Coronavirus outbreak - Covid-19 pandemic (2020)

Guideline for prevention: hygiene and cleaning the first defense

There is presently no vaccine accessible to stop an infection with Covid-19. The best way to prevent infection is to stop the virus being released. As a reminder, however, CDC also recommends routine protective measures to help prevent the spread of respiratory viruses including:

Avoid close contact with sick people.
Do not touch your lips, your nose and your mouth with unwashed hands.
When you're sick, stay home.
Use tissue to cover the cough or sneeze, then chucks the tissue in the garbage.
The regularly handled items and surfaces are washed and disinfected using a regular household spray or scrub.
Follow CDC's Facemask instructions.

CDC does not commend that individuals who are well wearing a facemask, like Covid-19, protect themselves from respiratory viruses. Facemask should be used by people with 2019 novel corona virus symptoms, to shield others from the risk of infection. The use of facemasks is also important for health workers and people who care for someone in close proximity (at home or in a health care facility).

Your hands must be washed often for at least 20 seconds with soap and water, especially after getting to the bathroom; before eating; and after blowing your nose, coughing, or sneezing. Use an alcohol-based hand sanitizer with at least 60 per cent alcohol if soap and water are not readily available. Where hands are visibly dirty, wash hands using soap and water always. For hand washing information, see CDC's Hand washing Website for healthcare specific information, see CDC's Hand Hygiene in Healthcare Settings These are daily practices that can help prevent the spread of multiple viruses. CDC has specific guidelines for travelers. There is no approved clear antiviral treatment for an infection in Covid-19. People infected with Covid-19 will receive medical treatment to assist in symptom relief. Treatment for severe cases should include treatment to maintain vital functions of the organ.

People who think they could have been exposed to Covid-19 will immediately contact their healthcare provider. To prevent spreading in homes and residential areas, there is an interim advice for individuals who may have 2019 Novel Corona virus (Covid-19). This interim advice is focused on what's known about the Covid-19 epidemiology and other viral respiratory infections transmission. The interim guidance will be revised by CDC when required and as additional information becomes available.

This interim guidance is intended for:

Persons with confirmed or suspected Covid-19 infection, including those under investigation who do not need to be hospitalized and who may receive care at home (see Interim Guidance on Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Corona virus (Covid-19));
Hospitalized persons with confirmed Covid-19 infection, found to be medically stable and discharged (see Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Corona virus (Covid-19));
Other persons with close contact with a person with confirmed Covid-19 infection.

Below are prevention measures for persons with confirmed or suspected Covid-19 infection (including persons under investigation) who do not need to be hospitalized and persons with confirmed Covid-19 infection who have been hospitalized and who are considered to be medically safe to go home.

The physicians and public health workers can decide whether you can be treated at home. If it's decided that you don't need to be treated and can be protected at home, staff from your local or state health department can track you. Until a health care provider or local or state health department confirms you should return to your normal activities, you will follow the preventive measures below.

Stay home except for medical treatment: you can avoid activities outside your house, except for medical treatment. Do not go to work, to school or to public spaces. None use of public transport, ride-sharing, or taxis.

Separate yourself from other people in your house : you should live in a specific room as much as possible and in your home away from other people. If available, you should also use a separate bathroom.

Call ahead before seeing the doctor: Contact the healthcare provider if you have a medical appointment and inform them you have or may have an infection with Covid-19. This will help the office of the healthcare provider take steps to prevent contamination or exposure of other individuals.

Wear a facemask: when you are with people (e.g. sharing a room or vehicle) and before entering the office of a health care provider, you will wear a facemask; If you can't wear a facemask (for example, because it creates breathing difficulties), either people who live with you shouldn't stay with you in the same room, or they should wear a facemask if they enter your house.

Protect your coughs and sneezes: If you cough or sneeze protect your mouth and nose with a tissue. Throw used tissues into a lined trash can and wash your hands for at least 20 seconds with soap and water. If there is no detergent and water at the moment, clean your hands immediately with an alcohol-based hand sanitizer containing at least 60 percent alcohol, covering the surfaces of your hands and rubbing them together until they feel warm. When hands are obviously unclean, soap and water should be used preferentially.

