What kind of precautions should be implemented for a patient with suspected or confirmed COVID‑19?

COVID-19 Precautions for Healthcare Settings

For patients with suspected or confirmed COVID-19, implement droplet and contact precautions with appropriate PPE including N95/FFP2 mask, fluid-resistant gown, gloves, eye protection (goggles or face shield), cap, and shoe covers, along with dedicated isolation areas and strict environmental controls. 1, 2

Personal Protective Equipment (PPE) Requirements

Healthcare workers caring for COVID-19 patients must wear:

• N95/FFP2 respirator mask (surgical mask may be substituted only when N95 supplies are critically limited for non-aerosol-generating procedures)
• Fluid-resistant/impermeable gown
• Double gloves (nitrile gloves plus sterile gloves for procedures)
• Eye protection (splash goggles or face shield; personal eyeglasses are insufficient)
• Surgical cap
• Shoe covers 1

For aerosol-generating procedures (intubation, bronchoscopy, cardiopulmonary resuscitation, non-invasive ventilation, nebulization, open suctioning), enhanced airborne precautions with N95 respirators or powered air-purifying respirators (PAPR) are mandatory. 1, 2

Critical caveat: All staff must receive supervised training in proper donning and doffing procedures. A trained observer should supervise the doffing process to minimize contamination risk—this is non-negotiable. 1

Patient Management Protocols

Screening and Triage

• Screen all patients for COVID-19 symptoms during scheduling and again at building entry
• Create system flags identifying patients with recent COVID-19
• Patients must wear surgical masks during transport and while in healthcare facilities (when breathing spontaneously) 3, 1

Spatial Separation

• Designate dedicated isolation areas for suspected/confirmed COVID-19 patients, separate from general patient populations
• Maintain at least 1-2 meters (3-6 feet) spatial separation in waiting areas, though evidence suggests droplets can travel up to 8 meters 3, 4
• Use negative pressure rooms when available, particularly for aerosol-generating procedures, with at least 12 air changes per hour 2

Procedure Room Management

For dedicated COVID-19 procedure rooms:

• Keep doors closed with signage preventing unauthorized entry
• Minimize personnel to only those directly involved in patient care
• Pre-stock all necessary equipment inside the room to avoid staff entry/exit during procedures
• Designate separate "clean" and "contaminated" zones with clear floor markings 1, 5, 1, 6

Environmental Controls

Equipment and Surface Management

• Cover all equipment that cannot be removed with plastic sheeting
• Clean and disinfect all high-touch surfaces (patient couches, door handles, imaging equipment) between each patient according to CDC guidelines
• For portable equipment (X-ray, ultrasound), designate specific units for COVID-19 patients
• Cover detectors/cassettes with disposable plastic wraps 3, 2

Ventilation Requirements

• Ensure adequate ventilation: natural ventilation with air flow of at least 160 L/s per patient, or mechanical ventilation with 12+ air changes per hour
• No waiting period for air exchanges is required after routine imaging procedures unless aerosol-generating procedures were performed 2

Workflow Optimization

Scheduling Strategies

• Schedule suspected/confirmed COVID-19 patients at end of day when possible
• Extend time between appointments to allow thorough cleaning
• Implement car-waiting systems to minimize time in waiting rooms
• Restrict visitors; prevent symptomatic visitors entirely 3, 2

Staff Protection Measures

• Divide staff into separate teams to limit simultaneous exposure and potential quarantine requirements
• Implement 14-day symptom monitoring (fever, respiratory symptoms) for all staff exposed to COVID-19 patients
• Enable remote work and telehealth when feasible
• Prohibit symptomatic staff from working 3, 1, 2

Procedure-Specific Precautions

During Patient Care

• Use contact/non-contact technique when possible (one staff member operates equipment remotely, another positions patient)
• Minimize procedure duration while maintaining quality
• Consider elective intubation before arrival in procedure rooms for high-risk patients
• Change outer gloves before any new surface contact 1, 2

Post-Procedure Protocol

1. Keep door closed after patient leaves
2. Perform supervised doffing (remove facial respirator outside the room)
3. Dispose of waste without squeezing to avoid aerosol generation
4. All personnel exit room
5. Perform terminal cleaning and disinfection 1

Important distinction: While WHO initially recommended droplet/contact precautions, emerging evidence supports airborne transmission with droplets traveling beyond 2 meters and SARS-CoV-2 remaining viable in air for 3 hours. 4 This supports the use of N95 respirators rather than surgical masks as the standard of care, particularly given documented healthcare worker infections.