Infectious Diseases Society of America Guidelines on Infection Prevention for Health Care Personnel Caring for Patients with Suspected or Known COVID-19

John B Lynch; Perica Davitkov; Deverick J Anderson; Adarsh Bhimraj; Vincent Chi-Chung Cheng; Judith Guzman-Cottrill; Jasmine Dhindsa; Abhijit Duggal; Mamta K Jain; Grace M Lee; Stephen Y Liang; Allison McGeer; Valery Lavergne; M Hassan Murad; Reem A Mustafa; Rebecca L Morgan; Yngve Falck-Ytter; Shahnaz Sultan

doi:10.1093/cid/ciaa1063

Infectious Diseases Society of America Guidelines on Infection Prevention for Health Care Personnel Caring for Patients with Suspected or Known COVID-19

Clin Infect Dis. 2020 Jul 27:ciaa1063. doi: 10.1093/cid/ciaa1063. Online ahead of print.

Authors

John B Lynch¹, Perica Davitkov², Deverick J Anderson³, Adarsh Bhimraj⁴, Vincent Chi-Chung Cheng⁵, Judith Guzman-Cottrill⁶, Jasmine Dhindsa⁷, Abhijit Duggal⁸, Mamta K Jain⁹, Grace M Lee¹⁰, Stephen Y Liang¹¹, Allison McGeer¹², Valery Lavergne¹³, M Hassan Murad¹⁴, Reem A Mustafa¹⁵, Rebecca L Morgan¹⁶, Yngve Falck-Ytter², Shahnaz Sultan¹⁷

Affiliations

¹ Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington.
² VA Northeast Ohio Healthcare System, Case Western Reserve University School of Medicine, Cleveland, Ohio.
³ Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, North Carolina.
⁴ Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio.
⁵ Queen Mary Hospital, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.
⁶ Department of Pediatrics, Division of Infectious Diseases, Oregon Health and Science University, Portland, Oregon.
⁷ Renown Health, University of Nevada, Reno, Nevada.
⁸ Department of Critical Care, Cleveland Clinic, Cleveland, Ohio.
⁹ Department of Internal Medicine, Division of Infectious Diseases, UT Southwestern Medical Center, Dallas, Texas.
¹⁰ Department of Pediatrics-Infectious Disease, Stanford University School of Medicine, Stanford, California.
¹¹ Divisions of Infectious Diseases and Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri.
¹² Department of Microbiology, Sinai Health System, University of Toronto, Toronto, Ontario.
¹³ Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada.
¹⁴ Division of Preventive Medicine, Mayo Clinic, Rochester, Minnesota.
¹⁵ Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas.
¹⁶ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario.
¹⁷ Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis VA Health care System, Minneapolis, Minnesota.

Abstract

Background: SARS-CoV-2 is a highly transmissible virus that can infect health care personnel and patients in health care settings. Specific care activities, in particular aerosol-generating procedures, may have a higher risk of transmission. The rapid emergence and global spread of SARS-CoV-2 has created significant challenges in health care facilities, particularly with severe shortages of personal protective equipment (PPE) used to protect health care personnel (HCP). Evidence-based recommendations for what PPE to use in conventional, contingency, and crisis standards of care are needed. Where evidence is lacking, the development of specific research questions can help direct funders and investigators.

Objective: Develop evidence-based rapid guidelines intended to support HCP in their decisions about infection prevention when caring for patients with suspected or known COVID-19.

Methods: IDSA formed a multidisciplinary guideline panel including front-line clinicians, infectious disease specialists, experts in infection control and guideline methodologists with representation from the disciplines of preventive care, public health, medical microbiology, pediatrics, critical care medicine and gastroenterology. The process followed a rapid recommendation checklist. The panel prioritized questions and outcomes. Then a systematic review of the peer-reviewed and grey literature was conducted. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence and make recommendations.

Results: The IDSA guideline panel agreed on eight recommendations and provided narrative summaries of other interventions undergoing evaluations.

Conclusions: Using a combination of direct and indirect evidence, the panel was able to provide recommendations for eight specific questions on the use of PPE for HCP providing care for patients with suspected or known COVID-19. Where evidence was lacking, attempts were made to provide potential avenues for investigation. There remain significant gaps in the understanding of the transmission dynamics of SARS-CoV-2 and PPE recommendations may need to be modified in response to new evidence.