CDC updates infection control guidelines

Nov. 6, 2020

The Centers for Disease Control and Prevention (CDC) announced it has updated its recommendations for infection prevention and control in healthcare settings during the COVID-19 pandemic, including options for screening people (healthcare personnel, patients, visitors) prior to their entry into a healthcare facility.

The agency provided information on factors that could impact thermometer readings, such as the temperature of the environment or the distance at which infrared must be held from the temporal artery in the forehead to take the temperature correctly. And it provided resources for evaluating and managing ventilation systems in healthcare facilities. It also added a link to frequently asked questions about the use of personal protective equipment.

Changes to the guidance as of November 4, 2020 include:

·        Provided different options for screening individuals (healthcare personnel, patients, visitors) prior to their entry into a healthcare facility

·         Provided information on factors that could impact thermometer readings

·         Provided resources for evaluating and managing ventilation systems in healthcare facilities

·         Added link to Frequently Asked Questions about use of Personal Protective Equipment

This guidance is applicable to all U.S. settings where healthcare is delivered.

CDC recommends using additional infection prevention and control practices during the COVID-19 pandemic, along with standard practices recommended as a part of routine healthcare delivery to all patients. These practices are intended to apply to all patients, not just those with suspected or confirmed SARS-CoV-2 infection. Facilities should develop policies and procedures to ensure recommendations are appropriately applied in their setting (e.g., emergency department, home healthcare delivery).

These additional practices include:

·         Implement Telehealth and Nurse-Directed Triage Protocols

·         Continue to use telehealth strategies to reduce the risk of SARS-CoV-2 transmission in healthcare settings while maintaining high quality patient care.

When scheduling appointments for routine medical care (e.g., annual physical, elective surgery):

·         Advise patients that they should put on their own cloth mask before entering the facility.

·         Instruct patients to call ahead and discuss the need to reschedule their appointment if they have symptoms of COVID-19 within the 10 days prior to their appointment, if they have been diagnosed with SARS-CoV-2 infection within the 10 days prior to their appointment, or if they have had close contact with someone with suspected or confirmed SARS-CoV-2 infection within 14 days prior to their scheduled appointment.

When scheduling appointments for patients requesting evaluation for possible SARS-CoV-2 infection, use nurse-directed triage protocols to determine if an appointment is necessary or if the patient can be managed from home.

If the patient must come in for an appointment, instruct them to take appropriate preventive actions (e.g., follow triage procedures, put on their own cloth mask before entry and throughout their visit or, if a cloth mask cannot be tolerated, hold a tissue against their mouth and nose to contain respiratory secretions) and immediately inform triage personnel upon arrival (e.g., call from car) so they can be placed in an examination room.

Screen and Triage Everyone Entering a Healthcare Facility for Signs and Symptoms of COVID-19

Although screening for symptoms will not identify asymptomatic or pre-symptomatic individuals with SARS-CoV-2 infection, symptom screening remains an important strategy to identify those who could have COVID-19 so appropriate precautions can be implemented”

·         Take steps to ensure that everyone adheres to source control measures and hand hygiene practices while in a healthcare facility

·         Post visual alerts (e.g., signs, posters) at the entrance and in strategic places (e.g., waiting areas, elevators, cafeterias) to provide instructions (in appropriate languages) about wearing a cloth face covering or facemask for source control and how and when to perform hand hygiene.

·         Provide supplies for respiratory hygiene and cough etiquette, including alcohol-based hand sanitizer (ABHS) with 60-95percent alcohol, tissues, and no-touch receptacles for disposal, at healthcare facility entrances, waiting rooms, and patient check-ins.

·         Limit and monitor points of entry to the facility.

·         Establish a process to ensure everyone (patients, healthcare personnel, and visitors) entering the facility is assessed for symptoms of COVID-19,  or exposure to others with suspected or confirmed SARS-CoV-2 infection and that they are practicing source control.

Options could include (but are not limited to): individual screening on arrival at the facility; or implementing an electronic monitoring system in which, prior to arrival at the facility, people report absence of fever and symptoms of COVID-19, absence of a diagnosis of SARS-CoV-2 infection in the prior 10 days, and confirm they have not been exposed to others with SARS-CoV-2 infection during the prior 14 days.

Fever can be either measured temperature ≥100.0°F or subjective fever. People might not notice symptoms of fever at the lower temperature threshold that is used for those entering a healthcare setting, so they should be encouraged to actively take their temperature at home or have their temperature taken upon arrival.

Obtaining reliable temperature readings is affected by multiple factors, including:

·         The ambient environment in which the temperature is measured: If the environment is extremely hot or cold, body temperature readings may be affected, regardless of the temperature-taking device that is used.

·         Proper calibration of the thermometers per manufacturer standards: Improper calibration can lead to incorrect temperature readings.

·         Proper usage and reading of the thermometers: Non-contact infrared thermometers frequently used for health screening must be held at an established distance from the temporal artery in the forehead to take the temperature correctly. Holding the device too far from or too close to the temporal artery affects the reading.

·         Properly manage anyone with suspected or confirmed SARS-CoV-2 infection or who has had contact with someone with suspected or confirmed SARS-CoV-2 infection:

·         Healthcare personnel (HCP) should be excluded from work and should notify occupational health services to arrange for further evaluation.

·         Visitors should be restricted from entering the facility and be referred for proper evaluation.

·         Patients should be isolated in an examination room with the door closed.

·         If an examination room is not immediately available, such patients should not wait among other patients seeking care.

·         Identify a separate, well-ventilated space that allows waiting patients to be separated by 6 or more feet, with easy access to respiratory hygiene supplies.

·         In some settings, patients might opt to wait in a personal vehicle or outside the healthcare facility where they can be contacted by mobile phone when it is their turn to be evaluated.

·         Depending on the level of transmission in the community, facilities might also consider designating a separate area at the facility (e.g., an ancillary building or temporary structure) or nearby location as an evaluation area where patients with symptoms of COVID-19 can seek evaluation and care.

Re-evaluate admitted patients for signs and symptoms of COVID-19

Screening for fever and symptoms should also be incorporated into daily assessments of all admitted patients. All fevers and symptoms consistent with COVID-19 among admitted patients should be properly managed and evaluated (e.g., place any patient with unexplained fever or symptoms of COVID-19 on appropriate Transmission-Based Precautions and evaluate).

Other key recommendations included:

·         Implement Universal Source Control Measures

·         Encourage Physical Distancing

·         HCP should follow Standard Precautions (and Transmission-Based Precautions if required based on the suspected diagnosis); Wear eye protection in addition to their facemask during patient care encounters

·         Consider Performing Targeted SARS-CoV-2 Testing of Patients Without Signs or Symptoms of COVID-19

·         Optimize the Use of Engineering Controls and Indoor Air Quality

·         Establish Reporting within and between Healthcare Facilities and to Public Health Authorities

·         Patient Placement

·         Hand Hygiene

·         Personal Protective Equipment Training

·         Aerosol Generating Procedures (AGPs)

·         Collection of Diagnostic Respiratory Specimens

·         Manage Visitor Access and Movement Within the Facility

·         Environmental Infection Control

CDC has the guidance.

More COVID-19 coverage HERE.