February 13, 2020

CDC Adds Resources for Healthcare Workers Potentially Exposed to Coronavirus

Resources released this week by the Centers for Disease Control and Prevention offer guidance related to respiratory protection for healthcare workers potentially exposed to the novel coronavirus that originated in Wuhan, China, last December. The virus, which the World Health Organization recently named COVID-19, has infected more than 45,000 people worldwide and killed 1,115, according to WHO. As of Feb. 12 all but one of the fatalities and 99 percent of infections have occurred in China, per WHO’s official statistics.

The new CDC resources include interim infection protection and control recommendations, FAQs for personal protective equipment, and information about the supply of PPE for healthcare personnel, as well as strategies for optimizing the supply of N95 respirators.

Links to these and other resources from CDC, OSHA, and AIHA are available on AIHA’s Coronavirus Outbreak Resource Center.

On a conference call with CDC representatives held Feb. 11, Dr. Anita Patel said the potential threat of COVID-19 is high but that the immediate risk for most Americans is low. However, that risk assessment is likely to change, Dr. Patel said. She confirmed that two instances of person-to-person transmission of COVID-19 have occurred in the U.S., both after close, prolonged contact with a traveler returning from Wuhan.

Dr. Mike Bell of CDC’s healthcare quality promotion division clarified that “we don’t have any evidence to suggest” that person-to-person transmission is happening easily and that “we have a lot of information about what needs to be done to control the spread.” Effective source control measures include barriers such as masks that can keep people with COVID-19 symptoms from coughing openly. In a community setting, Dr. Bell said, source control can be accomplished with handkerchiefs.

Dr. Bell said that one lesson of the SARS and MERS outbreaks is that healthcare delivery can increase disease transmission if hygiene principles are not followed. The 13 U.S. patients who have been infected with COVID-19 are being isolated in negative-pressure rooms. Healthcare personnel who interact with these patients are wearing respiratory and eye protection. “We feel we’re being more conservative than is absolutely required,” Dr. Bell said, though he acknowledged that community spread of the virus in the U.S. is likely to develop eventually.

“Ambulatory care settings, acute care settings, and places where people walk in” are among the facilities of concern. Dr. Bell recommended that these facilities ask patients with symptoms to put on masks. To reduce the amount of time symptomatic individuals spend in healthcare facilities, Dr. Bell suggested that patients be asked to wait in their cars and then called on their cell phones when healthcare personnel are ready to admit them.

During the call, Dr. Marie de Perio of NIOSH emphasized that healthcare facilities should use a mix of administrative and engineering controls in addition to PPE to control the spread of the virus. Engineering controls can include placing barriers between healthcare personnel and patients, such as glass or plastic windows at information booths.

To address concerns about the supply of N95 respirators, Dr. de Perio recommended limiting face-to-face interaction with patients and “bundling” tasks so that healthcare personnel are not constantly going in and out of rooms where patients are kept.

“An important strategy to conserve N95s is to exclude healthcare personnel who are not directly involved” in patient care, Dr. de Perio said. She recommended the “cohorting” of both patients and healthcare personnel—keeping patients with the same virus separate from other patients, and forming teams of professionals whose sole responsibility is to treat patients with COVID-19.

Other respirators that can be used to protect against the virus include N99s, N100s, powered air-purifying respirators (PAPRs), and elastomeric respirators, Dr. de Perio said. She reminded listeners that because PAPRs and elastomeric respirators are reusable, facilities need to implement regular cleaning and maintenance procedures.

Surgical N95s, Dr. de Perio said, should not need to be used outside healthcare facilities.