Guidelines for Management of Coronavirus Disease 2019 ...

Shaukat Khanum

Guidelines for Management of

Coronavirus Disease 2019 (COVID-19)

Prepared by the

Infection Control Committee

2

Updated: March 26, 2020

Shaukat Khanum Memorial Cancer Hospital and Research Centre

Shaukat Khanum Memorial Cancer Hospital and Research Centre

Infection Control Committee

Coronavirus Disease 2019 (COVID-19)

Contents

Section 1: COVID-19 Basics, Outpatient Pathway and Testing

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Background; Case definitions 2 Isolation precautions; COVID-19 screening 3 Pathway for patients with suspected COVID-19 in the outpatient setting 4 COVID-19 Testing 6 Cleaning of rooms and medical equipment used for COVID-19 patients 7

Section 2: COVID-19 Clinical Syndromes and Inpatient Management

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Isolation precautions and PPE for COVID-19 patients 11 Transporting COVID-19 patients 12 Room allocation for COVID-19 patients 12 COVID-19 patients requiring medical procedures 12 COVID-19 visitor policy 13 COVID-19 patients and cardiopulmonary resuscitation 13 When can isolation precautions be discontinued? 13 What if there is strong clinical suspicion but test results are negative? 13 When can the patient be discharged? 13 What instructions must patients be given on discharge? 13

Section 3: Personal Protective Equipment (PPE)

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Recommendations for PPE use 14 Recommendations for PPE in the EAR, IPD 15

Recommendations for PPE in the ICU 16

Recommendations for PPE Reuse 17

Section 4: Frequently Asked Questions (FAQs)

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What resources are these guidelines based on? 19 What is the policy for pregnant healthcare workers? 19 What should employees with cough/cold symptoms do? 19

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How can hospital staff protect themselves from COVID-19? 19 Appendix A: Patient Under Investigation (PUI) Form 20

Section 1: COVID-19 Basics, Outpatient Pathway and

Testing

Background

• Caused by SARS-COV-2, first identified in Wuhan, China in 12/2019

• Transmission: human-to-human

→modes of transmission: contact and droplets

• Incubation period: 5-14 days

• Spectrum of infection: mild respiratory illness (~80% of cases) to pneumonia/acute respiratory

distress syndrome; mortality 2-3%

Case Definitions: Suspect case

1. A patient with acute respiratory illness (fever and at least one sign/symptom of respiratory disease, e.g., cough, shortness of breath), AND a history of travel to or residence in a location reporting community transmission of COVID-19 disease during the 14 days prior to symptom onset (includes international travel and travel from Karachi) OR

2. A patient with any acute respiratory illness AND having been in contact with a confirmed or probable COVID-19 case (see definition of contact) in the last 14 days prior to symptom onset; OR

3. A patient with severe acute respiratory illness (fever and at least one sign/symptom of respiratory disease, e.g., cough, shortness of breath; AND requiring hospitalization) AND in the absence of an alternative diagnosis that fully explains the clinical presentation.

Probable case

1. A suspect case for whom testing for the COVID-19 virus is inconclusive OR

2. A suspect case for whom testing could not be performed for any reason. Confirmed case

1. A person with laboratory confirmation of COVID-19 infection, irrespective of clinical signs and symptoms.

Definition of contact

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• A contact is a person who experienced any one of the following exposures during the 2 days before and the 14 days after the onset of symptoms of a probable or confirmed case:

1. Face-to-face contact with a probable or confirmed case within 1 meter and for more than 15 minutes;

2. Direct physical contact with a probable or confirmed case; 3. Direct care for a patient with probable or confirmed COVID-19 disease without using proper

personal protective equipment; OR

4. Other situations as indicated by local risk assessments. Note: for confirmed asymptomatic cases, the period of contact is measured as the 2 days before through the 14 days after the date on which the sample was taken which led to confirmation

Isolation Precautions:

• Standard + contact+ droplet: for all patients

• Standard+ contact+ airborne: for patients requiring aerosol-generating procedures e.g.

bronchoscopy, CPR, intubation, nasopharyngeal specimen collection, noninvasive ventilation,

airway suctioning, dental procedures ONLY. Any other procedures do not fall under this list.

