To guide facilities and healthcare personnel in management of suspected or confirmed COVID-19 patients amid ongoing critical shortages of personal protective equipment, the Society for Healthcare Epidemiology of America (SHEA) joined with the Infectious Diseases Society of America and the Pediatric Infectious Diseases Society in releasing the infection prevention and control portion of a three-part guideline based on the best evidence available.

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

The societies developed the guideline under a rapid process to complete it in a matter of weeks to respond quickly to the pandemic, where guideline development generally takes well over a year.

The guideline was developed by a committee of frontline clinicians, healthcare epidemiologists, and other infectious diseases specialists with expertise in infection control. The writing panel applied the rigorous Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to assess the certainty of evidence and make eight recommendations:

1. Masks: Healthcare personnel caring for patients with suspected or known COVID-19 use either a surgical mask or N95 (or N99 or PAPR) respirator as part of appropriate personal protective equipment (PPE) (Strong recommendation, moderate certainty of evidence)
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 use a surgical mask or re-processed respirator instead of no mask 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, re-processed 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 re-processed 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 reuse of re-processed 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, as part of appropriate PPE.

The SHEA Board of Trustees endorsed the guideline’s Infection Prevention section, released today on the IDSA website, and the previously published section on Treatment and Management of Suspected and Confirmed COVID-19 patients. The third section will address diagnostic issues. The panel will continue to review evidence on preventing and managing COVID-19, and update recommendations as needed.

Source: Society for Healthcare Epidemiology of America (SHEA)