Infection Prevention and Control (IPC) in the management of COVID-19

Infection Prevention and Control (IPC) is a core clinical safety strategy that must begin at the first point of patient contact (triage, outpatient department, emergency unit) and continue throughout hospitalization and discharge. The objectives are to:

• Prevent transmission to healthcare workers

• Prevent cross-infection between patients

• Protect the community

• Maintain functionality of the health system

Standard precautions must be applied to all patients at all times, regardless of diagnosis.

1. STANDARD PRECAUTIONS (UNIVERSAL APPLICATION)

Standard precautions assume every patient may harbor transmissible pathogens.

1.1 Hand Hygiene

Hand hygiene is the single most effective measure for preventing healthcare-associated infection.

Perform hand hygiene:

Before

• Touching patient

• Aseptic procedures

After

• Body fluid exposure

• Touching patient

• Touching patient surroundings

• Removing gloves

Methods

Minimum duration

• Alcohol rub: 20–30 seconds

• Soap & water: 40–60 seconds

1.2 Personal Protective Equipment (PPE)

Use PPE based on anticipated exposure risk.

1.3 Safe Handling of Sharps

• Never recap needles

• Dispose immediately into puncture-proof container

• Do not overfill sharps containers (>¾ full)

• Report needlestick injury immediately

1.4 Environmental Cleaning

High-touch surfaces cleaned at least 2–4 times daily

Examples:

• Bed rails

• Monitors

• Door handles

• Oxygen knobs

Disinfectants:

• 0.1% chlorine (routine)

• 0.5% chlorine (body fluids)

• 70% alcohol (electronics)

1.5 Waste Management

• Infectious waste → yellow bag

• Sharps → safety box

• General waste → black bag

2. IPC FOR SUSPECTED OR CONFIRMED CASES

2.1 TRIAGE AREA CONTROL MEASURES

Immediately upon arrival:

• Provide medical mask

• Separate respiratory patients

• Maintain 1–2 m distancing

• Direct to isolation area

• Provide respiratory hygiene education

Cough etiquette

• Tissue disposal in closed bin

• Flexed elbow technique

• Hand hygiene after coughing

3. DROPLET PRECAUTIONS

Prevent transmission via large respiratory droplets (>5 µm).

Required measures

• Medical mask within 1–2 meters

• Single isolation room preferred

• Cohorting allowed if same diagnosis

• Eye protection during close care

• Limit patient movement

• Mask patient during transport

4. CONTACT PRECAUTIONS

Prevent transmission via contaminated surfaces or equipment.

PPE

• Gloves

• Gown

• Eye protection

• N95 when indicated

Environmental controls

• Dedicated equipment (stethoscope, BP cuff)

• Disinfect shared equipment between patients

• Avoid touching face with gloves

• Reduce unnecessary surface contact

• Ensure ventilation

5. AIRBORNE PRECAUTIONS (AEROSOL-GENERATING PROCEDURES)

Aerosol-generating procedures (AGPs)

• Intubation

• Open suctioning

• Bronchoscopy

• CPR

• Nebulization

Required protection

• Fit-tested N95 or higher respirator

• Eye protection

• Long-sleeved gown

• Gloves

Room requirements

Additional measures

• Minimal staff presence

• Close doors

• Continue same precautions post-ventilation

6. COMMUNITY-LEVEL IPC MEASURES

6.1 Hand Hygiene

Wash hands frequently with soap or alcohol rub.

6.2 Respiratory Hygiene

• Cover mouth/nose when coughing

• Dispose tissue immediately

• Clean hands after

6.3 Physical Distancing

Maintain at least 1 meter distance

6.4 Avoid Face Touching

Prevents self-inoculation from contaminated surfaces.

6.5 Early Medical Care

Seek medical attention if:

• Fever

• Cough

• Difficulty breathing

6.6 Mild Symptoms Without Exposure Risk

• Stay home

• Self-isolate

• Continue hygiene practices

7. VACCINATION

Vaccination is a primary public health preventive intervention and is recommended for:

• Healthcare workers

• High-risk populations

• General public when available

Benefits:

• Reduces severe disease

• Reduces transmission

• Protects healthcare capacity

8. HEALTHCARE WORKER SAFETY PRINCIPLES

• Never reuse disposable PPE unless approved protocol

• Perform donning and doffing in designated areas

• Monitor staff exposure

• Report breaches immediately