• Eye protection: for all patients

COVID-19 Screening:

• 9:00 am to 5:00 pm Monday to Friday:

→Screening will be performed at designated COVID screening counters outside the hospital

→PCOs inside the hospital will continue to screen the patients arriving at their counters

• 5:00 pm to 9:00 am Monday to Friday and on weekends:

→Screening to be performed by PCOs at their respective counters

• For patients meeting the case definition, activate the plan for suspected COVID cases:

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PCO to screen patient:--cough/fever/sore throat/

shortness of breathAND

--ANY international travel; or travel to Karachi; or contact with a

person with known or suspected COVID-19

--Offer surgical mask (simple mask-not N-95)--Cough etiquette teaching--Call area supervisor--Transfer to clinic room reserved for patients meeting case definition (Room 23 OPD counter 2 at SKM-LHR)--Inform Infection Control nurse and ID fellow on call

ID team to assess severity of illness.

Does the patient require admission?

-Inpatient management-Allocate single room-Follow contact and droplet precautions-Follow contact and airborne precautions for patients undergoing aerosol generating precedures*-Use eye protection for all patients-Nasopharyngeal swab to be collected and transported to the lab by ID fellow ⴕ-ID fellow to fill out PUI form-Maintain a list of all hospital staff involved in care of suspected or confirmed cases-No visitors allowed

-Outpatient management -Follow contact and droplet precautions during evaluation-Follow contact + airborne precautions for patients undergoing aersol-generating procedures*-Use eye protection-Nasopharyngeal swab to be collected and transported to the lab by ID fellowⴕ-ID fellow to fill out PUI form-Discharge with supportive medications

No additional steps required . Proceed as per routine .

Pathway for Patients with Suspected COVID-19 in the Outpatient Setting

YES NO

YES NO

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PCO: patient care officer; PUI : person under investigation

*Aerosol generating procedures: nasopharyngeal sample collection, bronchoscopy, airway suctioning,

noninvasive ventilation, intubation, CPR, dental procedures

ⴕWear a simple surgical mask for nasopharyngeal samples collected in open air

All samples must be placed in a biohazard bag, then in a puncture proof container or a second biohazard

bag and transported to the lab.

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COVID-19 Testing

• Who should be tested for COVID-19?

→Patients meeting the case definition

• What COVID-19 test are we performing?

→PCR on nasopharyngeal swab

→Nasopharyngeal swab must be collected as shown in the diagram below

→Additionally, 5 ml of blood must be drawn in a purple top vial and transported to the lab for

storage as per NIH guidelines

• Where will samples be collected?

For stable patients:

→In open air

→Those collecting the sample in open air should wear a surgical mask

For unstable patients in EAR/IPD/ICU:

→In negative pressure rooms

→Those collecting the sample must wear N-95 masks

• Who will collect and transport the sample?

Outpatient:

→9:00 am to 5:00 pm: Samples to be collected by ID fellow on call; transport by porter

→5:00 pm to 9:00 am: NO outpatient testing for stable patients

Inpatient and EAR:

→Sample collection by on-call IM resident; transport by porter

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*Samples must be placed in a biohazard bag, then in a puncture proof container or a second

biohazard bags for transport

• What is the reporting time for COVID-19 testing?

48 hours

Cleaning of rooms and medical equipment used for

COVID-19 patients

• The virus can persist on surfaces for up to 72 hours

• Therefore, it is crucial to clean rooms and medical equipment as per hospital policy for contact

and droplet/airborne precautions where applicable

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Section 2: Clinical Syndromes Associated with COVID-19

and Inpatient Management

1. Clinical syndromes associated with COVID-19

Clinical Syndrome

Features Laboratory Investigations

Management

Mild illness • Uncomplicated upper respiratory tract viral infection

• Non-specific symptoms such as fever, fatigue, cough (with or without sputum production), anorexia, malaise, muscle pain, sore throat, dyspnea, nasal congestion, or headache

• Rarely, patients may also present with diarrhea, nausea, and vomiting

• No breathing difficulty or supplemental oxygen requirement

• None

As prescribed by registered medical practitioner

Severe pneumonia

• Adolescent or adult: fever and lower respiratory infection, plus one of the following: respiratory rate > 30 breaths/min; severe respiratory distress; or SpO2 ≤ 93% on room air

• Child with cough or difficulty in breathing, plus at least one of the following: central cyanosis or SpO2 < 90%; severe respiratory distress (e.g. grunting, very severe chest indrawing); signs of

• Tests should be ordered in view of the patient’s clinical condition

• It is reasonable to order baseline investigations e.g. CBC, U&E, LFTs, blood cultures, sputum culture and chest X Ray

• Lab abnormalities identified among COVID cases may include leukopenia, mild


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pneumonia with a general danger sign: inability to breastfeed or drink, lethargy or unconsciousness, or convulsions. Other signs of pneumonia may be present: chest indrawing, fast breathing (in breaths/min): < 2 months: ≥ 60; 2–11 months: ≥ 50; 1–5 years: ≥E 40

elevation of transaminases, bilateral chest infiltrates on chest X Ray

Acute respiratory distress syndrome (ARDS)

• Onset: within 1 week of a known clinical insult or new or worsening respiratory symptoms.

