- Hong Kong clinicians share that caring for COVID-19 patients is associated with a high infection acquisition risk.
- Per WHO, invoke institutional risk management strategies.
- WHO offers an infection prevention course for additional strategies.
Why this matters
Numbers of health care workers who have died caring for patients with COVID-19 remain low, but airborne precautions are esssential, especially while performing aerosol-generating procedures (e.g., noninvasive ventilation [NIV], high-flow nasal cannula [HFNC], bag-mask ventilation, and intubation).
- Clinicians performing aerosol-generating procedures in cases of confirmed COVID-19 are at high acquisition risk.
- Conduct aerosol-generating procedures in an airborne infection isolation room.
- If isolation rooms are unavailable, airway devices that provide ≥6 L/minute oxygen are discouraged.
- As modes, models differ across institutions; avoid NIV, HFNC until patients are cleared of COVID-19.
- Consider early endotracheal intubation in patients with deteriorating respiratory function.
- Avoid bag mask ventilation for as long as possible; use non-aerosol-generating strategies (e.g., bed-up-head-elevated position) to optimize preoxygenation.
- Use of continuous waveform capnography may help ensure supraglottic device seal adequacy.
- Rapid sequence induction with rocuronium (full 1.2 mg/kg IV) may prevent coughing, vomiting associated with short-acting muscle relaxants.
- Confirm correct endotracheal tube positioning before inflating cuff and initiating ventilation.