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Infection control in the intensive care unit: expert consensus statements for SARS-CoV-2 using a Delphi method
During the current COVID-19 pandemic, health-care workers and uninfected patients in intensive care units (ICUs) are at risk of being infected with SARS-CoV-2 as a result of transmission from infected patients and health-care workers. In the absence of high-quality evidence on the transmission of SARS-CoV-2, clinical practice of infection control and prevention in ICUs varies widely. Using a Delphi process, international experts in intensive care, infectious diseases, and infection control developed consensus statements on infection control for SARS-CoV-2 in an ICU. Consensus was achieved for 31 (94%) of 33 statements, from which 25 clinical practice statements were issued. These statements include guidance on ICU design and engineering, health-care worker safety, visiting policy, personal protective equipment, patients and procedures, disinfection, and sterilisation. Consensus was not reached on optimal return to work criteria for health-care workers who were infected with SARS-CoV-2 or the acceptable disinfection strategy for heat-sensitive instruments used for airway management of patients with SARS-CoV-2 infection. Well designed studies are needed to assess the effects of these practice statements and address the remaining uncertainties.
Introduction
The COVID-19 pandemic continues to cause substantial strain on health-care resources worldwide. As the primary mode of transmission of SARS-CoV-2 was initially considered to be droplets, the main focus of infection control was towards preventing direct human-to-human transmission with social distancing, wearing face masks, hand washing, and disinfection of virus-contaminated surfaces.
However, emerging evidence suggested an important role for airborne transmission, especially in indoor environments, such as health-care establishments. Major public health agencies have accepted the evidence of airborne spread,
and the urgent need to minimise spread to both health-care workers and uninfected patients has resulted in many structural and organisational changes in intensive care units (ICUs) in the absence of strong evidence.
Health-care workers, their households, and hospitalised patients are at a higher risk of being infected with SARS-CoV-2 compared with the general community.This risk is attributed to close contact with patients, especially due to coughing and using aerosol-generating procedures (AGPs).
According to WHO estimates, health-care workers contributed to 2–35% of all reported cases with COVID-19 depending on the country’s resources and reporting systems.
Patients with COVID-19 treated in ICUs are unique in that they have a greater severity and duration of illness, their treatment involves AGPs, and they might receive immunosuppressive agents, and are therefore at a higher risk of acquiring healthcare-associated infections compared with non-ICU patients.
An increase in healthcare-associated infections has also been noted in patients with COVID-19 during the pandemic. This increase most likely has several causes, including fear of self-contamination and the unprecedented strain on health-care resources resulting in suboptimal infection control practices.
Public health agencies have issued general recommendations for infection control of SARS-CoV-2, including prevention of nosocomial spread and health-care worker safety.Most recommendations are based on commonly used measures to prevent droplet and airborne infections, and on experience from previous coronavirus outbreaks, caused by SARS-CoV and MERS-CoV. However, absence of evidence-based recommendations for infection control for patients with COVID-19 in ICUs has led to modifications in standard infection control practices. Given the dearth of evidence, we aimed to reach a consensus on infection control in the ICU for SARS-CoV-2, using a Delphi process.
Créditos: Comité científico Covid