Clean your hands: Wash your hands regularly over at least 20 seconds with soap and water. If soap and water are not available, use an alcohol-based hand sanitizer that contains at least 60 percent alcohol to clean your hands, cover all surfaces of your hands and rub them together until they feel dry. When hands are visibly unclean, detergent and water should be used preferentially. Stop using unwashed hands to brush your eyes, nose and mouth.

Avoid sharing personal household items : In your home, you should not share dishes, drink glasses, cups, eating utensils, towels, or bedding with others. They should be washed scrupulously with detergent and water after using those things.

Track your symptoms: If your condition worsens (e.g., shortness of breath or difficulty breathing) seek prompt medical treatment. Contact your health care providers before looking for maintenance to tell them you have, or are being treated for, an infection with Covid-19. Place yourself on a facemask before entering the room. Those measures will allow the office of the health care provider to prevent other individuals from becoming contaminated or exposed. Tell the health-care provider to contact the department of local or state safety. Persons put under active supervision or facilitated self-monitoring will, as applicable, follow the instructions given by their local health department or occupational health professionals.

Discontinued home isolation: Patients with confirmed Covid-19 infection will remain under the precautions of home isolation until the risk of secondary transmission to others is considered low. The decision to discontinue measures about home isolation should be taken on a case-by-case basis, in consultation with health care providers and departments of state and local health. Current Covid-19 knowledge is limited; thus, home precautions are cautious and based on general recommendations for other corona viruses, such as Middle East Respiratory Syndrome (MERS).

CDC also advises that:

While the potential risk to the American public of this new virus is believed to be small at this time, everyone can do their part to help us respond to this growing public health threat: It is currently the season for flu and respiratory diseases and CDC recommends taking a flu vaccine, taking regular preventive measures to help avoid germ spread and taking antiviral flu.

If you are a healthcare provider, watch out for people with fever and respiratory symptoms who have recently traveled from China.
Please take care of yourself and follow approved infection control protocols if you are a healthcare provider who cares for a Covid-19 patient or a public health responder.
Call the healthcare provider for people who have had close contact with someone who experiences problems with Covid-19 to inform them about your symptoms and exposure to the Covid-19 patient.

For those suffering from Covid-19, please follow CDC recommendations on how to reduce the risk of spreading the disease to others.

Interim Control for Businesses and Employers to Plot and Respond to 2019 Novel Corona virus (Covid-19)

This interim control is based on what is presently known about the 2019 novel corona virus. CDC works in the public health response to Covid-19 across the Department of Health and Human Services and throughout the U.S. government. Of how the Covid-19 spreads, much is unclear. Current awareness is based in large part on what is learned about related corona viruses.

Corona viruses are a large family of viruses common to humans and numerous different animal species, including camels, goats, cats, and bats. Animal corona viruses will occasionally infect people and then spread among people, for example with MERS and SARS. Covid-19 spreads person-to-person in China and some small person-to-person transmission has been recorded in non-China countries, including the USA. Respiratory infections, such as seasonal influenza, are now prevalent in many populations across the US.

In non-healthcare settings, the following interim guidelines can help prevent occupational exposures to acute respiratory diseases, including nCoV. The advice also includes contingency guidelines where the Covid-19 outbreaks are more common, population. To reduce occupational stigma and prejudice, use only the guidelines provided below to assess the risk of infection with nCoV. Don't make risk determinations based on race or country of origin, and be sure to keep people with reported corona virus infection confidential. There's much more to be learned about the Covid-19 transmissibility, frequency, and other features and inquiries are continuing. The reports can be found on the CDC web page.

Recommended Strategies for Employers to Use Now

Actively encourage sick employees to stay at home:
- Workers with symptoms of acute respiratory illness are advised to stay at home and not come to work until they are free of fever (100.4 ° F[ 37.8 ° C] or higher using an oral thermometer), fever signs, and any other symptoms for at least 24 hours without the use of fever-reducing or othorax thermometer. Employees should alert their boss if they are sick, and stay at home.
- Ensure that your sick leave program is flexible and compatible with guidelines on public health and that staff are aware of those policies.
- Speak to people that work with your company or temporary workers about the value of staying at home for sick employees and urge them to create non-punitive leave policies.
- Do not request a notice from a health care provider for workers suffering from acute respiratory disease to confirm their condition or return to work, as health care providers ' offices and medical facilities may be extremely busy and unable to provide such paperwork in a timely manner.
- Employers should develop flexible practices allowing employees to stay home to care for a sick member of their family. Employers should be aware that more staff may need to stay at home to care for sick children or other members of the sick family than is usual.

