Monday, August 2, 2021
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Coronavirus Illness 2019 (COVID-19)

The U.S. Facilities for Illness Management and Prevention (CDC) is working carefully with worldwide companions to answer the coronavirus illness 2019 (COVID-19) pandemic. CDC supplies technical help to assist different international locations improve their capacity to stop, detect, and reply to well being threats, together with COVID-19.

This doc is supplied by CDC and is meant to be used in non-US healthcare settings.

1. Overview

This doc supplies steering on the identification or screening of healthcare employees1 and inpatients with signs of suspected COVID-19. Rational, necessities, and concerns can be mentioned for 3 broad case identification methods:

  • Passive methods: Reporting/alerts are initiated by the information supply (e.g., healthcare employee or treating clinician) based mostly on a identified algorithm or laws.
  • Enhanced passive methods: Reporting/alerts are initiated by the information supply with an added mechanism to immediate information assortment, assessment, and/or reporting.
  • Lively methods: Reporting/alerts are initiated by the centralized well being authority (e.g., Ministry of Well being, facility an infection preventionist, facility administration) utilizing a identified algorithm or laws.

Extra steering on managing guests to healthcare services and triage of suspected COVID-19 sufferers in non-US healthcare settings can be out there.

Whereas, epidemiologic, virologic, and modeling stories help the opportunity of SARS-CoV-2, the virus that causes COVID-19,  transmission from individuals who’re presymptomatic (SARS-CoV-2 detected earlier than symptom onset) or asymptomatic (SARS-CoV-2 detected however signs by no means develop), essential data gaps stay concerning the advantage of routine or repeated screening of healthcare employees and inpatients with out signs for prevention of COVID-19 unfold inside well being services exterior of an outbreak response state of affairs.2 Subsequently, dialogue round optimum testing methods for the identification of healthcare employees with presymptomatic and asymptomatic SARS-CoV-2 an infection are exterior the scope of this steering.

 2. Indicators and Signs In keeping with COVID-19

Presenting indicators and signs of COVID-19 differ, limiting the definition of a generalizable set of attribute indicators and signs for COVID-19. At finest, present proof suggests substantial variability starting from delicate to extreme and based mostly on solely partially described patient-level elements. The WHO interim steering for medical administration of COVID-19exterior icon supplies the next abstract of printed COVID-19 symptom descriptions and noticed frequency (see field):

Amongst individuals who develop signs, most expertise fever (83%–99%), cough (59%–82%), fatigue (44%–70%), anorexia (40%–84%), shortness of breath (31%–40%), and myalgias (11%–35%). Different non-specific signs, reminiscent of sore throat, nasal congestion, headache, diarrhea, nausea, and vomiting, have additionally been reported. Lack of scent (anosmia) or lack of style (ageusia) previous the onset of respiratory signs has additionally been reported.

Older folks and immunosuppressed sufferers particularly might current with atypical signs reminiscent of fatigue, decreased alertness, decreased mobility, diarrhea, lack of urge for food, delirium, and absence of fever.

Signs reminiscent of dyspnea, fever, gastrointestinal (GI) signs or fatigue as a consequence of physiologic variations in pregnant ladies, hostile being pregnant occasions, or different illnesses reminiscent of malaria, might overlap with signs of COVID-19.

Kids won’t have reported fever or cough as often as adults.

Given these limitations, services ought to outline a standardized set of indicators and signs (e.g., fever and/or cough/shortness of breath) to display healthcare employees and sufferers for suspected COVID-19. A excessive stage of suspicion is essential to make sure circumstances don’t go unrecognized as a consequence of a considerable proportion of sufferers and healthcare employees presenting with atypical or minimal signs.

3. Basic Finest Practices

Along with a particular technique for the identification of suspected COVID-19 circumstances, there are common finest practices that may enhance each healthcare employee and inpatient COVID-19 screening. Some examples embrace:

Monitor and Handle Ailing and Uncovered Healthcare Employees

  • Amenities and organizations offering healthcare ought to implement sick depart insurance policies for healthcare employees which are non-punitive, versatile, and in step with public well being steering.
  • Motion and monitoring selections for healthcare employees with publicity to COVID-19 needs to be made in session with public well being authorities.

