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ISDA Recommendations – Infection Prevention in Patients with Suspected/Known COVID-19

The Infectious Diseases Society of America (ISDA) released a set of eight recommendations on April 27, 2020 as part of its Guidelines on Infection Prevention in Patients with Suspected or Known COVID-19. The recommendations cover the following areas:

  • N95 Masks and Respirators (Routine Patient Care)
    • ISDA recommends in conventional settings that healthcare staff caring for patients with suspected/known COVID-19 use either a surgical mask or N95 (or N99 or PAPR) respirator as part of appropriate PPE (vs. no mask)
    • In contingency or crisis settings: ISDA recommends that staff use a surgical mask or reprocessed respirator (vs. no mask)
  • Double vs. Single Gloves (Routine Patient Care)
    • ISDA does not recommend using double gloves versus single gloves in conventional, contingency or crisis situations, citing a lack of sufficient evidence to make such a recommendation.
  • Shoe Covers vs. No Shoe Covers (Routine Patient Care)
    • ISDA does not make a recommendation to use shoe covers when caring for patients with suspected/known COVID-19 as part of appropriate PPE use.
  • N95 Respirators vs. Surgical Masks (Aerosol-Generating Procedures)
    • ISDA recommends in conventional settings that staff wear an N95 respirator (in addition to gown, gloves and eye protection) instead of a surgical mask when involved with aerosol-generating procedures on a patient with suspected/known COVID-19.
  • Reuse/Extended Use of N95 Respirators vs. Surgical Masks (Aerosol-Generating Procedures)
    • ISDA suggests that during contingency/crisis situations, healthcare workers who are involved with aerosol-generating procedures on a patient with suspected/known COVID-19 use a reprocessed N95 respirator for reuse.
  • Face Shield/Surgical Mask + N95 Respirator (Aerosol-Generating Procedures)
    • ISDA recommends that during contingency/crisis situations when there are respirator shortages that healthcare personnel who are involved with aerosol-generating procedures on a patient with suspected/known COVID-19 add a face shield or surgical mask as a cover for the N95 respirator to allow for extended use. Further, ISDA wrote in a comment that this recommendation is based on staff using the correct doffing sequence and performing hand hygiene before and after removing the face shield/surgical mask covering the respirator.
    • ISDA’s final recommendation is that during contingency/crisis situations when there are respirator shortages, that healthcare staff involved with aerosol-generating procedures on patients with suspected/known COVID-19 add a face shield or surgical mask as a cover for the N95 respirator to allow for reuse. A comment is also included with this recommendation that assumes staff use the correct doffing sequence and perform hand hygiene before and after removing the face shield or surgical mask that is covering the respirator.

The full set of recommendations, along with associated evidence, rationale and full details on each recommendation can be found on the ISDA website.

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