Separate sick workers:

CDC advises that employees who tend to be suffering from acute respiratory symptoms (i.e. cough, shortness of breath) should be isolated from other employees upon arrival at work or become ill during the day and sent home immediately. When you sneeze or cough (or an elbow or shoulder if there is no tissue available), sick workers will cover their noses and mouths with a towel.
Emphasize staying at home when sick, breathing sign and hand hygiene for all employees: o Place signs that promote staying at home when sick, cough and sneeze, and hand hygiene at the entrance to your workplace and in other workplace places where they are likely to be seen.
Provide no-touch and tissue disposal receptacles for employee use.
Instruct workers to disinfect their hands often with an alcohol-based hand sanitizer that contains at least 60-95 percent alcohol, or to wash their hands for at least 20 seconds with soap and water. When hands are visibly dirty, soap and water should be used preferentially.
Include on - the-job soap and water and alcohol-based hand rubs. Make sure you keep sufficient supplies. To promote hand hygiene, put hand rubs in multiple locations or at conference rooms.
For more information, visit the Coughing and Sneezing etiquette and clean hands website.

Environmental daily cleaning:

Daily cleaning of all regularly touched office surfaces, such as workstations, countertops, and door knobs; Use the cleaning agents usually used in these areas, and obey the label instructions.
No further disinfection is recommended beyond the routine cleaning at this time.
Include disposable wipes to allow widely used surfaces (e.g., doorknobs, keyboards, remote controls, desks) to be cleaned off by employees prior to each usage.

Advise staff to take certain precautions before traveling:

Consult the Traveler’s Health Notices CDC for the current advice and guidelines for each country you are traveling to. On the CDC website you can find specific travel information for travelers entering and returning from China, as well as information for aircrew.
Advise staff to search for acute respiratory disease symptoms before beginning travel and alert their boss and stay home if they are sick.
Ensure that workers who become sick while traveling or on a temporary assignment recognize that they should alert their boss and contact the healthcare provider immediately for advice if appropriate.
If outside the United States, sick workers should follow the policy of receiving medical care from your employer or contact a healthcare provider or medical assistance company overseas to help them find a suitable healthcare provider in that country. A consular officer in the U.S. can assist in locating health services. U.S. embassies, consulates, and military facilities, however, do not have the legal authority, capacity, and resources to transfer or provide medications, vaccines, or medical care to U.S. citizens outside the country.

Additional measures in response to Current Sporadic Imports of the Covid-19:

Workers who are safe but have a sick family member at home with Covid-19 will alert their supervisor and refer to the CDC guidelines on how to carry out a risk assessment of their potential exposure.
Where an employee has been reported to be infected with Covid-19, employers should warn fellow employees of their possible exposure to Covid-19 in the workplace but maintain confidentiality as allowed by the American Disability Act (ADA). Employees exposed to a co-worker with Covid-19 reported will refer to CDC guidelines on how to perform a risk valuation of their possible exposure.

Preparing for a Possible Covid-19 Plague in the US

The extent of the disease or how many people will fall sick from Covid-19 at this time is unclear. If there is evidence of an outbreak in the U.S. in Covid-19, businesses should expect to be able to respond flexibly to varying gravity levels and be prepared to adapt their business response plans as required. The instant health danger from Covid-19 is measured low for the general American public, such as staff in non-healthcare environments and where it is unlikely that job activities pose an increased risk of exposures to Covid-19. The CDC and its collaborators will continue to monitor national and international data on the seriousness of the Covid-19 outbreak, disseminate the findings of these ongoing surveillance assessments, and make additional recommendations as required.