Practice and Educate Healthcare Employees

  • Present healthcare employees with job- or task-specific schooling and coaching on figuring out and stopping transmission of infectious brokers, together with refresher coaching.
  • Be sure that healthcare employees are educated, skilled, and have practiced the suitable use of non-public protecting gear (PPE) previous to caring for a affected person.
  • Present job-aids and up-to-date reference supplies.
  • Encourage and help a excessive index of suspicion in healthcare employees concerning suspect COVID-19 circumstances.

Set up Reporting inside and between Healthcare Amenities and to Public Well being Authorities

  • Implement mechanisms and insurance policies that promote situational consciousness for facility workers about confirmed or suspected COVID-19 sufferers and facility plans for response, together with:
    • An infection management
    • Healthcare epidemiology
    • Facility management
    • Occupational well being
    • Scientific laboratory
    • Frontline workers
  • Talk and collaborate with public well being authorities.
  • Talk details about confirmed or suspected COVID-19 sufferers to applicable personnel earlier than transferring to different departments within the facility and to different healthcare services.

4. Surveillance Capacities

Facility-based surveillance for healthcare-associated infections (HAIs), together with infections in healthcare employees and inpatients, is likely one of the WHO’s eight core parts of an infection prevention and management (IPC)exterior icon.  Whereas surveillance is a essential element of offering secure healthcare, you will need to acknowledge that it requires experience, good high quality information, and a longtime IPC program and thus, might require time to arrange. Because of this, throughout public well being emergency response, healthcare services are inspired to initially implement facility-based, suspect COVID-19 affected person case discovering (surveillance) that’s possible with present surveillance capacities.

Well being facility surveillance capability varies significantly even inside well being techniques.  A sensible appraisal of capability will help determine the very best technique for a given context.  A common description of surveillance capacities based mostly on present HAI surveillance exercise is supplied for steering.

5. Identification of Healthcare employees with suspected COVID-19

Goal:  Forestall publicity of at-risk sufferers and workers to symptomatic COVID-19 constructive healthcare employees.

Figure: Passive identification of healthcare workers with suspected COVID-19

Determine: Passive identification of healthcare employees with suspected COVID-19

Passive technique

All healthcare employees self-assess for fever and/or an outlined set of newly current signs indicative of COVID-19.  If fever or respiratory signs are current, healthcare employees:


Establishes mechanisms for the identification of healthcare employees at elevated chance of an infection with minimal useful resource necessities.


  • Checklist of signs and thermometer for self-assessment.
  • Workers and mechanism (e.g., phone line) for distant reporting of fever and/or presence of signs in step with COVID-19. Ideally this method is all the time out there for fast medical evaluation. If reporting system shouldn’t be out there, symptomatic healthcare employees mustn’t report back to their facility till they are often evaluated.
  • Resolution algorithms for response to healthcare employee stories and the outcomes of secondary evaluation.
  • Standardized medical evaluation and motion and monitoring varieties.


  • Adherence is very depending on healthcare employee motivation and applicable self-assessment of danger.
  • May end up in discount in work drive, significantly amongst some essential staffing classes.
  • Provision of paid sick depart/compensation for all healthcare employees not allowed to work is usually essential for fulfillment, requiring substantial sources.
Figure: Enhanced passive identification of healthcare workers with suspected COVID-19

Determine: Enhanced passive identification of healthcare employees with suspected COVID-19

Enhanced passive technique

Along with passive technique, set up a plan to remind or immediate employees to self-assess for signs in step with COVID-19. Frequent reminders embrace automated textual content messages or telephone calls.


Proof suggests that straightforward automated reminders can improve adherence.


  • All necessities of Passive Technique
  • Automated (e.g., mass texting service) or handbook system (e.g., direct messaging or telephone calls) to contact healthcare employees as immediate for self-assessment

Necessities (Automated System):

  • Mass Textual content Messaging Companies able to sending textual content messages to teams of individuals concurrently. Mass Textual content Messaging Companies are typically supplied by unbiased internet-based service firms or are typically supplied by mobile service suppliers.
  • Database of contacts (i.e., healthcare employees below monitoring). Along with contact quantity, database fields might embrace title, place, work unit/space, and monitoring finish date.
  • An efficient and informative textual content message together with frequency of messaging, timing of supply, and any interactivity of interventions5.

