COVID-19: An ACP Physician’s Guide + Resources:
March 18, 2020
Issued by: American College of Physicians, ACP
[Chapter 8 – Infection Control: Advice for Physicians, A Step-by-Step Overview]
“Infection Control: Before Patients Present
Screen and Triage All Patients
Ask patients before and upon arrival if they have symptoms of a respiratory infection. Preferably, telephone triage can identify options for evaluation that minimize risks for community exposure. If possible, provide triage outside the facility entrance, at a designated site/tent/facility, or with drive-up triage and testing. At the facility entrance, provide face masks and other respiratory hygiene supplies (tissues, hands free trash receptacles) and alcohol-based hand sanitizers.”
See Infection Control: Advice for Physicians, A Step-by-Step Overview: acponline.org
See complete guide: acponline.org
COVID-19 Personal Protective Equipment (PPE) During the Pandemic
March 20, 2020
Issued by: American College of Emergency Physicians, ACEP
“Our emergency care team is the front line in this crisis at a time when identifying those who may have COVID-19 is very challenging. Given the guidance from the CDC that droplet precautions recommend use of a face mask or surgical mask, ACEP believes that healthcare personnel in the emergency department (ED) and emergency medical services (EMS) should consider wearing a face mask or surgical mask during their entire shift if they are providing patient care, unless the mask becomes soiled and needs replacement.”
See complete statement: acep.org
Surviving Sepsis Campaign COVID-19 Guidelines:
March 20, 2020
Issued by: European Society of Intensive Care Medicine, ESICM
Society of Critical Care Medicine, SCCM
“The SSC COVID-19 subcommittee panel (36 experts from 12 countries) issued 53 statements based on the available evidence, four of which are best practices based on high-quality evidence:
- Healthcare workers performing aerosol-generating procedures (e.g. intubation, bronchoscopy, open suctioning, etc.) on patients with COVID-19 should wear fitted respirator masks, such as N-95, FFP2 or equivalent – instead of surgical masks – in addition to other personal protective equipment, such as gloves, gown and eye protection.
- Aerosol-generating procedures should be performed on ICU patients with COVID-19 in a negative pressure room, if available. Negative pressure rooms are engineered to prevent the spread of contagious pathogens from room to room.
- Endotracheal intubation of patients with COVID-19 should be performed by healthcare workers with experience in airway management to minimize the number of attempts and risk of transmission.
- Adults with COVID-19 who are being treated with non-invasive positive pressure ventilation or a high flow nasal canula should be closely monitored for worsening respiratory status and intubated if necessary.”
See complete guidelines: sccm.org
COVID-19 ICU Preparedness Checklist:
Issued by: Society of Critical Care Medicine, SCCM
Covering:
PREPAREDNESS
LOGISTICS/SURGE CAPACITY
COMMMUNICATION
CRITICAL CARE TRIAGE
PROTECTION OF ICU WORKFORCE
STAFFING CAPACITY
ESSENTIAL EQUIPMENT
See complete checklist: sccm.org
COVID-19 Webinars:
Featured by: European Society of Intensive Care Medicine, ESICM
- First-hand experience of the situation in China
February 26, 2020 - Managing critically ill patients with the virus
March 9, 2020 - National Coordination & Experience in Italy
March 19, 2020
Access Webinars: esicm.org
COVID-19: Guidance for Triage of Non-Emergent Surgical Procedures
March 17, 2020
Issued by: American College of Surgeons, ACS
- “Hospitals and surgery centers should consider both their patients’ medical needs, and their logistical capability to meet those needs, in real time.
- The medical need for a given procedure should be established by a surgeon with direct expertise in the relevant surgical specialty to determine what medical risks will be incurred by case delay.
- Logistical feasibility for a given procedure should be determined by administrative personnel with an understanding of hospital and community limitations, taking into consideration facility resources (beds, staff, equipment, supplies, etc.) andprovider and community safety and well-being.
- Case conduct should be determined based on a merger of these assessments using contemporary knowledge of the evolving national, local and regional conditions, recognizing that marked regional variation may lead to significant differences in regional decision-making.”