Planning Deliberations

All employers have to contemplate on how best to reduce the spread of acute respiratory disease and reduce the impact of Covid-19 on their workplace in case of an outbreak in the United States. We should define and communicate their priorities, which may include one or more of the following: (a) reducing workforce delivery, (b) protecting people at higher risk for adverse health conditions, (c) sustaining business operations, and (d) mitigating adverse effects on other organizations in their supply chains. Some of the main factors when making decisions regarding appropriate responses are:

Seriousness of the disease (i.e., number of people who are sick, hospitalization and mortality rates) in the community where the business is located;
Effect of the disease on workers who are vulnerable and may be at higher risk for adverse health effects in Covid-19. Inform staff that some individuals, such as older adults and those with chronic medical conditions, may be at a higher risk for serious illness.
Plan for potential increased numbers of employee absences due to illness in workers and their family members, dismissals from early childhood services andK-12 schools due to high levels of absenteeism or disease: o Employers should prepare to track and respond to absenteeism at the workplace. Implement plans to continue your critical business functions in the event you encounter absenteeism higher than usual.

Cross-train staffs perform essential functions so that the workforce can run even when key staffs are absent.
Assess your core functions and the reliance on your services or products that others and the society have. Be ready to adjust your business practices if compulsory to maintain essential operations (e.g., find substitute suppliers, prioritize customers or, if appropriate, temporarily suspend some of your operations).

Employers with over one business site are advised to allow local managers to take the appropriate action outlined in their Business Infectious Disease Outbreak Response Plan, based on the condition of each locality.
Coordination with state and local health officials for all organizations is strongly encouraged so that timely and reliable information can direct appropriate responses wherever their operations reside. As the severity of an outbreak can vary depending on the geographic location, local health authorities may provide specific guidance for their communities.

Important Considerations for Creating an Infectious Disease Outbreak Response Plan

Both companies should be ready to implement measures from Covid-19 to protect their employees while maintaining organizational continuity. Both sick workers should stay at home during a Covid-19 outbreak and be welcomed away from the office, respiratory safety and hand hygiene, and thorough washing of frequently touched surfaces should be done regularly.

Ensure that the program is flexible, and include your staff in the production and analysis of your strategy.
Hold a concentrated conversation or exercise using your strategy, to decide in advance whether there are holes or issues that need to be addressed.
Share the strategy with workers and explain what programs are open to them on human resources, job and leave flexibilities, and pay and benefits.
Exchange best practices with other businesses in your communities (especially those within your supply chain), chambers of commerce and organizations to strengthen community response efforts.

Recommendations for an Infectious Disease Outbreak Response Plan

Identify potential work-related threats to your workers and their safety. Further details on how to protect employees from potential exposure to Covid-19 is available at OSHA.
Review human resources programs to ensure that policies and practices are consistent with public health guidelines and in accordance with current federal and state labor laws.
Consider how policies and procedures such as flexible workplaces (e.g., telecommuting) and flexible working hours (e.g. staggered shifts) can be developed to increase physical distance between workers and between employees and others when state and local health authorities consider using social distance strategies. Supervisors should allow workers to telework for employees who are willing to telework, rather than coming into the office before symptoms are fully resolved. Make sure you have the information technology and infrastructure required to support multiple employees who can work from home.
Identify basic business functions, key positions or responsibilities, and critical elements within the supply chains (e.g., raw materials, manufacturers, subcontractor services / products, and logistics) needed to sustain business operations. Plan how the company will work if there is growing absenteeism or disruption of those supply chains.
Establish guidelines, triggers and protocols to enable and stop the company's infectious disease outbreak response plan, change business operations (e.g., likely altering or closing operations in the affected areas), and pass business knowledge to key staff. To recognize those causes, work closely with your local health officials.
Aim to minimize exposure between workers and, if public health officials call for social distancing, also between employees and the public.
Establish a mechanism for communicating information on your infectious disease outbreak response plans to employees and business partners and the latest Covid-19 details; Anticipate stress, anxiety, rumors, and misinformation among employees, and schedule contact accordingly.
Early childhood services andK-12 schools may be discontinued in some communities, particularly if Covid-19 worsens. Determine how you will work if absenteeism spikes from increased numbers of sick workers, those who stay at home to care for sick family members, and those who have to stay at home to watch their kids if they are fired. Businesses and other employers should be prepared to set up flexible places of work and leave plans for these workers.
Local conditions will affect public health officials ' decisions regarding community-level strategies; businesses should now take the time to learn about the plans in place in each community where they have a business.
If proof of a Covid-19 outbreak is available in the United States, consider canceling non-essential business travel to additional countries via travel guidance on the CDC website;

Certain countries that impose travel restrictions which may limit employees ' ability to return home if they become ill while on travel status.
Consider canceling large meetings or activities related to the job.