Necessities (Guide System):

  • Database of contacts (i.e., healthcare employees below monitoring). Due to the hassle required in handbook techniques, this database needs to be fastidiously focused to attenuate workload and maximize profit. Issues for concentrating on would possibly embrace:
    • Documented COVID-19 publicity
    • Serving a inhabitants at high-risk for extreme sickness from COVID-19
    • Serving a inhabitants at elevated danger of being COVID-19 constructive circumstances
  • Workers out there to contact monitored healthcare employees with reminders.
  • Telephone and telephone credit score to help messaging and or calls.


  • Similar as Passive Technique
  • Funding could also be required to help bulk textual content messaging
Figure: Active identification of healthcare workers with suspected COVID-19

Determine: Lively identification of healthcare employees with suspected COVID-19

Lively technique

All healthcare employees current for in-person analysis of signs and fever prior to every shift. If signs constant of COVID-19 are reported or noticed, healthcare employees are supplied with fast follow-up actions.

Distant energetic technique

All healthcare employees report (e.g., by name or textual content) the absence or presence of signs in step with COVID-19 remotely every day. Workers that fail to report or report signs are adopted up.


Whereas there’s restricted proof for the advantage of energetic healthcare employee monitoring, energetic methods will theoretically end in elevated healthcare employee adherence to self-evaluation of signs, thus enhancing affected person and healthcare employee safety.

Necessities (Lively technique):

  • All necessities of Passive Technique
  • Devoted workers to judge healthcare employees earlier than their shift (energetic) or reply and monitor healthcare employee stories
  • Bodily space for employees evaluations that may enable really helpful social distancing (i.e., no less than one meter) and consists of sufficient hand hygiene stations (cleaning soap and working water or alcohol-based hand rub)
  • No contact thermometers
  • Implementation plan that features a methodology to make sure that workers current at a given place for pre-shift analysis
  • Accountability system to make sure all healthcare employees have been evaluated (e.g., work slip sign-off)

Necessities (Distant Lively Technique):

  • All necessities of Passive Technique
  • Accountability system to make sure all healthcare employees report in remotely previous to their work shift


  • Similar as Passive Technique.
  • Lively monitoring of healthcare employees may be extremely resource-intensive. There’s restricted proof of elevated effectiveness in prevention of nosocomial transmission past passive methods.
  • Acceptance by workers may be restricted by perceptions of distrust in capacity to observe and appropriately report signs.
  • Lively monitoring can lower the chance that healthcare employees self-monitor indicators and signs. Ideally, healthcare employees are checking their very own temperature and signs and won’t current if not indicated. Any motion that weakens self-monitoring needs to be carried out with warning.
  • To lower workload, and if accountability may be maintained, the next may be delegated to unit/fast supervisors (e.g., head/cost nurses, division heads):
    • Accountability for receiving symptom/temperature stories
    • Monitoring workers compliance for the distant energetic technique

6. Identification of Inpatients with suspected COVID-19

The event of acute respiratory an infection and healthcare-associated pneumonia are widespread problems of hospitalization. Nevertheless, it will be significant that clinicians preserve a excessive stage of suspicion for COVID-19 when there’s a appropriate presentation. As a result of healthcare services typically characterize a gathering of people at larger danger of an infection and hostile outcomes, the potential for outbreaks and hurt to sufferers requires particular effort to make sure any inpatient COVID-19 circumstances are recognized.

A aim of figuring out inpatients with suspected COVID-19 is to information IPC methods to stop or restrict transmission in healthcare setting.  See interim WHO steering on an infection prevention and management throughout well being care when COVID-19 is suspectedexterior icon.

