COVID-19 TRAINING

Direction des soins infirmiers

Infection prevention and control team

March 2020

TRAINING PLAN

• Mission and objectives

• Clinical features

• Emergency department triage tool

• Treatment of a suspected case

• Additional precautions

• User transfer

• Hygiene and sanitation

• Roles and responsibilities

• Instruction to follow during home isolation

Mission of the CISSS de la Côte-Nord

• Quickly screen or detect the presence of the virus in

order to control its transmission.

• Protect employees providing care and services.

TRAINING OBJECTIVES

Infection prevention and control (IPC) team of the CISSS Côte-Nord:

• Train multiplying agents on the various measures related to COVID-19 in

order for them to deliver this training in their respective sectors.

Multiplying agents:

• Read and understand the content of the training, as well as all available

documents related to COVID-19.

• Emergency department only: Read the documents on the procedure

regarding patients with a non-severe clinical condition.

Employees:

• Read the information contained in this document, as well as all documents

made available to you.

• Learn how to implement all procedures related to COVID-19.

HISTORY OF THE COVID-19

• December 2019: Outbreak of pneumonia of unknown origin in the

city of Wuhan, China.

• January 2020: The pathogen is identified as SARS-CoV-2 (severe

acute respiratory syndrome coronavirus 2).

• January 25th, 2020: First COVID-19 case in Canada, related to a

trip to Wuhan, China.

• January 30th, 2020: The World Health Organization (WHO) declares

the COVID-19 outbreak a public health emergency of international

concern.

• February 2020: The virus spreads quickly in other countries, such

as mainland China, Hong Kong, South Korea, Iran, Italy, Japan,

Singapore, etc.

• March 11th, 2020: WHO characterizes COVID-19 as a pandemic.

EPIDEMIOLOGY

In Canada

• Most cases are between 20 and 59 years of age, and

over 80 years of age.

• Women are more affected by COVID-19 than men.

• The global case fatality rate is of 5.73%. It varies from

province to province, between 0 and 6.62%.

• The mortality rate gradually increases with age.

WHAT IS COVID-19

COVID-19 is a disease in the family of viruses called coronaviruses.

Coronaviruses are viruses that can cause mild respiratory infections in humans and animals.

Certain specific coronaviruses may be more virulent, such as the Severe Acute Respiratory Syndrome (SARS) and the Middle East respiratory syndrome coronavirus (MERS-CoV).

The strain of COVID-19 is called SARS-CoV-2.

CLINICAL FEATURES

Symptoms vary from a mild infection (more frequent) to a

severe lower respiratory tract infection.

Sore throat

Intermittent (sometimes absent) fever in the early stages of the

disease

Cough

Abdominal pain or discomfort, sometimes in the early stages of the

disease

Mild to severe pneumonia

Breathing difficulties which may lead to acute respiratory distress

syndrome

Sudden anosmia with nasal obstruction

Ageusia

CLINICAL FEATURES (continued)

Incubation period: 3 to 14 days

Mode of transmission: Enhanced contact/droplet

The disease is mostly spread through contact with

respiratory droplets from a symptomatic infected

person.

Fecal/oral transmission is possible because of the

presence of viral particles in the feces of a confirmed

case.

Airborne transmission is possible during aerosol

generating medical procedures.

Contagious period: Still unknown.

PRE-TRIAGE

** Pre-triage required when the user meets with an administrative officer before the triage with the nurse at the emergency department.

Have you been in contact with an investigated or confirmed COVID-19 case?

Do you have fever or cough symptoms, breathing difficulties, or a loss of taste or smell?

If the patient answers yes to one of these questions, ask them to wear a procedure mask and to disinfect their hands, and notify the triage nurse of the emergency department.

EMERGENCY DEPARTMENT TRIAGE TOOL

EMERGENCY DEPARTMENT TRIAGE TOOL

TREATMENT OF A SUSPECTED CASE

Step 1

Get the user to wash their hands with a hydroalcoholic solution.

The user must keep their procedure mask on at all times. If

they wear a personal face covering, replace it with a

procedure mask.

Place the user AND their escort, if applicable, in a separate

room with the door closed.