Engage state and local health departments to validate communication channels and strategies for disseminating local information about the outbreak.

Interim Contagion Prevention and Control References for Patients with Confirmed 2019 Novel Corona virus (Covid-19)

Infection control protocols including administrative guidelines and engineering tests, environmental sanitation, proper work practices, and sufficient use of personal protective equipment (PPE) are all necessary to prevent infections from spreading during delivery of health care. Prompt diagnosis and efficient triage and isolation of potentially infectious patients are important to prevent unnecessary interactions at the facility between patients, health care personnel and visitors. All health care facilities must ensure that their personnel are properly trained and able to carry out infection control procedures; individual health care staff should ensure that they understand and can comply with the standards for infection control.

This advice is focused on the currently limited information available about Covid-19 related to seriousness of disease, efficiency of transmission and duration of shedding. A cautious approach will be modified and revised as more information becomes available in the United States, and as the response needs change. This policy extends to all health care environments in the United States. This guideline is not intended for non-healthcare environments (e.g., schools) OR for non-healthcare individuals. Refer to the main CDC Covid-19 website for guidelines related to clinical care, air or ground medical transport, or laboratory settings.

Definition of Healthcare Personnel (HCP): For the purposes of this guideline, HCP refers to all individuals, paid and unpaid, working in healthcare settings engaged in patient care activities, including: triage assessment of patients, entry of examination rooms or patient rooms to care for or clean and disinfect the environment, collecting clinical specimens, handling of soiled medical supplies or equipment

Required

Reduce Exposure Risk Ensure policies and practices in place to minimize exposure to respiratory pathogens like Covid-19. Measures should be introduced in the clinical environment prior to patient admission, upon diagnosis and throughout the course of the life of the affected patient.

Upon arrival: when making appointments, advise patients and accompanying individuals to call or alert HCP upon arrival if they have any signs of respiratory infection (e.g. cough, runny nose, fever1) and to take appropriate preventive measures (e.g., wear a facemask at entry to avoid cough, obey triage procedures). When a patient arrives by emergency medical services (EMS) transport, the driver will call the receiving emergency department (ED) or healthcare facility and follow local or regional transport procedures previously agreed upon. This will encourage the healthcare facility to prepare for the patient's acceptance.
Upon onset and all through the stay: take steps to ensure that all individuals with suspected Covid-19 symptoms or other respiratory infections (e.g., fever, cough) adhere to breathing hygiene and cough protocol, hand hygiene and triage throughout the visit. Consider posting visual warnings (e.g. signage, posters) at the entrance and in strategic locations (e.g. waiting rooms, elevators, and cafeterias) to provide patients and HCP with guidance on hand hygiene, respiratory hygiene, and cough etiquette (in relevant languages). Instructions may include how to use facemasks (see Facemask Description in Appendix) or tissues to cover the nose and mouth while coughing or sneezing, how to dispose of tissues and hazardous products in waste receptacles, and how and when to conduct hygiene by hand. Ensure patients with suspected Covid-19 symptoms or other respiratory infections (e.g., fever, cough) are not required to wait among other patients seeking care. Identify a clear, well ventilated room with easy access to respiratory hygiene supplies, allowing waiting patients to be separated by 6 feet or more. In some settings, patients who are medically stable may choose to wait in a personal vehicle or outside the health care facility where they can be reached by mobile phone when it is their turn to be assessed. Ensure the rapid triage and isolation of patients with suspected Covid-19 symptoms or other respiratory infections (e.g., fever, cough): o Identify patients at risk for Covid-19 infection before or immediately after arrival at the health care facility.

