Clinical Information
The American Nurses Association supports your ongoing efforts on the frontlines to treat and prevent the spread of COVID-19. Read about proper protection, infection control, and standard precautions for patient care.
What is Coronavirus Disease (COVID-19)?
Coronavirus was first identified in December 2019 in China. In February 2020, the World Health Organization (WHO) named it COVID-19. CO stands for corona, VI for virus, and D for disease. Although much about this disease remains a mystery, we do know that COVID-19 spreads from person to person via respiratory droplets produced from coughs, sneezes, and even speaking. It is possible to contract COVID-19 by touching infected surfaces and then touching your eyes, nose, or mouth. It is also possible for people who have no symptoms to spread the disease.
According to the CDC, symptoms may appear 2-14 days after exposure to the virus. People with these symptoms or combinations of symptoms may have COVID-19:
- Cough
- Shortness of breath or difficulty breathing
Or at least two of these symptoms:
- Fever
- Chills
- Repeated shaking with chills
- Muscle pain
- Headache
- Sore throat
- New loss of taste or smell
Preparedness, Early Identification, and Notification
All nurses and the health care team must receive the highest level of protection to provide care for the individuals and communities in which they serve. It is essential to develop and educate ALL staff on preparedness plans that provide infection control procedures and protocols used within the health care facility for the early identification, containment, and care of patients with symptoms associated with Coronavirus Disease (COVID-19) to prevent spread within the facility.
- Develop inpatient, ambulatory, and home care policies and procedures that are in line with current CDC guidelines for COVID-19
- Provide training to all personnel on screening and isolation procedures
- Provide updated training and guidelines on the use of Personal Protective Equipment (PPE), including the use of N-95 respirators, gloves, gowns, masks, eye protection, and a face shield
- Display clear signage with instructions for access and use of PPE
- Ensure consistent use of proper hand hygiene, standard precautions, contact precautions, and airborne precautions, along with the proper use of a National Institute for Occupational Safety and Health (NIOSH)-Approved N-95 respirator or higher (refer to Infection Control and Prevention Section)
- Clearly display signage for patients that lists symptoms and instructions to wear a face mask before entering the health care facility
- To address asymptomatic and pre-symptomatic transmission, update the policy to require everyone (e.g., healthcare personnel, patients, visitors) entering a healthcare facility wear a cloth face mask, regardless of symptoms.
- This helps prevent transmission from infected individuals who may or may not have symptoms of COVID-19.
- Cloth face coverings are not considered PPE and do not replace the use of PPE for health care personnel
- Create a designated point of entry for all patients
- Eliminate visiting hours to protect hospitalized patients from further exposure
- Incorporate assessment questions to document a detailed travel and community exposure history when patients present with fever, cough, or respiratory illness
- Identify, in advance, rooms designated, for quarantine and screening
- Plan for patient surge. Cohort patients with respiratory symptoms during triage. Identify a designated unit or wing to cohort patients with confirmed positive COVID-19 tests
- Outline staffing protocols to facilitate care of patients with COVID-19 to minimize patient-to-patient and patient to health care worker transmission
- Develop a telephone triage protocol for patients to access from home to minimize community-based transmission
- Have available for immediate notification of Patient’s Under Investigation (PUI) the infection control personnel at your facility and the local and state health department.
Isolation, Quarantine, Monitoring, and Hospitalization
The CDC recommends several steps to identify and care for persons with suspected or confirmed coronavirus infection (COVID-19) The modes of transmission include respiratory droplets from coughs and sneezes and transmission by touching the eyes, nose, or mouth after contact with an infected surface. Airborne transmission can occur during aerosol-generating procedures, such as, but not limited to, positive pressure ventilation, endotracheal intubation or extubation, bronchoscopy, airway suction, ventilator care, tracheostomy care, Chest PT, nebulizer treatment, and sputum induction.
- Have masks available for patients to don before entering the health care facility
- Once identified, place a patient in a private room with the door closed for assessment. Limit the number of staff entering the room. All staff entering the room must don a N95 respirator (or surgical/medical mask if the N95 respirator is not available), gown, gloves, face shield or goggles for eye protection
- Health care personnel entering the room should use standard precautions, contact precautions, droplet precautions, airborne precautions if performing an aerosolizing procedure, and eye protection (goggles or a face shield)
- Perform hand hygiene, don Personal Protective Equipment (PPE) before entering the room doff PPE before exiting and perform hand hygiene. If following guidelines for extended use of the N95 Respirator and face shield, only doff gown and gloves
- Have guidelines for the proper use of PPE displayed throughout the health care facility
- Have infection control personnel available to provide just-in-time training on proper PPE use
- Notify your infection control personnel and the local and state health department of suspected cases