See complete statement: facs.org
Sages Recommendations Regarding Surgical Response To Covid-19 Crisis
March 19, 2020
Issued by: Society of American Gastrointestinal and Endoscopic Surgeons, SAGES
“1. All elective surgical and endoscopic cases should be postponed at the current time. There are different levels of urgency related to patient needs, and judgment is required to discern between these. However, with the numbers of COVID-19 patients requiring care expected to escalate over the next few weeks, the surgical care of patients should be limited to those whose needs are imminently life threatening, with malignancy that could progress or with active symptoms that could require urgent care. All others should be delayed until after the peak of the pandemic is seen. This minimizes risk to both patient and health care team, as well as minimizes utilization of necessary resources, such as beds, ventilators, personal protective equipment (PPE), and unexposed health care providers and patients.”
See complete recommendations: sages.org
2020 AABIP Statement on Bronchoscopy in COVID 19 Infections:
March 12, 2020
Issued by: American Association for Bronchology and Interventional Pulmonology, AABIP
“Indications for Bronchoscopy in patients with suspected or confirmed COVID-19 infections: Bronchoscopy is relatively CONTRAINDICATED in patients with suspected and confirmed COVID19 infections. The only role for bronchoscopy would be when less invasive testing to confirm COVID-19 are inconclusive, suspicion for an alternative diagnosis that would impact clinical management is suspected, or an urgent life-saving intervention as cited below.”
See complete statement: aabronchology.org
ASE Statement on Protection of Patients and Echocardiography Service Providers During the 2019 Novel Coronavirus Outbreak
2020
Issued by: American Society of Echocardiography, ASE
“Equipment care is critical in the prevention of transmission. Some institutions cover probes and machine consoles with disposable plastic and forego the use of ECG stickers. Some institutions set aside certain machines or probes for use on patients with suspected or confirmed infection. Although SARS-CoV-2 is sensitive to most standard viricidal disinfectant solutions, care must be taken when cleaning. Local standards vary, but echocardiogram machines and probes should be thoroughly cleaned, ideally in the patient’s room and again in the hallway. Smaller, laptopsized portable machines are more easily cleaned, but use of these machines should be balanced against potential tradeoffs in image quality and functionality.”
See complete recommendations: asecho.org
Joint Gi Society Message: COVID-19 Clinical Insights for Gastroenterologists and Gastroenterology Care Providers:
Issued by: The American Association for the Study of Liver Diseases, AASLD
The American College of Gastroenterology, ACG
The American Gastroenterological Association, AGA
The American Society for Gastrointestinal Endoscopy, ASGE
“Strongly consider rescheduling elective non-urgent endoscopic procedures. Some non-urgent procedures are higher priority and may need to be performed (examples include cancer evaluations, prosthetic removals, evaluation of significant symptoms). Classification of procedures into non-urgent/postpone and non-urgent/perform may be useful. Of note, the Surgeon General on 3/14/20 advised hospitals to postpone all elective surgeries”
See complete statement: asge.org
Practice Advisory: Novel Coronavirus 2019 (COVID-19)
March 13, 2020
Issued by: The American College of Obstetricians and Gynecologists, ACOG
“At this time, very little is known about COVID-19, particularly related to its effect on pregnant women and infants, and there currently are no recommendations specific to pregnant women regarding the evaluation or management of COVID-19.
Currently available data on COVID-19 does not indicate that pregnant women are at increased risk. However, pregnant women are known to be at greater risk of severe morbidity and mortality from other respiratory infections such as influenza and SARS-CoV. As such, pregnant women should be considered an at-risk population for COVID-19. Adverse infant outcomes (eg, preterm birth) have been reported among infants born to mothers positive for COVID-19 during pregnancy. However, this information is based on limited data and it is not clear that these outcomes were related to maternal infection. Currently it is unclear if COVID-19 can cross through the transplacental route to the fetus. In limited recent case series of infants born to mothers infected with COVID-19 published in the peer-reviewed literature, none of the infants have tested positive for COVID-19 (1).”
See complete statement: acog.org
Outpatient Assessment and Management for Pregnant Women With Suspected or Confirmed Novel Coronavirus (COVID-19)
March, 2020
Issued by: The American College of Obstetricians and Gynecologists, ACOG
The Society for Maternal-Fetal Medicine, SMFM
“Unlike influenza and other respiratory illnesses, based on a limited number of confirmed COVID-19 cases, pregnant women do not appear to be at increased risk for severe disease. However, given the lack of data and experience with other coronaviruses such as SARS-CoV and MERS-CoV, diligence in evaluating and treating pregnant women is warranted.