Figure: Passive strategy for identification of inpatients with suspected COVID-19

Determine: Passive technique for identification of inpatients with suspected COVID-19

Passive Technique:

Clinicians are stored knowledgeable6 on:

Clinicians are additionally made conscious of what to do if they think COVID-19 in a hospitalized affected person, together with isolation precautions, PPE use, reporting/informing IPC point of interest on the facility and public well being authorities, and tips on how to receive testing, if out there.

Beneficial Surveillance Capability Stage:

Relevant in any respect HAI surveillance capability ranges (i.e., very low to excessive)


Minimal disruption of present medical observe and no requirement for standardized information assortment or kind completion. Technique seeks to encourage recognition and reporting by astute clinicians.


  • Common and up-to-date academic supplies/job aids supplied to and accessible by clinicians
  • COVID-19 case definitions
  • Commonplace working process (SOP) for response to recognized suspect case sufferers (e.g., isolation, cohorting, PPE).
  • Acceptable reporting/communication channels to hospital administration and public well being authorities


  • Technique relies on participation and talent of obtainable clinicians and an understanding of native epidemiology and medical presentation of COVID-19, which can differ in several populations.
  • Restricted entry to diagnostic testing will complicate this effort with probably the most conservative technique being to deal with all suspect circumstances as confirmed circumstances (empirical case dedication) – doubtlessly losing sources, and if circumstances are cohorted, mixing constructive and detrimental sufferers for prolonged durations.
    • The diploma of useful resource waste and case affected person mixing will rely on the accuracy of empirical case dedication.
    • Supporting empirical case dedication by way of clinician schooling and job aids (as described) will help enhance accuracy of medical analysis of COVID-19.
Figure: Enhanced passive strategy for identification of inpatients with suspected COVID-19

Determine: Enhanced passive technique for identification of inpatients with suspected COVID-19

Enhanced Passive Technique:

Enhancement of the passive technique may be achieved by way of establishing techniques that immediate or require clinicians to frequently assessment all sufferers for suspected COVID-19. Instance enhanced passive methods would possibly embrace:

  • Incorporating consideration of COVID-19 into sign-out reporting
  • Requiring items to supply a each day clinician-generated record of suspected circumstances, together with if there are zero circumstances
  • Sending particular each day requests to clinicians to report and talk about encountered sufferers with signs in step with COVID-19

Beneficial Surveillance Capability Stage:

Relevant in most HAI surveillance capability ranges (very low to excessive)


Dialogue and accountability for case discovering and reporting can enhance empirical case dedication, guarantee affected person evaluations should not missed, and assist keep away from clinician complacency over the long-term


  • All necessities of Passive Technique
  • Technique to immediate and/or guarantee clinician assessment – necessities will rely on chosen technique


  • Efficient methods can be context particular and require thought and energy in design and implementation
  • Could characterize adjustments to present observe, which may restrict acceptability
Figure: Active strategy for identification of inpatients with suspected COVID-19

Determine: Lively technique for identification of inpatients with suspected COVID-19

Lively Technique:

Lively case identification includes focused information assortment and assessment of affected person info by teams particularly chargeable for the identification of suspected COVID-19 circumstances. Examples of teams chargeable for case identification and energetic case identification might embrace:

  • Ministries of Well being
  • Sub-national/native public well being authorities
  • Facility an infection prevention and management groups

Beneficial Surveillance Capability Stage:

Excessive present surveillance capability or medium capability with the availability of further sources


Smaller extra centralized staff chargeable for case identification can improve total high quality by way of devoted coaching, improved engagement, limiting of competing priorities, and standardization of strategies


  • Crew with the data entry, sources, and expertise obligatory for systematic assessment of affected person info so as to appropriately apply standardized suspect case definitions
  • Group(s) with availability and duty for information assortment, evaluation/presentation, and knowledge sharing
  • Group(s) with availability and duty for assessment of case-finding info with the authority and willingness to take applicable motion


  • Extremely resource-intensive
  • Groups with the requisite abilities may be troublesome to construct throughout outbreak response durations
  • Separates case discovering actions from affected person care actions, which may lower acceptability and affect sustainability
  • Worth of energetic inpatient case discovering, particularly the context of restricted diagnostic testing, needs to be fastidiously thought of

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