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VOLUME 25 , ISSUE 3 ( March, 2021 ) > List of Articles


Extra Precautions while Caring for a Suspected COVID-19 Patient in an ICU beyond PPE and Hand Hygiene

Vitrag Shah, Darshan Trivedi

Citation Information : Shah V, Trivedi D. Extra Precautions while Caring for a Suspected COVID-19 Patient in an ICU beyond PPE and Hand Hygiene. Indian J Crit Care Med 2021; 25 (3):331-336.

DOI: 10.5005/jp-journals-10071-23767

License: CC BY-NC 4.0

Published Online: 01-04-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Since the diagnosis of the first case of COVID-19 in December 2019, there have been reports of several healthcare workers infected with COVID-19. It has changed the infection control practices of most ICUs all over the world. Prevention is better than cure is definitely proven true as there is no definite cure for COVID-19 yet. Personal protective equipment and hand hygiene are a must while handling any suspected COVID-19 patient. Apart from that, there are several other things, which should be followed in ICU and specifically while caring for a patient on ventilator. There are a large number of interventions done while treating any critically ill patient in ICU, which can generate aerosols and exaggerate spread of COVID-19, which include high-flow nasal cannula, NIV, nebulization, suctioning, bag and mask ventilation, endotracheal intubation, and bronchoscopy. We will be reviewing those things beyond PPE and hand hygiene along with the rationale of each of them, which can help to minimize the risk of exposure to healthcare workers and other patients in the surrounding. It will help not only to prevent COVID-19 transmission but also to reduce overall nosocomial infection rate. As per our knowledge, this will be the first paper reviewing innovative ideas to minimize the risk of infection in a comprehensive manner.

  1. World Health Organization. Infection prevention and control during health care when COVID-19 is suspected: interim guidance. Geneva: World Health Organization; 2020.
  2. Rungta N, Zirpe KG, Dixit SB, Mehta Y, Chaudhry D, Govil D, et al. Indian Society of Critical Care Medicine Experts Committee Consensus Statement on ICU planning and designing, 2020. Indian J Crit Care Med 2020;24(Suppl 1):S00. DOI: 10.5005/jp-journals-10071-G23185.
  3. Saran S, Gurjar M, Baronia A, Sivapurapu V, Ghosh PS, Raju GM, et al. Heating, ventilation and air conditioning (HVAC) in intensive care unit. Crit Care 2020;24:194. DOI: 10.1186/s13054-020-02907-5.
  4. Liew MF, Siow WT, Yau YW, See KC. Safe patient transport for COVID-19. Crit Care 2020;24(1):94. DOI: 10.1186/s13054-020-2828-4.
  5. Fehr AR, Perlman S. Coronaviruses: an overview of their replication and pathogenesis. In: Coronaviruses. New York: Humana Press; 2015, pp. 1–23.
  6. Dragor. Guideline breathing system filter. April 2020.
  7. Dragor. Filter/HMEs: supporting daily clinical routine.
  8. Dragor. SARS-CoV-2 and handling of medical devices for intensive care (January 28, 2020) updated March 24, 2020.
  9. Wilkes AR. Heat and moisture exchangers and breathing system filters: their use in anaesthesia and intensive care. Part 1 - history, principles and efficiency. Anaesthesia 2011;66(1):31–39. DOI: 10.1111/j.1365-2044.2010.06563.x.
  10. Wilkes AR. Heat and moisture exchangers and breathing system filters: their use in anaesthesia and intensive care. Part 2 - practical use, including problems, and their use with paediatric patients. Anaesthesia 2011;66(1):40–51. DOI: 10.1111/j.1365-2044.2010.06564.x.
  11. Alhazzani W, Møller MH, Arabi YM, Loeb M, Gong MN, Fan E, et al. Surviving sepsis campaign: guidelines on the management of critically ill adults with coronavirus disease 2019 (COVID-19). Intensive Care Med 2020;46(5):854–887. DOI: 10.1007/s00134-020-06022-5.
  12. Respiratory care Committee of Chinese Thoracic Society. Expert consensus on respiratory therapy related to new coronavirus infection in severe and critical patients. Zhonghua Jie He He Hu Xi Za Zhi 2020;17:E020. DOI: 10.3760/cma.j.issn.1001-0939.2020.0020.
  13. Cook, TM, El-Boghdadly K, McGuire B, McNarry AF, Patel A, Higgs A. Consensus guidelines for managing the airway in patients with COVID-19: guidelines from the Difficult Airway Society, the Association of Anaesthetists the Intensive Care Society, the Faculty of Intensive Care Medicine and the Royal College of Anaesthetists. Anaesthesia 2020;75(6):785–799. DOI: 10.1111/anae.15054.
  14. Apeksh P, Shah A, Garg R, Divatia JV, Kundra P, Doctor JR, et al. All India difficult airway association (AIDAA) consensus guidelines for airway management in the operating room during the COVID-19 pandemic. Indian J Anaesth 2020;64(14):107. DOI: 10.4103/ija.IJA_498_20.
  15. Matava CT, Yu J, Denning S. Clear plastic drapes may be effective at limiting aerosolization and droplet spray during extubation: implications for COVID-19. Can J Anaesth 2020;67(7):902–904. DOI: 10.1007/s12630-020-01649-w.
  16. Peng F, Wang M, Yang H, Yang X, Long M. Efficacy of intracuff lidocaine in reducing coughing on tube: a systematic review and meta-analysis. J Int Med Res 2020;48(2):300060520901872. DOI: 10.1177/0300060520901872
  17. Chan, MTV, Chow BK, Lo T, Ko FW, Ng SS, Gin T, et al. Exhaled air dispersion during bag-mask ventilation and sputum suctioning-Implications for infection control. Sci Rep 2018;8(1):198. DOI: 10.1038/s41598-017-18614-1.
  18. Maves RC, Mukherjee V. Management of patients with COVID-19 infection. Chestnet.Org.
  19. Thomas P, Baldwin C, Bissett B, Boden I, Gosselink R, Granger CL, et al. Physiotherapy management for COVID-19 in the acute hospital setting: clinical practice recommendations. J Physiother 2020; 66(2):73–82. DOI: 10.1016/j.jphys.2020.03.011.
  20. Lazzeri M, Lanza A, Bellini R, Bellofiore A, Cecchetto S, Colombo A, et al. Respiratory physiotherapy in patients with COVID-19 infection in acute setting: a Position Paper of the Italian Association of Respiratory Physiotherapists (ARIR). Monaldi Arch Chest Dis 2020;90(1):1285. DOI: 10.4081/monaldi.2020.1285.
  21. Frank S, Brown SM, Capriotti JA, Westover JB, Pelletier JS, Tessema B. In vitro efficacy of a povidone-iodine nasal antiseptic for rapid inactivation of SARS-CoV-2. JAMA Otolaryngol Head Neck Surg 2020;146(11):1–5. DOI: 10.1001/jamaoto.2020.3053.
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