Recommended Droplet Precautions for SARS-CoV-2
For healthcare workers caring for patients with COVID-19, droplet precautions should include surgical/medical masks, eye protection, gowns, and gloves at minimum, with N95/FFP2 respirators required for aerosol-generating procedures. 1, 2
Personal Protective Equipment Requirements
For Non-Aerosol-Generating Procedures:
- Surgical/medical masks are recommended for healthcare workers caring for non-ventilated COVID-19 patients 1
- Complete PPE should include gloves, gown, and eye protection (face shield or safety goggles) in addition to masks 2
- Patients should wear surgical facemasks to prevent droplet transmission 1, 2
- A minimum physical separation zone of 2 meters (6 feet) should be maintained between workers whenever possible 1, 3
For Aerosol-Generating Procedures:
- N95/FFP2 respirators or equivalent are required along with other PPE (gloves, gown, eye protection) 1, 2
- Aerosol-generating procedures should be performed in negative pressure rooms when available 1, 2
- Common aerosol-generating procedures include:
Procedural Considerations
Airway Management:
- Video-guided laryngoscopy is preferred over direct laryngoscopy when available 1
- Endotracheal intubation should be performed by the most experienced healthcare worker to minimize attempts and risk of transmission 1
- Pre-oxygenation should achieve an end-tidal expired oxygen concentration of >90% before airway interventions 1
- Ensure adequate neuromuscular blockade before all airway interventions 1
- Release positive pressure within the breathing circuit by opening the adjustable pressure-limiting valve before airway interventions 1
Oxygen Therapy:
- The flow of oxygen should be kept to a minimum while maintaining adequate saturation 1, 2
- Avoid humidified oxygen and nebulized drugs when possible 1
- Consider placing a surgical mask over the patient's mouth during oxygen therapy 1
Room and Environmental Requirements
- Aerosol-generating procedures should be performed in negative pressure rooms 1, 2
- When negative pressure rooms are unavailable, ensure adequate ventilation with at least 160 L/s air changes per hour 1
- Allow adequate time (>30 minutes) to elapse before the next procedure in the same room 1
- Disinfect floors and surfaces of the procedure suite after each patient 1
- Minimize the amount of equipment inside the room to what is absolutely essential 1
Special Considerations
Regional Anesthesia:
- Regional anesthesia procedures are not considered aerosol-generating, and therefore droplet precautions are recommended as a minimum 1
- Higher-level precautions may be appropriate when caring for patients under spinal anesthesia in certain situations 1
Thoracic Surgery:
- Efforts should be made to minimize the number of staff present in theater for aerosol-generating procedures 1
- Double-lumen tubes should only be open to the atmosphere after allowing release of positive pressure through a HEPA viral filter 1
- Flexible bronchoscopes pose significant contamination risks and should be stored in a designated area during procedures 1
Common Pitfalls and Caveats
- Do not assume that a surgical mask provides the same protection as an N95/FFP2 respirator during aerosol-generating procedures 2, 4
- Staff should be fit-tested for each different type of respirator to ensure proper protection 2
- When scarcity is not an issue, use of a fitted respirator is a reasonable option even for non-aerosol-generating procedures 1
- Airborne precautions should be maintained for the appropriate duration based on room air exchanges after aerosol-generating procedures are completed 2
- The effectiveness of masks depends on proper fit and consistent use - N95/KN95 respirators offer the highest level of personal protection 5