Shoe covers: Citing a lack of evidence, the panel did not make a recommendation to support the use of shoe covers.

Recommendations for aerosol-generating procedures:

5. N95 masks: Healthcare personnel involved with aerosol-generating procedures on suspected or known COVID-19 patients should use an N95 (or N99 or PAPR) respirator instead of a surgical mask, as part of appropriate PPE.
6. Reprocessed N95 masks: If respirators are in shortage, reprocessed N95 respirators should be reused instead of surgical masks as part of appropriate PPE during aerosol-generating procedures on suspected or known COVID-19 patients.
7. Extended use of N95s through face shields and surgical masks: If due to shortages, reprocessed respirators are being used for aerosol-generating procedures, the panel recommends healthcare personnel use a face shield or surgical mask over the reused respirator to aid extended use, instead of using a surgical mask alone. This recommendation assumes correct PPE donning and doffing techniques.
8. Reuse of N95s with face shields and surgical masks: To allow for the reuse of reprocessed respirators during contingency or crisis settings, healthcare personnel involved with aerosol-generating procedures on suspected or known COVID-19 patients should add a face shield or surgical mask as a cover for the N95 respirator instead of a using a surgical mask alone.