Pragmatic Recommendations for Infection Prevention and Control Practices for Healthcare Facilities in Low- and Middle-Income Countries during the COVID-19 Pandemic

View More View Less
  • 1 Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington;
  • 2 Division of Pulmonary and Critical Care Medicine, Atrium Health, Charlotte, North Carolina;
  • 3 Section of Operative Research, Doctors with Africa, CUAMM, Padova, Italy;
  • 4 Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand;
  • 5 Department of Intensive Care, Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam University Medical Centers, Amsterdam, The Netherlands;
  • 6 Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom;
  • 7 Divisao de Pneumologia, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil

Infection prevention and control (IPC) strategies are key in preventing nosocomial transmission of COVID-19. Several commonly used IPC practices are resource-intensive and may be challenging to implement in resource-constrained settings. An international group of healthcare professionals from or with experience in low- and middle-income countries (LMICs) searched the literature for relevant evidence. We report on a set of pragmatic recommendations for hospital-based IPC practices in resource-constrained settings of LMICs. For cases of confirmed or suspected COVID-19, we suggest that patients be placed in a single isolation room, whenever possible. When single isolation rooms are unavailable or limited, we recommend cohorting patients with COVID-19 on dedicated wards or in dedicated hospitals. We also recommend that cases of suspected COVID-19 be cohorted separately from those with confirmed disease, whenever possible, to minimize the risk of patient-to-patient transmission in settings where confirmatory testing may be limited. We suggest that healthcare workers be designated to care exclusively for patients with COVID-19, whenever possible, as another approach to minimize nosocomial spread. This approach may also be beneficial in conserving limited supplies of reusable personal protective equipment (PPE). We recommend that visitors be restricted for patients with COVID-19. In settings where family members or visitors are necessary for caregiving, we recommend that the appropriate PPE be used by visitors. We also recommend that education regarding hand hygiene and donning/doffing procedures for PPE be provided. Last, we suggest that all visitors be screened for symptoms before visitation and that visitor logs be maintained.

Author Notes

Address correspondence to Natalie Cobb, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington Medical Center, 1959 NE Pacific St., Box 356522, Seattle, WA 98195. E-mail: ncobb@uw.edu

COVID–LMIC Task Force members (in alphabetical order): Andrew Achilleos (Sunnybrook Health Sciences Centre, Toronto, Canada); Hanan Y. Ahmed (Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia); Kevan M. Akrami (Universidade Federal da Bahia, Salvador, Brazil; University of California San Diego, San Diego, CA); Lia M. Barros (University of Washington, Seattle, WA); Jason Brotherton (AIC Kijabe Hospital, Kijabe, Kenya); Sopheakmoniroth Chea (Calmette Hospital, Phnom Penh, Cambodia); William Checkley (The Johns Hopkins University School of Medicine and The Johns Hopkins University Center for Global Health, Baltimore, MD); Elif Cizmeci (Interdepartmental Division of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada); Natalie Cobb (University of Washington, Seattle, WA); Finot Debebe (Department of Emergency Medicine and Critical Care, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia); Juliana C. Ferreira (University of São Paulo, São Paulo, Brazil); Gabriela Galli (University of Pittsburgh School of Medicine, Pittsburgh, PA); Tewodros Haile (Department of Internal Medicine, College of Health Sciences, Addis Ababa University); Bhakti Hansoti (Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD); Madiha Hashmi (Ziauddin University, Karachi, Pakistan); Rebecca Inglis (Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Mahosot Hospital, Vientiane, Lao People's Democratic Republic and Department of Intensive Care, Oxford University Hospital Trust, Oxford, United Kingdom); Burton W. Lee (NIH, Bethesda, MD; University of Pittsburgh School of Medicine, Pittsburgh, PA); Faith Lelei (AIC Kijabe Hospital, Kijabe, Kenya); Ganbold Lundeg (Mongolian National University of Medical Sciences, Ulan Bator, Mongolia; David Misango (The Aga Khan University, Nairobi, Kenya); Ary Serpa Neto (Department of Critical Care Medicine and Institute of Education and Research, Hospital Israelita Albert Einstein, São Paulo, Brazil; Department of Intensive Care, Amsterdam University Medical Centers, location “AMC,” University of Amsterdam, Amsterdam, The Netherlands); Alfred Papali (Atrium Health, Charlotte, NC); Casey Park (Interdepartmental Division of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada); Rajyabardhan Pattnaik (Ispat General Hospital, Rourkela, India); Jennifer L. Pigoga (Division of Emergency Medicine, University of South Africa, Cape Town, South Africa); Luigi Pisani (Doctors with Africa – CUAMM, Padova, Italy; Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand); Elisabeth D. Riviello (Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA); Kristina E. Rudd (University of Pittsburgh School of Medicine, Pittsburgh, PA); Marcus Schultz (Mahidol University, Bangkok, Thailand; University of Oxford, Oxford, United Kingdom; Amsterdam University Medical Centers, location “AMC,” Amsterdam, The Netherlands); Varun U. Shetty University of Pittsburgh School of Medicine, Pittsburgh, PA); Gentle S. Shrestha (Tribhuvan University Teaching Hospital, Kathmandu, Nepal); Chaisith Sivakorn (Mahidol University, Salaya, Thailand); Shaurya Taran (Interdepartmental Division of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada); T. Eoin West (University of Washington, Seattle, WA).

Group members of the subgroup “Organization”: Natalie Cobb (University of Washington, Seattle, WA); Juliana Ferreira (University of São Paulo, São Paulo, Brazil); Alfred Papali (Atrium Health, Charlotte, NC); Luigi Pisani (Doctors with Africa – CUAMM, Padova, Italy; Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand); and Marcus Schultz (Mahidol University, Bangkok, Thailand; University of Oxford, Oxford, United Kingdom; Amsterdam University Medical Centers, location “AMC,” Amsterdam, The Netherlands).

Financial support: Open access fees for this article and all nine others in the series were supported by the Wellcome Trust of Great Britain.

Authors’ addresses: Natalie Cobb, University of Washington, Seattle, WA, E-mail: ncobb@uw.edu. Alfred Papali, Atrium Health, Charlotte, NC, E-mail: alfred.papali@atriumhealth.org. Luigi Pisani, Doctors with Africa, CUAMM, Padova, Italy, and Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand, E-mail: luigipisani@gmail.com. Marcus J. Schultz, Mahidol University, Bangkok, Thailand, and Amsterdam University Medical Center, Amsterdam, The Netherlands, E-mail: marcus.j.schultz@gmail.com. Juliana C. Ferreira, University of São Paulo, São Paulo, Brazil, E-mail: juliana.ferreira@hc.fm.usp.br.

Save