Develop triage protocols for the identification of persons under investigation (PUI) for Covid-19 during or prior to patient triage or registration (e.g. at the time of patient check-in) and ensure that all patients are informed about the occurrence of symptoms of respiratory infection and travel history to areas experiencing Covid-19 transmission or possible Covid-19 patients contact.
Apply respiratory hygiene and cough etiquette (i.e., put a facemask over the patient's nose and mouth, if not already done) and, where possible, isolate the Covid-19 PUI in the Airborne Infection Isolation Room (AIIR). For "Patient Placement" guidelines see below.
Alert infection prevention and control programs, local and state public health agencies and other health-care personnel as needed of the involvement of an individual under investigation for Covid-19.

Provide supplies of respiratory hygiene and cough etiquette including 60 percent-95 percent alcohol-based hand sanitizer (ABHS), wipes, no touch receptacles for disposal, and facemasks at entrances to health care facilities, waiting rooms, patient check-in, etc.

2. Obedience to Standard, Contact, and Airborne Safety measures, including the Use of Eye Protection

Standard Precautions presume that each person is potentially contaminated or colonized with a pathogen that could be transmitted in the healthcare setting. Standard Precautionary Elements applicable to patients with respiratory infections, including those caused by Covid-19, are listed below. Education on proper use, proper donation (putting on) and doffing (taking off) and disposal of any PPE should be taken care. This document does not highlight all aspects of the Standard Precautions (e.g., injection safety) needed for all patient care; the full description is given in the Isolation Guideline

Patient Placement

Install a patient with known or suspected Covid-19 (i.e., PUI) in an AIIR built and maintained in compliance with current guidelines.
AIIRs are single-patient rooms with negative pressure compared to surrounding areas and with at least 6 air changes per hour (12 air changes per hour are recommended for new or revamped construction). Before recirculation, air from these rooms should be exhausted directly to the outside or filtered through a high-efficiency particulate air filter (HEPA). Room doors should be shut except when entering or exiting the room and there should be minimal entry and exit. Facilities should track and log those rooms ' proper negative-pressure work.
If no AIIR is open, patients requiring hospitalization should be moved to an AIIR facility as soon as possible. If the patient does not need hospitalization, when considered medically and socially necessary, they may be discharged to the home (in conjunction with the state or local public health authorities). Pending transfer or discharge, place the patient in a facemask and isolate him / her in an exam room with the door closed. Ideally, the patient should not be put in any space within the building where exhaust is re-circulated without HEPA filtration.
Once an AIIR is in operation, the facemask of the patient may be removed. Restrict the patient's travel and movement outside the AIIR to medically necessary purposes. If not in an AIIR (e.g. during travel, or if there is no AIIR), patients will wear a facemask to prevent secretions.
Personnel entering the room, as mentioned below, should use PPE, including respiratory protection;
The room should be accessed only by essential personnel. Implement personnel policies to reduce the number of HCP people entering the room.
Facilities will consider taking care of these committed HCP patients to reduce risk of transmission and exposure to other patients and other HCP patients.
Facilities should keep a log of all individuals who care for or access certain patients ' rooms or areas of treatment.
Using non-critical, dedicated or disposable patient care devices (e.g., blood pressure cuffs). When equipment is used for more than one patient, clean and disinfects this equipment according to manufacturer's instructions prior to use on another patient.
HCP should use respiratory protection when entering the room soon after a patient has vacated the bed. (See Personal Protective Equipment section below) The standard practice for airborne pathogens (e.g., measles, tuberculosis) is to prevent unprotected individuals, including HCP, from accessing a vacant space before sufficient time has elapsed for sufficient air changes to eradicate potentially infectious particles (more detail on clearance rates under various ventilation conditions). We still don't know how long Covid-19 remains infectious in the soil. In the meantime, adding a similar time period before entering the room without respiratory protection as used for pathogens transmitted through the airborne route (e.g., measles, tuberculosis), is appropriate. The space should also undergo proper cleaning and surface disinfection before returning to daily use.

