Chinese clinicians: staff safety is essential while treating patients with COVID-19

  • Cheung J C-H, et al
  • Lancet Respir Med
  • 25 Feb 2020

  • curated by Liz Scherer
  • Clinical Essentials
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Takeaway

  • 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). 

Key points

  • 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.