Table 2.

Measures to prevent SARS-CoV-2 nosocomial transmission within healthcare settings

Health services:

• Communicate risk and treatment advice to the community, so as to promote early recognition of symptoms by patients and their caregivers, and informed decisions on whether and where to seek care;

• Manage patients at home or at the outpatient level where possible and safe to do so (see Table 1);

• Make every health service contact count: reinforce messaging on behaviour change and hygiene measures for patients and their caregivers;

• Adopt at a minimum distancing between people where possible, universal usage of face coverings (especially where distancing between people is not possible), good ventilation and basic IPC measures (frequent hand hygiene and wearing of medical masks as appropriate) [40] to minimise the risk of asymptomatic or pre-symptomatic spread;

• Triage all patients at all contact points, separating suspected COVID-19 cases from other patients [41], and adopt appropriate IPC measures [42] for any contact with suspected COVID-19 patients (see text for proposed scenarios of testing and separation). If triage and separation measures are unfeasible or overwhelmed by caseload, ensure basic IPC measures;

• Adopt patient cohorting and separation measures to minimise mixing of COVID-19 and non COVID-19 patients (see text).

Healthcare workers:

• Ensure all healthcare workers adhere to IPC measures [42] for any contact with patients, irrespective of patients’ signs and symptoms and depending on level of exposure, and minimise physical contact (without such adaptations compromising clinical effectiveness);

• Ensure all healthcare workers (including community health workers and non-clinical staff) monitor themselves and household contacts and immediately report COVID-19 symptoms. Staff should be supported to stay away from work while they or a member of their household is unwell. Where available and possible, they could be supported to stay elsewhere if a member of the household unwell and they are well (whilst still being required to isolate for the 14 day period);

• Prioritise SARS-CoV-2 testing for health care workers who are have symptoms, so that they can return to work if negative (rather than self-isolate), and to identify those who need to stay away from work if positive.