Just the Facts: Protecting frontline clinicians during the COVID-19 pandemic

Atkinson, Paul; French, James; Lang, Eddy; McColl, Tamara; Mazurik, Laurie

In addition, targeted administrative, environmental, and engineering controls should be implemented to reduce the risk of exposure. The National Institute for Occupational Safety and Health (NIOSH) 7 outline a hierarchy of controls. Health care organizations should ensure input from infection prevention and control (IPC) specialists to ensure appropriate infrastructure, testing capacity, zoning of patients according to risk of disease, and adequate staffing levels and training. Engineering interventions, such as physical separation of staff from patients where possible (e.g., the use of telephone or intercom communications) and appropriate ventilation (e.g., negative pressure rooms for aerosolizing procedures), are important in minimizing the viral exposure to health care workers. Realistically, many EDs will not be equipped with the "recommended" infrastructure or equipment, but reasonable alternatives exist. These may include identifying walled rooms for aerosol-generating medical procedures (AGMPs) with appropriately sized high-efficiency particulate air (HEPA) filters, taping off donning/doffing areas at least 2 meters from the patient, communicating with patients/teams using walkie-talkies or baby monitors, requiring patients to wear face masks, and establishing "clean/cold" and "dirty/hot" areas of the department with respect to suspected or confirmed COVID-19 patients with dedicated staff in each area if resources allow.