Infection Prevention and Control during COVID-19

Talk Tuesday - April 14, 2020

Feature Presenter

Barbara Catt RN CIC MEd

Barbara Catt has worked in the field of IPAC for many years. Her nursing experiences include emergency room, operating room, ICU, medical-surgical, long-term care, and professor of nursing at college and university levels. She has worked in a variety of health care settings including public health, a small community hospital and a large tertiary healthcare center and now is currently working with Public Health Ontario and teaching faculty member at Centennial College with their IPAC Basic and Practicum Courses.

Barbara is a registered nurse and holds a Master in Education where her research focus was adult learner principles.  She has been involved in research and publications regarding disease transmission and education such as IPAC Core Competencies.

She has been working at Public Health Ontario since 2017 as the IPAC Manager of Response and System Support Unit. She continues to be an active member with IPAC Canada, APIC, and CNA.
Barbara is a past member of IPAC Canada Standards and Guidelines, HealthPro Clinical Advisory Committee and past president for IPAC Greater Toronto and Area Chapter. She continues to be an active participant on committees such as IPAC Canada’s Prehospital Care Interest Group, Core Education Committee and Basic IPAC Course Advisory Committee.  Since 2014, Barbara has served as a Board Member for IPAC Canada and is currently the IPAC Canada President.

 

Summary

Barbara shared some background on coronaviruses in general, compared this COVID-19 outbreak to SARS and MERS outbreaks and explained the timeline of this COVID-19 outbreak. She then went into detail about communicability and incubation periods before assuring us that there is no evidence that our dogs and cats could spread COVID-19 and reviewed community and facility measures to stop the spread. 

Question and answer

If COVID-19 has a lower mortality rate than MERS, why didn't everything shut down for MERS like it has for COVID-19?

We didn’t have transmission here in Canada.

How do we know that COVID-19 is large droplets and not airborne?

More than 50 studies have shown this. The only way it gets aerosolized is with an Aerosol Generating Medical Procedure - then the drops are smaller and go further but still don’t hang around in the air like TB does.

WHO - Modes of transmission of virus causing COVID-19: implications for IPC precaution recommendations - Scientific brief - 29 March 2020

How can one mask be used safely for a whole shift?

It’s recognized that this direction is different from previous advice and prompted by source control (minimizing risk of transmission from a or pr-symptomatic staff) and concerns about PPE supply. It's suggested that you:
  • Only remove your mask in a designated area or at minimum 2 meters away from any other person
  • Clean your hands - remove the mask - place the mask outside toward the counter with the side that touches your face upwards. When you're ready to put it back on, clean your hands, put it on carefully and then clean your hands again
  • Don't wear your mask tugged down under your chin. You collect organisms on your skin & scrubs all day walking around (especially in a health facility), when you tug your mask down you allow the inside of the mask to scrape up all the organisms on your neck, then you pull it back up to cover the vulnerable mucosa of your mouth and nose
  • Don't put it on your pocket or on your lap - the inside may be contaminated by your scrubs brushing against it
  • Best to store it on a counter in a clean area where it won't be jostled or a locker or similar area

What are universal precautions?

This is what routine practices used to be called. Routine practices and additional precautions is the terminology used in Canada. USA uses the language "Standard Precautions".

Why is COVID-19 more transmissible than SARS or MERS?

Just the type of organism that it is.

How accurate are the reported numbers given variable testing criteria between provinces and should we test asymptomatic people too?

  • Definitely under-reported - provinces prioritizing testing for high risk and vulnerable first and widening the criteria as capacity increases
  • Much of the talk about testing asymptomatic people is in context of protecting vulnerable populations e.g. testing all health care workers in long term or personal care homes
  • No diagnostic test is perfect, there will always be false negatives and false positives, but the proportion of false negatives increases so much in people who don’t have respiratory symptoms there is much debate about whether it’s accurate enough to base decisions on. The worry is someone who is a or pre-symptomatic tests negative, then goes on to develop symptoms a few days later and has been working unmasked with vulnerable people and their colleagues - broad consensus is to emphasize not coming to work while unwell & mask everybody in the meantime

What is the latest on vaccine development?

There are so many studies, not only for vaccines but treatments as well. We will likely have no firm direction until at least the fall. There are lots of preprints being discussed, but mind the methods and sample sizes.

Why are healthy young people getting so sick without underlying health conditions while some people are asymptomatic?

COVID-19 mortality tends to skew toward the elderly with pre-existing conditions but there young healthy people have also had significant morbidity and mortality. Still ongoing research but at this point viral load seems to be important to how sick people get, whether they die and if they’re heavy shedders of the virus.

AGMP definition describes the airway being manipulated to generate a cough, is an NP swab an AGMP?

No - there is a technical brief that outlines this (see resources below), but the force generated by an involuntary sneeze or cough is crucial so an NP swab is not considered an AGMP.

Once we know covid is in a population - is there any benefit to further testing when we know treatment won’t change?

Yes, for lots of reasons, but two big ones are:

  • To support contact tracing to gain a good understanding of how this virus is moving in the population
  • The test might show COVID-19 but it also might grow additional organisms and that is useful to know for public health

Should dietary staff in long term care wear masks while in the kitchen or only when in patient care areas?

Direction is likely to be specific to the facility. Given there is known community transmission of COVID-19 and that people may be contagious before they feel unwell the safest thing to protect the staff and residents would be for everyone to be masked all the time.

How do we do our best to ensure we don't bring COVID-19 home with us?

  • Follow the IP&C direction at work the best that you can. Go slow and be thoughtful
  • Change out of your scrubs and work shoes at work, shower at work or immediately at home
  • When you're worried, recall how careful you were, consider mindfulness or other apps to help with sleep and make sure to keep up on the usual health maintenance (get enough sleep, eat nutritious food, move your body)

What types of PPE are required for footcare nurses currently? I see that regular home care staff don't need isolation gowns or N95 for non-suspect clients. Would it be the same for footcare nurses?

The PPE required is really dependent on the foot care procedure one is doing and COVID-19 recommendations.  For foot care, I would refer you to IPAC Canada’s Practice Recommendation for IPAC related to Foot Care in Health Care settings page 12 for guidance on selection and use of PPE specific to foot care. 

During COVID-19:

  • Based on the recommendation in Manitoba, during this time of COVID-19, one should always wear a mask and eye protection while providing care in the home.
  • In addition, the Public Health Agency of Canada states “Given community spread of COVID-19 within Canada and evidence that transmission may occur from those who have few or no symptoms, masking for the full duration of visits for all home care staff is recommended. The rationale for full-visit masking of staff is to reduce the risk of transmitting COVID-19 infection from staff to clients or other household members, at a time when no signs or symptoms of illness are recognized, but the virus can be transmitted. Use of eye protection (e.g., a face shield) for duration of visits should be strongly considered in order to protect staff from COVID-19 transmission occurring in the community.”

Would safety goggles be an acceptable substitute for eye shields?


In Ontario, safety goggles are adequate eye protection for IPAC. Below is a chart showing the advantages and disadvantage of different types of eye protection.

Is it expected that footcare nurses can enter only one long term care facility, and would this include assisted living facilities?

Follow the policies of jurisdictional public health authorities to determine what the restriction would be for visiting multiple facilities/patients.

Resources