If the escort shows symptoms consistent with COVID-19,

they must be considered possibly infected.

TREATMENT OF A SUSPECTED CASE

Step 2

Refer the user to the physician of the emergency

department for PRIORITY evaluation.

Apply these additional precautions:

Enhanced contact/droplet protection, including eye

protection, for all cases at the emergency department

(on a stretcher or not) and hospitalized cases without

severity criteria.

Enhanced airborne/contact protection, including eye

protection, for all cases requiring or at risk of requiring an

aerosol generating medical procedure.

TREATMENT OF A SUSPECTED CASE

Severity criteria in adults

Respiratory rate ≥ 24/min or respiratory distress

Oxygen need of ≥ 4L for 90% saturation

Systolic BP < 90 mmHg despite proper fluid resuscitation

Any criteria considered severe by the clinician

Severity criteria in children

Cough or breathing difficulties with one of the following symptoms:

Central cyanosis or saturation < 90% on room air

Severe respiratory distress

Signs of pneumonia with decline in general health

TREATMENT OF A SUSPECTED CASE (continued)

Step 3

Notify the microbiologist on duty if necessary.

Notify the IPC of the facility.

Limit investigations as much as possible.

Consider a return home while awaiting the result, if

the clinical condition permits.

SAMPLING OF A SUSPECTED CASE

Any sampling must be made by a member of the health care team

dedicated to the COVID-19 case.

Nasopharyngeal AND oropharyngeal swabbing (refer to the OCM).

Decontaminate the outside of the sample with a Clorox wipe before

leaving the room.

Identify the sample with the Omnilab label.

Put the sample in a biohazard bag.

Do not use a pneumatic system for transportation.

Notify the laboratory of the shipment of the sample.

ADDITIONAL PRECAUTIONS

Enhanced contact/droplet precaution

Suspected or confirmed COVID-19 cases hospitalized for symptoms consistent with COVID-19, not at risk of requiring an AGMP

Suspected or confirmed COVID-19 cases hospitalized for symptoms consistent with COVID-19, whose level of care does not require an AGMP

Cases hospitalized for a diagnosis other than COVID-19, but who have received a positive result for COVID-19

Enhanced airborne/contact precaution

Suspected or confirmed COVID-19 cases hospitalized for symptoms consistent with COVID-19, requiring or at risk of requiring an AGMP

No additional precaution

Users hospitalized for a diagnosis other than COVID-19, showing symptoms of COVID-19, but who have received a negative result.

*All professionals providing care within two metres of a user must wear a procedure mask.

ADDITIONAL PRECAUTIONS

* Negative pressure room or individual room with the door closed.

Here are the steps to follow before entering the room:

1. Wash your hands.

2. Put on the disposable, single-use, long-sleeved, non-sterile gown. Make sure

it is properly tied at the neck and waist. Use a waterproof gown if there is a

risk of contact with body fluids.

3. Put on the N95 mask so that it covers the chin and nose, without crossing the

straps. Mould the nose piece to the bridge of your nose and test for leaks.

4. Put on the single-use eye protection. Prescription glasses are not considered

adequate protection.

5. Put on the gloves over the cuffs of your gown and be careful not to tear or

pierce them.

PUTTING ON PPE

Wash your hands

Put on the gown

Put on a procedure or N95

mask

Put on the goggles or face

shield

Put on the gloves

ADDITIONAL PRECAUTIONS (continued)

Avoid touching eyes, nose and mouth with potentially

contaminated hands.

Limit the staff required to provide care to the user to a

minimum. Dedicate a health care team to COVID-19 cases.

Keep records of all health care workers entering the room.

Keep records of all family members entering the room, if

applicable.

Limit the amount of equipment entering the room.

Carry out process audits if necessary.

ADDITIONAL PRECAUTIONS (continued)

Here are the steps to follow when leaving the room (do these steps two metres away from the

user):

1. Remove gloves while avoiding any contamination. Take the outer edge of the glove near the

cuff, and roll it inside out. Slide your hand into the second gloves and remove it.

2. Perform hand hygiene with the hydroalcoholic solution.

3. Remove the gown while avoiding contaminating your clothes or skin. Grab the straps at the

neck, pull the outer “contaminated” side of the gown forward and roll it inside out. Roll up the

sleeves into a ball and dispose of the gown.