✵ Hand hygiene

HCP should perform manual hygiene using ABHS before and after all patient contact, contact with potentially infectious material, and before putting on and removing PPE, including gloves. Hand-hygiene in healthcare environments can also be done for at least 20 seconds by washing with soap and water. Use detergent and water before going back to ABHS, if the hands are visibly soiled.
Healthcare facilities should ensure that portable hygiene products are readily available at any place of treatment.

✵ Personal protective equipment

Employers should pick suitable PPE equipment and provide it to HCP in compliance with OSHA's PPE regulations (29 CFR 1910 Subpart I). HCP must be educated and demonstrate an understanding of when to use PPE; what PPE is needed; how to properly donate, use, and doff PPE to avoid self-contamination; how to properly dispose of, or clean, and preserve PPE; and the drawbacks of PPE. Each reusable PPE will need to be properly washed, decontaminated and maintained after and between uses. Facilities should have policies and procedures outlining a prescribed sequence for secure dressing and doffing of PPE:

Gloves: perform hand hygiene, and then put on clean, non-sterile gloves when entering the room or treatment area of the patient. If they get ripped or become highly polluted, change gloves. Before entering the patient's room or treatment area, remove and discard the gloves and practice hand hygiene immediately.

Gowns: put on a clean gown of insulation upon entering the room or region of the patient. If it gets soiled remove the robe. Remove and dispose of the gown in a designated waste or linen tub before leaving the room or treatment area for the patient. You will remove the disposable gowns after use. After each use cloth gowns should be laundered.
Respiratory Protection : Using respiratory protection (i.e., respiratory protection) that is at least as safe as a fit-tested disposable N95 NIOSH-certified respiratory face piece filter when entering the patient room or treatment area. See appendix for interpretation of respirator. Upon leaving the room or treatment area of the patient, and closing the door, remove and discard disposable respirators. Perform cleaning by hand after the respirator has been removed. When reusable respirators (e.g., powered air purifying respirator / PAPR) are used, they must be washed and disinfected prior to re-use in compliance with manufacturer's reprocessing instructions. Respiratory use must be in compliance with the Occupational Safety and Health Administration (OSHA) Respiratory Protection Code (29 CFR 1910.134 external icon) in the form of a full respiratory protection programme. Staff should be properly washed and fit-tested when using respirators with tight-fitting face parts (e.g., a NIOSH-certified disposable N95) and qualified in proper respiratory usage, safe removal and disposal, and medical contraindications for respiratory use.
Eye Protection: Using eye protection (e.g. goggles, face mask that protects the front and side of the face) when entering the patient room or treatment area. Disable the eye protection before leaving the room or area of treatment for the patient. Reusable eye protection (e.g., goggles) must be washed and disinfected according to the reprocessing instructions given by the manufacturer before re-use. Upon use, the eye cover should be removed.

Use caution to produce infectious aerosols while conducting aerosol-generating procedures

Some of the procedures performed on Covid-19 patients. In particular, procedures which are likely to induce coughing (e.g., induction of sputum, open suction of airways) should be performed with caution and avoided where possible.
Such procedures should take place in an AIIR if performed and staff should use respiratory protection as mentioned above.

Additionally:

Restrict the number of HCP present during the procedure to only those required for patient care and procedural assistance.
Clean and disinfect surfaces of the procedure room promptly as defined in the section below on the control of environmental infections.

Respiratory Diagnostic Specimen Collection

Collection of diagnostic respiratory specimens (e.g., nasopharyngeal swab) can cause coughing or sneezing. Ideally, people in the room during the treatment should be confined to the specimen being collected by the patient and by the health care provider.
HCP collecting Covid-19 test specimens from patients with known or suspected Covid-19 (i.e., PUI) will adhere to Normal, Contact and Airborne Precautions, including the use of eye care.
Such tests should be performed in an AIIR or in a closed-door exam room. Ideally, the patient should not be put in any space within the building where exhaust is re-circulated without HEPA filtration.

Length of Isolation Precautions for PUIs and confirmed Covid-19 patient’s

Before information on viral shedding following clinical progress is available, discontinuation of isolation precautions should be decided on a case-by-case basis, in accordance with local, state and federal health authorities.
Factors to be considered include: the occurrence of Covid-19 symptoms, the date symptoms resolved, other conditions requiring specific precautions (e.g., tuberculosis, Clostridioides diffici), other clinical-related laboratory details, alternatives to inpatient isolation, such as the likelihood of safe recovery at home.

