On Infection Prevention & Control

Experiences, case studies and news about infection prevention and control.

Managing the Threat of the New Coronavirus Strain

02/19/2020

By David Baker, MD, executive vice president 

As you are aware, an outbreak of a new strain of coronavirus, 2019-nCoV, presents an ongoing health threat across the globe.  We are sure you have already been working diligently to respond to this threat. 

As information and recommendations about 2019-nCoV continue to evolve, we want to emphasize our support of the Centers for Disease Control and Prevention (CDC) and other public health partners as the appropriate source of information and guidance for healthcare organizations and providers.  

The CDC’s Infection Control website for healthcare professionals addresses several areas worth emphasizing. 

Early Screening and Identification

  • Minimize the chance of exposure by working to identify patients before arrival (e.g., asking screening questions for patients calling for appointments) and as early as possible upon arrival (e.g., place signs for patients advising them to put on a mask if they have respiratory symptoms).
  • Implement triage procedures to detect  for 2019-nCoV during or before patient triage or registration (e.g., at the time of patient check-in) and ensure that all patients are asked about symptoms of a respiratory infection and history of travel to areas experiencing transmission of 2019-nCoV or contact with possible 2019-nCoV patients.

Managing Persons Under Investigation

  • If screening at triage is positive and the patient becomes a “person under investigation” (PUI), this should be communicated directly to the clinicians who will care for the patient, prevention and control services, and other healthcare facility staff according to a standard protocol.
  • Adhere to standard contact and airborne precautions, including eye protection.
  •  Monitor stock and the supply chain of personal protective equipment.
  • Manage visitor access and movement within the facility.

Communication on Infection Status

  •  Implement mechanisms and policies to promptly alert key facility staff including infection control, healthcare epidemiology, facility leadership, occupational health, clinical laboratory, and frontline staff about known or suspected 2019-nCoV patients.
  • Identify specific staff to communicate and collaborate with state or local public health authorities.

Remember also that some patients infected with 2019-nCoV will present with atypical symptoms, including those discussed in a Feb. 7 JAMA article such as:

  • nausea
  • diarrhea
  • abdominal pain

Patients who have recently visited China with symptoms whose etiology remains unknown should still be evaluated for 2019-nCoV.

Because this situation is changing rapidly and advice may change, all organizations should have a person(s) assigned to actively review information and guidance as it becomes available and evaluate the need to modify current practices and communications within their organization. Organizations are also encouraged to review their internal and external communication systems to ensure that those responsible know how to contact their local health authority during the day or night in the event of a suspect case.

Routine Infection Protocol
Joint Commission standards require health care organizations to have a plan for dealing with a surge of infectious patients (IC.01.06.01). Now (while the incidence of coronavirus in the U.S. is very low and while it’s still flu season) might be a good time to conduct a drill to test your procedures.

These practices should be in place regardless of any new identified infectious threat.

  • Clear system for notifying patients of their role in preventing the transmission of communicable diseases.  Most organizations do this by posting materials provided through the CDC such as respiratory etiquette and providing access to hand hygiene products and masks.
  • Staff at points of entry and intake should know how to screen and respond to patients or visitors who may be infectious (e.g., cough, fever, rash, diarrhea and vomiting).
  • Implement all elements of standard precautions as outlined in the CDC Core Practices including

          o hand hygiene
          o environmental cleaning and disinfection
          o risk assessment with use of appropriate personal protective equipment (e.g., gloves, gowns, face masks) based on activities being performed
          o reprocessing of reusable medical equipment between each patient and when soiled

  • Hand off communications, both inter- and intra-facility, should include notification of colonization or infection with a potentially transmissible pathogen.
  • Organizations should implement a system for evaluation and management of exposed or ill health care workers and support staff that could expose patients, visitors or other staff.

The Joint Commission standards were developed with an emphasis on decreasing risk and preparing organizations to respond to this type of emergency.  We are confident that accredited organizations who follow routine practices and follow evolving CDC guidance can continue to provide for the safety of their patients, visitors and staff.

David Baker, MD, is the Executive Vice President for Health Care Quality Evaluation at The Joint Commission. In this role, he leads the Department of Standards and Survey Methods, the Department of Quality Measurement, and the Department of Research. He oversees the development of performance measures, standards, survey methods, and National Patient Safety Goals for all Joint Commission accreditation and certification programs. He is also Editor-in-Chief for The Joint Commission Journal on Quality and Patient Safety.