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 that every patient may harbor transmissible pathogens.

1.1 Hand Hygiene

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

Perform hand hygiene:

Before:

• Touching a patient.

• Performing aseptic procedures.

After:

• Exposure to body fluids.

• Touching a patient.

• Touching the patient's surroundings.

• Removing gloves.

• Contact with respiratory secretions.

Methods

Minimum duration

• Alcohol-based hand rub: 20–30 seconds

• Soap and water: 40–60 seconds

1.2 Respiratory Hygiene

Ensure the following respiratory hygiene measures:

• Offer a medical mask (N95) or double cloth mask in healthcare settings.

• Cover the nose and mouth during coughing or sneezing using a tissue or flexed elbow.

• Dispose of used tissues immediately in a closed bin.

• Perform hand hygiene after coughing, sneezing, or contact with respiratory secretions.

• Provide respiratory hygiene education to patients and caregivers.

1.3 Personal Protective Equipment (PPE)

Rational, correct, and consistent use of available PPE, together with appropriate hand hygiene, helps reduce transmission of pathogens. PPE effectiveness depends on adequate supplies, proper staff training, correct use, and appropriate human behavior.

Use PPE according to the anticipated exposure risk.

Healthcare workers should:

• Perform hand hygiene before putting on and after removing PPE.

• Don and doff PPE in designated areas.

• Never reuse disposable PPE unless permitted by approved protocols.

• Report PPE breaches or occupational exposure immediately.

1.4 Safe Handling of Sharps

• Never recap used needles.

• Dispose of sharps immediately into puncture-proof containers.

• Do not overfill sharps containers beyond three-quarters (¾) capacity.

• Report needlestick or sharps injuries immediately.

1.5 Environmental Cleaning and Disinfection

Healthcare workers and administrators should ensure that environmental cleaning and disinfection procedures are consistently and correctly followed.

Clean environmental surfaces thoroughly using water and detergent followed by appropriate hospital-level disinfectants such as sodium hypochlorite.

High-touch surfaces should be cleaned at least 2–4 times daily, including:

• Bed rails

• Door handles

• Monitors

• Oxygen control knobs

Recommended disinfectants:

Laundry, food service utensils, medical equipment, linen, and medical waste should be managed according to standard safe procedures.

1.6 Waste Management

• Infectious waste → Yellow bag

• Sharps → Safety box

• General waste → Black bag

2. IPC for Suspected or Confirmed COVID-19 Cases

2.1 Triage Area Control Measures

Immediately upon patient arrival:

• Provide a medical mask.

• Separate patients with respiratory symptoms from others.

• Maintain at least 1–2 metres physical distancing.

• Direct suspected cases to the designated isolation area.

• Educate patients on respiratory hygiene and cough etiquette.

3. Droplet Precautions

Prevent transmission through respiratory droplets.

Measures include:

• Wear a medical mask when within 1–2 metres of the patient.

• Place patients in a single isolation room whenever possible.

• Cohort patients only if they have the same diagnosis.

• Wear eye protection during close patient care.

• Limit patient movement.

• Ensure patients wear a mask during transport.

4. Contact Precautions

Prevent transmission through contaminated hands, surfaces, or equipment.

Use:

• Gloves

• Gown

• Eye protection

• N95 respirator when indicated

Environmental measures:

• Use dedicated equipment whenever possible (e.g., stethoscope, blood pressure cuff).

• Disinfect shared equipment between patients.

• Avoid touching the face while wearing gloves.

• Minimize unnecessary contact with environmental surfaces.

• Ensure adequate room ventilation.

5. Airborne Precautions (During Aerosol-Generating Procedures)

Aerosol-generating procedures (AGPs)

• Intubation

• Open suctioning

• Bronchoscopy

• Cardiopulmonary resuscitation (CPR)

• Nebulization

Required protection:

• Fit-tested N95 respirator (or higher level)

• Eye protection

• Long-sleeved gown

• Gloves

Room requirements:

Additional measures:

• Allow only essential staff during procedures.

• Keep doors closed.

• Continue airborne precautions until adequate room ventilation has occurred.

6. Community-Level IPC Measures

Hand Hygiene

• Wash hands frequently using soap and water or alcohol-based hand rub.

Respiratory Hygiene

• Cover the mouth and nose during coughing or sneezing.

• Dispose of tissues safely.

• Perform hand hygiene immediately afterward.

Physical Distancing

• Maintain at least 1 metre distance from others where appropriate.

Avoid Touching the Face

• Avoid touching the eyes, nose, and mouth with unclean hands.

Early Medical Care

Seek medical attention promptly if experiencing:

• Fever

• Cough

• Difficulty breathing

Mild Illness

People with mild symptoms should:

• Stay at home.

• Self-isolate as appropriate.

• Continue good hygiene practices.

• Follow medical advice regarding monitoring and care.

7. Vaccination

Vaccination is a primary public health preventive intervention.

It is recommended for:

• Healthcare workers

• High-risk populations

• The general public according to national recommendations

Benefits include:

• Reducing severe disease.

• Reducing transmission.

• Protecting healthcare system capacity.

8. Healthcare Worker Safety Principles

• Apply standard precautions for every patient.

• Use appropriate PPE according to the level of exposure risk.

• Perform hand hygiene consistently.

• Ensure proper environmental cleaning and disinfection.

• Monitor healthcare worker exposures.

• Report occupational exposures or IPC breaches immediately.

• Follow safe waste management procedures.

• Maintain strict acute respiratory disease infection control practices throughout outbreaks.

Public Health Control Measures

• Establish an alert management system (e.g., call centre with hotlines).

• Verify alerts to determine whether they meet the standard COVID-19 case definition.

• Respond appropriately to suspected cases.

• Record all alerts in an alert/rumour log.

• Provide epidemiological information to support national, regional, and global risk assessment.

• Conduct epidemiological investigations to identify risk factors and populations at increased risk of severe disease.

• Mobilize communities for early case detection, reporting, and access to care.

• Conduct community education on disease transmission, home-based IPC measures, and safe practices during funerals and burials.

• Consider appropriate social distancing strategies during outbreaks.

• Conduct contact tracing, follow-up, and active case finding within communities.

• Distribute laboratory specimen collection kits to healthcare facilities.

• Establish treatment units according to national protocols to manage additional cases.

• Maintain designated isolation wards for suspected and confirmed cases.

• Maintain strict infection prevention and control practices throughout the outbreak.