This algorithm is designed to aid practitioners in promptly evaluating and treating pregnant persons with known exposure and/or those with symptoms consistent with COVID-19”
See complete statement: acog.org
Chinese Clinical Guidance for COVID-19 Pneumonia Diagnosis and Treatment (7th edition)
March 4, 2020
Issued by: China National Health Commission
Promoted by: American College of Cardiology, ACC
“The document reviews the etiology, epidemiology, pathology, clinical features and clinical classifications, including in children, of COVID-19. In addition, it provides information on warning signals in adults and children for severe and critical types of COVID-19 and how to differentiate COVID-19 infections and pneumonia from upper respiratory tract infections or other known viral pneumonias”
See complete China National Health Commission statement: meetingchina.org
See complete ACC statement: acc.org
AIUM Official Statement: Guidelines for Cleaning and Preparing External- and Internal-Use Ultrasound Transducers Between Patients & Safe Handling and Use of Ultrasound Coupling Gel
March 27, 2020
Issued by: American Institute for Ultrasound in Medicine, AIUM
“CHANGES DUE TO COVID-19 OUTBREAK
- Level of disinfection: For external and interventional procedures low-level disinfection is effective per CDC guidelines.(1) Currently, EPA approved disinfectants for use against COVID-19 (SARS-CoV-2) can be found online.(2) If LLD agents are depleted soap and water should be used per CDC guidelines. If indicated but no transducer covers are available, medical gloves or other physical barriers (e.g. compatible medical dressings) should be used.
- Education and execution: Dissemination of cleaning guidelines is essential and so is their proper execution. (10)
- Equipment: Cleaning involves all ancillary equipment involved in the procedure at hand. A cover sheet may be used as a physical barrier between the keyboard/console and the operator, in addition to LLD cleaning. If possible, use a dedicated system (scanner and transducers) for COVID-19, positive or suspected, patients. COVID-19 is viable on plastic surfaces for up to 72 hours (25)
- Special attention needs to be paid to COVID-19 and other respiratory infection cases requiring aerosolization procedures, i.e. mechanical ventilation, aerosolization application, etc. Here a transducer cover should be used and the entire equipment requires full LLD (top to bottom) as pathogens are likely to become airborne.
- Always follow manufacturer guidance and institutional guidelines.”
See complete AIUM statement: aium.org
Quick Guide on COVID-19 Protections – Patient and Ultrasound Provider Protection
March, 2020
Issued by: American Institute for Ultrasound in Medicine, AIUM
“STANDARD AND TRANSMISSION-BASED PRECAUTIONS FOR COVID-19
When planning an ultrasound examination in the context of COVID-19, the following are important steps:
- Where possible, call patients before they arrive to the ultrasound facility to make sure that only urgent or emergent cases remain on the ultrasound schedule, and routine appointments are postponed.
- Prepare and clean the ultrasound room and equipment prior to each examination.2
- During the examination, protect the patient and ultrasound providers (physicians, sonographers, allied professionals).”
See complete AIUM statement: aium.org
Quick Guide on COVID-19 Protections – Ultrasound Transducers, Equipment, and Gel
March, 2020
Issued by: American Institute for Ultrasound in Medicine, AIUM
- “Equipment: Cleaning involves all ancillary equipment involved in the procedure at hand. A cover sheet may be used as a physical barrier between the keyboard/console and the operator, in addition to LLD cleaning. If possible, use a dedicated system (scanner and transducers) for COVID-19, positive or suspected, patients. COVID-19 is viable on plastic surfaces for up to 72 hours
- Special attention needs to be paid to COVID-19 and other respiratory infection cases requiring aerosolization procedures, i.e. mechanical ventilation, aerosolization application, etc. Here a transducer cover should be used and the entire equipment requires full LLD (top to bottom) as pathogens are likely to become airborne.”
See complete AIUM guide: aium.org
Is there a role for lung ultrasound during the COVID‐19 pandemic?