3. Manage Guest Access and Movement inside the Facility

Establish guest tracking, control and training procedures;
Restricts visitors to access known or suspected Covid-19 patients (i.e., PUI) rooms. Alternate strategies should be considered for patient and guest experiences, such as video-call apps on mobile phones or tablets. Facilities may take exceptions based on end-of-life conditions or when a visitor is necessary for the emotional well-being and treatment of the patient.
Visitors to patients with known or suspected Covid-19 (i.e., PUI) should be scheduled and monitored to allow:

Visitors to be checked for signs of acute respiratory disease before accessing the health care facility;
Facilities should determine the visitor's health risk (e.g., visitors may have an underlying disease that puts them at a higher risk for Covid-19) and their ability to comply with precautions.

Installations should provide guidance on hand hygiene, restriction of touched surfaces and use of PPE in compliance with current facilities policy while in the patient's room before visitors enter the rooms.
Facilities should keep a record (for example, log book) of all patients accessing patient rooms.
Visitors should not be present during procedures for the processing of aerosols.
Visitors should be advised to limit their movement within the building.
Exposed visitors (e.g., contact with Covid-19 patient prior to admission) should be recommended to disclose to their health care provider any signs and symptoms of acute illness for a period of at least 14 days after the last reported exposure to the patient.

Respiratory hygiene and cough etiquette care should be taken by all patients while in common areas of the facility.

4. Implement Engineering Controls

Consider developing and implementing controls to reduce or eliminate exposures from infected individuals by protecting HCP and other patients. Types of engineering controls include physical barriers or partitions to guide patients through triage areas, curtains between patients in shared areas, closed airway suction systems for intubated patients, as well as suitable air-handling systems (with correct directionality, filtration, exchange rate, etc.) that are designed and maintained properly.

5. Monitor and Manage Ill and Exposed Healthcare Personnel

Workers Movement and control decisions should be taken in coordination with public health authorities for HCP with access to Covid-19. Health care facilities and entities will adopt HCP sick leave policies that are non-punitive, flexible, and compatible with recommendations for public health.

6. Train and Educate Healthcare Personnel

Provide HCP with job-or task-specific training and training to prevent infectious agent transmission, including refresher training. HCP must be medically cleaned, trained and checked for the use of respiratory protective devices (e.g., N95 filtering face piece respirators) or medically cleaned and trained to use an alternative respiratory protective device (e.g., Powered Air-Purifying Respirator, PAPR) if respirators are needed. OSHA has a variety of videos external symbol for the respiratory instruction.

Ensure that HCP is prepared, qualified and used properly before taking care of a patient, including consideration for proper use of PPE and avoidance of clothing, skin and environment contamination during the removal process.

7. Implement Environmental Infection Control

All non-dedicated, non-disposable medical equipment used for patient care should be washed and disinfected as per the guidelines and facilities policies of the manufacturer.

Ensure the processes for the environmental cleaning and disinfection are regularly and correctly followed. Routine cleaning and disinfection procedures (e.g., use of cleaners and water on pre-clean surfaces before applying an EPA-registered, hospital-grade disinfectant to regularly touched surfaces or items for acceptable contact times as indicated on the product label) are appropriate for Covid-19 in healthcare environments, including those patient care areas where aerosol-generating procedures are used. Goods that are believed to have emerging viral pathogens licensed by EPA are recommended for use against Covid-19.

8. Establish Reporting within Healthcare Facilities and to Public Health Authorities

Develop systems and policies that quickly warn key facilities personnel including infection control, health care epidemiology, facility leadership, occupational health, clinical laboratory, and front-line staff regarding Covid-19 patients known or suspected (i.e., PUI). Communicate with public health agencies and cooperate. Notify patients with known or suspected Covid-19 (i.e., PUI) immediately by the State or local public health authorities. Facilities will appoint specific individuals who are responsible for interacting with public health officials and disseminating information to HCP within the health care facility.