#17,720
The World Health Organization has published their latest (ver. 6.0) in an ongoing series of infection prevention and control recommendations for COVID-19, which primarily deals with IPC measures in health-care settings, but also addresses mask use and social distancing in the community.
This `living document' has grown from 78 pages (vers 4.0 January 2023) to 141 pages in this latest edition.
9 October 2023. Geneva: World Health Organization; 2023 (WHO/2019-nCoV/IPC/guideline/ 2023.3). Licence: CC BY-NC-SA 3.0 IGO.
The WHO summary follows:
Overview
The Infection prevention and control in the context of coronavirus disease 2019 (COVID-19): a living guideline consolidates technical guidance developed and published during the COVID-19 pandemic into evidence-informed recommendations for infection prevention and control (IPC). This living guideline is available both online and PDF.
This version of the living guideline (version 6.0) includes fifteen statements on IPC measures in health-care settings (screening and patient placement, ventilation, physical barriers, environmental cleaning, waste management, amongst others) as well as one statement on mask fit in the community context.
Understanding the updated section
The update to this guideline considers the transition from critical emergency-response activities to longer-term, sustained COVID-19 disease prevention, control and management, and a shift towards integration of IPC activities into routine systems and practices. This includes a return to standard and transmission-based precautions in health-care settings, and the adoption of public health practices for community settings. Updated recommendations for health-care facilities include a focus on the hierarchy of control measures, source control, standard and transmission-based precautions. The prevention of health care-associated infections involves a multi-pronged and multi-factorial approach that includes infection prevention and control and occupational health and safety measures.
Aside from its expanded size, this latest document spends a good deal more time discussing airborne spread of the virus, using the term `airborne' 51 times compared to only 9 times in last January's (Ver. 4.0) edition.
Due to its length, I've elected only to post their opening list of new, and updated, recommendations. Follow the link to read the full document.
1.1 Summary of new and updated statementsNew statements1. A respirator or a medical mask should be worn along with other PPE – a gown, gloves and eye protection – by health and care workers providing care to a patient with suspected or confirmed COVID-19. (Strong recommendation, based on low certainty of evidence)
2. Suggested factors for informing the choice of the type of mask include a risk assessment and health and care workers’ values and preferences. WHO suggests respirators be used in care settings where ventilation is known to be poor or cannot be assessed, or the ventilation system is not properly maintained. (Conditional recommendation, based on low certainty of evidence)
3. WHO suggests using airborne precautions while performing aerosol-generating procedures (AGPs) and, based on a risk assessment, when caring for patients with suspected or confirmed COVID-19. (Conditional recommendation, very low certainty of evidence)
4. The WHO recommends adhering to the ventilation rate requirements for health-care facilities in the context of COVID-19. (Strong recommendation, very low certainty of evidence)
5. Maintain a physical distance of at least one metre between and among patients, staff and all other persons in health-care settings, when feasible. When possible, increase this distance. (Good practice statement)
6. WHO suggests that physical barriers such as glass or plastic windows may be considered for areas where patients first present, such as screening and triage areas, the registration desk at the emergency department and the pharmacy window. (Conditional recommendation, very low certainty of evidence)
7. For COVID-19, health care settings should use standard precautions for the cleaning and disinfection of the environment and other frequently touched surfaces. (Good practice statement)
8. Health-care facilities should follow standard precautions for handling, transporting, sorting and laundering of linens of patients with suspected or confirmed COVID-19. (Good practice statement)
9. Health-care waste generated from care provided to suspected or confirmed COVID-19 patients should be segregated according to existing guidelines (e.g. non-infectious, infectious, sharps) for disposal and, where necessary, treated per national/subnational/local regulations and policies. (Good practice statement)
10. Health and care workers and other persons involved in handling the deceased should follow standard precautions according to risk assessment and existing national/subnational/local protocols for handling the bodies of deceased persons infected with COVID-19. (Good practice statement)
11. When wearing masks in community settings, individuals should use well-fitting masks with full coverage of the nose and mouth. (Good practice statement)
Updated statements1. WHO recommends universal masking in health-care facilities when there is a significant impact of COVID-19 on the health system. (Strong recommendation, based on very low certainty of evidence)2. WHO suggests targeted continuous medical mask use in health-care facilities in situations with minimum to moderate impact of COVID-19 on the health system. (Conditional recommendation, based on very low certainty of evidence)3. Appropriate mask fitting should always be ensured (for respirators, through fit testing and a user seal check when a filtering facepiece respirator is put on; and for medical masks, through methods to reduce air leakage around the mask) as well as compliance with appropriate use of PPE and other standard and transmission-based precautions. (Good practice statements)4. A respirator should always be worn along with other PPE by health workers performing aerosol-generating procedures (AGP) and by health workers on duty in settings where AGP are regularly performed on patients with suspected or confirmed COVID-19, such as intensive care units, semi-intensive care units or emergency departments. (Strong recommendation, based on low certainty of evidence)