4. Perform hand hygiene with the hydroalcoholic solution.

5. Remove the eye protection with the temples or the headband of the face shield. The front of

the eye protection is considered contaminated.

6. To perform in the anteroom. If there is no anteroom, do it outside the room. Remove the

N95 mask using the straps. The front of the mask is considered contaminated.

7. Wash your hands.

REMOVING PPE

Remove the gloves

Wash your hands

Remove the gown

Wash your hands

Remove the eye protection

Remove the procedure or

N95 mask

Wash your hands

ADDITIONAL PRECAUTIONS (continued)

ADDITIONAL PRECAUTIONS (continued)

USER TRANSFER

Ask the user to perform hand hygiene before putting on the personal protective equipment (PPE).

Make the user wear the PPE, based on the current type of isolation. Make them wear a procedure mask

(do not make the user wear a N95 mask).

Cover the wheelchair with a clean bedsheet.

Make sure the staff member escorting the user during the transfer is wearing clean PPE.

Notify the receiving department that additional protection measures are required.

Make sure the receiving department and the stretcher-bearer are wearing the required PPE.

The hygiene and sanitation team of the receiving department must perform disinfection in accordance

with the chlorine enhanced contact/airborne poster.

Remove the PPE once the transfer is complete and perform hand hygiene.

Disinfect the stretcher or the wheelchair used for the transfer.

HYGIENE AND SANITATION

Wear the PPE, as shown near the entrance of the room, when performing

daily maintenance.

Pay special attention to frequently touched areas.

When additional precautions no longer apply, remove the room’s bedding

and curtains. Respiratory protection and eye protection are no longer

necessary for the final disinfection.

Dispose of all the material that cannot be disinfected (including toilet

paper).

Disinfection is performed using chlorine products or Clorox wipes.

* Do not forget the two-hour wait after the negative pressure is turned off

before disinfecting the room.

ROLES AND RESPONSIBILITIES

Quickly implement additional precautions.

Ensure safe, quality care.

Limit the number of staff members providing care to the COVID-19 case,

as far as possible.

Ensure good communication between the health care team, the

managers and public health.

Ensure confidentiality.

Properly complete the registers dedicated to the COVID-19 case.

*Refer to the fact sheets on the roles and responsibilities of each job title,

found in the “marche à suivre en présence d’un usager dont l’état clinique

est sévère et/ou nécessitant une hospitalisation (COVID-19)”, in Annex 2.

INSTRUCTIONS TO FOLLOW DURING HOME ISOLATION

• Refer to the latest version of the document “Instructions for home

isolation, person under investigation”.

https://publications.msss.gouv.qc.ca/msss/fichiers/2019/19-210-08F.pdf

https://publications.msss.gouv.qc.ca/msss/document-002458/

LIST OF AEROSOL GENERATING MEDICAL PROCEDURES (AGMP)

Recognized risk

Bronchoscopy

Tracheal intubation and extubation

Cardio-pulmonary resuscitation

Manual ventilation before intubation

Open airway suctioning in an intubated or tracheostomized user

Nasopharyngeal aspiration in children

Possible risk

Non-invasive positive pressure ventilation (BiPAP, CPAP)

Tracheostomy care

Uncertain risk

High-flow oxygen therapy

Nebulization

REFERENCES

Government of Canada (2020). Epidemiological summary of

COVID-19 cases in Canada.

INSPQ (2020). COVID-19: Mesures de prévention et de contrôle des

infections pour les milieux de soins aigus : Recommandation

intérimaires version 8.0.

INSPQ (2020). COVID-19: Avis du CINQ: gestion du risque pour la

protection respiratoire en milieux de soins aigus.

INSPQ (2020). COVID-19: Caractéristiques épidémiologiques et

cliniques.

INSPQ (2020). Interventions médicales générant des aérosols.

MSSS (2019). Instructions for home isolation, person under

investigation.

MSSS (2020). Coronavirus (COVID-19).

Government of Canada (2020). Coronavirus disease (COVID-19):

Outbreak update.

QUESTIONS