March 20, 2020
Accepted for publication in: Journal of Ultrasound in Medicine, JUM
“The current clinical evidence (although not yet represented in the literature), the theoretical bases of LUS in the areated lung, and LUS findings of similar aspects in other pathologies (ARDS, flu virus pneumonia) strongly suggest a potential diagnostic accuracy of LUS that may be useful for
- triage (pneumonia / non-pneumonia) of symptomatic patients at home as well as in the pre-hospital
- diagnostic suspicion and awareness in the Emergency Room setting
- prognostic stratification and monitoring of subjects with pneumonia on the basis of the extension of specific patterns and their evolution towards the consolidation phase in the Emergency Room setting
- management of ICU patients with regard to ventilation and weaning
- monitoring the effect of therapeutic measures (antiviral or others)
- reducing the number of healthcare professionals exposed during patient stratification (a single clinician would be necessary to perform an objective medical examination and imaging investigation directly at the patient’s bed)
See complete article: doi: 10.1002/jum.15284
RECOMMENDATIONS. When considering a procedure for a patient with known or suspected COVID-19 infection
Issued by: American Society of Anesthesiologists, ASA
- “Postpone non-urgent surgical procedures until the patient is determined to be non-infectious or not infected.
- If respiratory support is indicated, then planning ahead may avoid the need for rescue interventions (e.g., crash intubations), which have greater potential for infectious transmission due to mishaps during the use of barrier protections.
- In patient with acute respiratory failure, it may be prudent to proceed directly to endotracheal intubation, because non-invasive ventilation (e.g. CPAP or biPAP) may increase the risk of infectious transmission.
- When possible, perform procedures in an airborne infection isolation room rather than in an operating room. An airborne isolation room has a negative-pressure relative to the surrounding area. In contrast, a typical operating room is designed to provide positive-pressure relative to the surrounding area and incoming air is often flow-directed, filtered, and temperature and humidity controlled.
- If a procedure cannot be postponed or done at the bedside, then schedule the patient when a minimum number of healthcare workers and other patients are present in the surgical suite.
See complete ASA recommendations: ASA.org
RECOMMENDATIONS. When performing procedures on patients with known or suspected COVID-19 infection:
Issued by: American Society of Anesthesiologists, ASA
“During laryngoscopy and intubation:
- Double gloves will enable one to shed the outer gloves after intubation and minimize subsequent environmental contamination.
- In each location where intubations take place, the most experienced professional for that location should perform the intubation. In the operating room, this should be the most experienced anesthesia professional available. In non-operating room locations, including the Emergency Room and ICU, this should be an emergency medicine, critical care medicine, or anesthesia professional, depending on availability and staffing for the facility. Every facility should develop a protocol for which medical service responds to the need for non-OR intubations.
- Avoid awake fiberoptic intubation unless specifically indicated. Droplets containing viral pathogens may become aerosolized during this procedure. Aerosolization generates smaller liquid particles that may become suspended in air currents, traverse filtration barriers, and inspired.
- Consider a rapid sequence induction (RSI) in order to avoid manual ventilation of patient’s lungs and potential aerosolization. If manual ventilation is required, apply small tidal volumes.
See complete ASA recommendations: ASA.org
Catheterization Laboratory Considerations During the Coronavirus (COVID-19) Pandemic: From ACC’s Interventional Council and SCAI
March 16, 2020
Issued by: American College of Cardiology, ACC
Society for Cardiovascular Angiography and Interventions, SCAI
Accepted for publication in: Journal of The American College of Cardiology, JACC
“COVID-19 has placed an enormous strain on the healthcare systems of the nations where it has spread widely, with specific implications of the disease on practice in the catheterization laboratory. These implications include how we might modify practice for standard cardiac patients, those who are suspected COVID-19 patients, and those patients with COVID-19 who have either unrelated cardiac conditions or cardiac manifestations of the disease. It merits emphasis that this is a dynamic situation and one for which there are limited data. In addition, local conditions may vary considerably. The purpose of this joint statement from the ACC Interventional Council and SCAI is to discuss issues facing catheterization laboratory personnel during this time.”
See complete article: https://doi.org/10.1016/j.jacc.2020.03.021
Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the Coronavirus Disease 2019 (COVID-19) Pandemic
March 17, 2020
Accepted for publication in: Journal of The American College of Cardiology, JACC
“Based on currently observed disease patterns, cardiovascular (CV) specialists will be actively engaged in the care of patients with COVID-19. The infection may directly impact cardiovascular disease (CVD). Preexisting cardiovascular disease (CVD) may predispose to COVID-19 infection. Those with CVD who are infected by the virus have an elevated risk of adverse outcomes; and infection, itself, is associated with cardiovascular complications (4-6). Moreover, COVID-19 infection may also have numerous indirect effects relevant to CV health.”
See complete article: onlinejacc.org