As global cases of the novel coronavirus (2019-nCoV) surpass 4600 and about 100 people are being investigated for it across 26 states in the United States, there is an urgent need now more than ever to focus on facts and response measures. The World Health Organization reported Sunday that 2744 cases have been confirmed in mainland China, including 461 severe cases and 80 deaths. In this uncertain time of constantly changing news and updates that often stress response efforts, it is important to focus on opportunities for prevention and ensuring staff have the right information.
For infection prevention efforts, it can be challenging to know where to begin. When people hear “quarantine,” there is instant panic. It’s helpful to remind the public that we isolate individuals who are symptomatic and quarantine those who have been exposed to the virus but are not yet showing symptoms.
The current guidance from the US Centers for Disease Control and Prevention (CDC) includes criteria used to guide evaluation of patients under investigation for 2019-nCoV. These criteria include clinical features such as fever and/or symptoms of lower respiratory illness (such as cough and difficulty breathing), in addition to travel to Wuhan, China, in the last 14 days prior to symptom onset or close contact with a laboratory-confirmed case or someone under investigation for 2019-nCoV. The CDC also includes recommendations for reporting, testing, and specimen collection.
Now is the key time to ensure healthcare facilities have enough supplies of surgical and N95 masks, gowns, gloves, and eye protection. Moreover, this is a perfect time to ensure negative pressure rooms are functioning and frontline staff are vigilant in asking about recent travel history. Reminding staff of the importance of hand hygiene, staying home when they’re sick, and environmental disinfection is key. Practice makes permanent.
As staff see images of mass quarantine efforts and over-hyped measures, now is the time to get in front of the hysteria-inducing news and provide correct information to the public and staff. Attending huddles and rounding, especially in emergency departments and urgent care centers, is a great way to share information and answer questions. Providing staff with simple guidance on isolation, contact information, and testing processes can help reduce the potential they will make a hasty decision in fear.
Perhaps one of the most important things to emphasize during this time is to reinforce that these are not new skills staff need to learn. This is not Ebola, where a novel set of personal protective equipment (PPE) and processes are necessary. The current isolation precautions are Airborne + Contact, which means a gown/gloves, N95 mask, and eye protection. The employment of the i3 approach is a foundational tool that we can use for 2019-nCoV, but also future infectious disease outbreaks—identify, isolate, and inform. Honing these skills and reinforcing the role of travel screening, rapid identification of cases, appropriate isolation, and communication with infection prevention and local public health are not new skills. Putting a surgical mask on the patient until they can be moved to a negative pressure room is not a novel skill. The biggest challenge is that failure to follow these infection prevention practices occurs all too frequently. Adhering to the skills we possess and resources we have is a good lesson that will last beyond this outbreak.