Triage, Source Control and Additional Control Measures Dr Purva Mathur md all India Institute of Medical Sciences New Delhi


IPC in Critical Care for COVID-19



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IPC in Critical Care for COVID-19

  • Patients should wear simple flexible fabric masks to reduce droplet generation unless wearing an oxygen mask
  • Intermittent rather than continuous oximetry and cardiac monitoring may be instituted with separate for each patient
  • Use inhalers in lieu of nebulized medications to reduce droplet generation
  • Coordinate with critical care physicians regarding
    • Threshold for intubation
    • Use of bridging techniques (e.g. high flow cannula/BiPAP)
    • Requirement of special area and augmented PPE for providers given the higher risk of aerosol generation

IPC in critical care

  • Use rapid sequence intubation (RSI) techniques to minimize aerosol generation
  • Aggressively control and suppress patient cough, as possible
  • Consider more aggressive sedation/paralysis strategies to reduce coughing
  • Reduce suctioning as possible
  • Use of High Efficiency Particulate Air (HEPA) filters on ventilators or at minimum in-line HME/HEPA filters on the endotracheal tube
  • Monitor MoHFW and latest literature to determine potential efficacy of antivirals and other therapies; currently there are no known effective medications and limited evidence for bacterial super-infection

Airborne Infection Control: Ventilation

Fans in isolation wards – key factors

Choose the fan based on what you want the fan to do

  • Cool ambient temperature through dissipation of radiant heat
  • Provide directionality in order to improve ventilation
    • Intake – suck air out of the room
    • Out-take – blow air in the room

Cools and mixes the air
Exhausts the air
Directs the air
Directs the air

Using fans in isolation wards – key factors

  • Direction of fans should deflect air away from health care workers
    • i.e. airflow should go from health care worker to patient
  • The use of either fans pictured would work

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