Coronavirus disease (COVID-19) technical guidance by WHO Infection prevention and control

Infection prevention and control during health
care when COVID-19 is suspected.
Interim guidance
19 March 2020
Background
1.
This is the first edition of guidance on infection prevention
and control (IPC) strategies for use when COVID-19 is
suspected. It has been adapted from WHO’s Infection
prevention and control during health care for probable or
confirmed cases of Middle East respiratory syndrome
coronavirus (MERS-CoV) infection, 1 based on current
knowledge of the situation and experience with severe acute
respiratory syndrome (SARS) and MERS. 2
Clinical triage includes a system for assessing all patients at
admission, allowing for early recognition of possible
COVID-19 and immediate isolation of patients with
suspected disease in an area separate from other patients
(source control). To facilitate the early identification of cases
of suspected COVID-19, health care facilities should:

WHO will update these recommendations as new information
becomes available. 
This guidance is intended for health care workers (HCWs),
health care managers, and IPC teams at the facility level but
it is also relevant for national and district/provincial levels.
Full guidelines are available from WHO. 2 

Principles of IPC strategies associated with
health care for suspected COVID-19.
2.
4.
5.
Applying standard precautions for all patients
Standard precautions include hand and respiratory hygiene,
the use of appropriate personal protective equipment (PPE)
according to a risk assessment, injection safety practices, safe
waste management, proper linens, environmental cleaning,
and sterilization of patient-care equipment.
Ensure that the following respiratory hygiene measures are
used:

IPC strategies to prevent or limit transmission in health care
settings include the following:
2.
3.
encourage HCWs to have a high level of clinical
suspicion;
establish a well-equipped triage station at the
entrance to the facility, supported by trained staff;
institute the use of screening questionnaires
according to the updated case definition. Please
refer to the Global Surveillance for human
infection with coronavirus disease (COVID-19) for
case definitions, and
post signs in public areas reminding symptomatic
patients to alert HCWs.
Hand hygiene and respiratory hygiene are essential
preventive measures.
To achieve the highest level of effectiveness in the response
to the COVID-19 outbreak using the strategies and practices
recommended in this document, an IPC programme with a
dedicated and trained team or at least an IPC focal point
should be in place and supported by the national and facility
senior management. 3 In countries where IPC is limited or
inexistent, it is critical to start by ensuring that at least
minimum requirements for IPC are in place as soon as
possible, both at the national and facility level, and to
gradually progress to the full achievement of all requirements
of the IPC core components according to local priorities. 4
1.
Ensuring triage, early recognition, and
source control.

ensuring triage, early recognition, and source
control (isolating patients with suspected
COVID-19);
applying standard precautions for all patients;
implementing empiric additional precautions
(droplet and contact and, whenever applicable,
airborne precautions) for suspected cases of
COVID-19;
implementing administrative controls;
using environmental and engineering controls.

ensure that all patients cover their nose and mouth
with a tissue or elbow when coughing or sneezing;
offer a medical mask to patients with suspected
COVID-19 while they are in waiting/public areas or
in cohorting rooms;
perform hand hygiene after contact with respiratory
secretions.
HCWs should apply WHO’s My 5 Moments for Hand
Hygiene approach before touching a patient, before any
clean or aseptic procedure is performed, after exposure to
body fluid, after touching a patient, and after touching a
patient’s surroundings. 5


- 1-
hand hygiene includes either cleansing hands with
an alcohol-based hand rub or with soap and water;
alcohol-based hand rubs are preferred if hands are
not visibly soiled;