• Chest imaging (radiograph, CT scan, or lung ultrasound): bilateral opacities, not fully explained by volume overload, lobar or lung collapse, or nodules.

• Origin of pulmonary infiltrates: respiratory failure not fully explained by cardiac failure or fluid overload. Need objective assessment (e.g. echocardiography) to exclude hydrostatic cause of infiltrates/edema if no risk factor present.

• Tests should be ordered in view of the patient’s clinical condition.


• Lab abnormalities identified among COVID cases may include leukopenia, mild elevation of transaminases, bilateral chest infiltrates on chest X Ray


Sepsis • Adults: life-threatening organ dysfunction caused by a dysregulated host response to suspected or proven infection. Signs of organ dysfunction include:


• It is reasonable to order baseline investigations e.g. CBC, U&E,


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altered mental status, difficult or fast breathing, low oxygen saturation, reduced urine output, fast heart rate, weak pulse, cold extremities or low blood pressure, skin mottling, or laboratory evidence of coagulopathy, thrombocytopenia, acidosis, high lactate, or hyperbilirubinemia

• Children: suspected or proven infection and ≥ 2 age- based systemic inflammatory response syndrome criteria, of which one must be abnormal temperature or white blood cell count.

LFTs, blood cultures, sputum culture and chest X Ray

• Lab abnormalities identified among COVID cases may include leukopenia, mild elevation of transaminases, bilateral chest infiltrates on chest X Ray

Septic shock

• Adults: persisting hypotension despite volume resuscitation, requiring vasopressors to maintain MAP ≥ 65 mmHg and serum lactate level > 2 mmol/L.

• Children: any hypotension (SBP < 5th centile or > 2 SD below normal for age) or two or three of the following: altered mental state; tachycardia or bradycardia (HR < 90 bpm or > 160 bpm in infants and HR < 70 bpm or > 150 bpm in children); prolonged capillary refill (> 2 sec) or feeble pulse; tachypnoea; mottled or cool skin or petechial or



• Lab abnormalities identified among COVID cases may include leukopenia, mild elevation of transaminases, bilateral interstitial chest infiltrates on chest imaging


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purpuric rash; increased lactate; oliguria; hyperthermia or hypothermia

• All patients requiring admission will be treated with chloroquine or hydroxychloroquine as

outlined in the chart above

• Consider early intubation for all those requiring noninvasive ventilation

• ACE-i and ARBs may be continued for patients already on these

• Use paracetamol instead of ibuprofen as an antipyretic

2. Isolation Precautions and PPE for COVID-19 patients

• Standard + contact+ droplet: for all patients

• Standard+ contact+ airborne: for COVID-19 patients admitted in the ICU and those requiring

aerosol-generating procedures e.g. bronchoscopy, CPR, intubation, nasopharyngeal specimen

collection, noninvasive ventilation, airway suctioning, dental procedures ONLY. Any other

procedures do not fall under this list.

• Eye protection: for all patients

• To minimize exposure to airborne droplet nuclei, N-95 masks must form a tight seal around the

nose and mouth. Facial hair present along the edges of the mask prevents formation of this seal

and results in exposure to airborne infections.

• Since specialized respirators are not available at our facility, staff members with

beards/sideburns/moustaches, who are expected to perform or assist with aerosol generating

procedures, or care for patients in the ICU or the floor must ensure that the area of the mask

seal is clean shaven • The virus can persist on surfaces for up to 72 hours. Therefore, it is crucial to clean rooms and

medical equipment as per hospital policy for contact and droplet/airborne precautions where

applicable

• PPE guidelines must be followed by ALL staff members entering patient rooms

3. Transporting COVID-19 patients

• Patients must NOT be transported to other departments unless absolutely necessary (eg for

emergent, life-saving procedures, or EAR to IPD or ICU)

• In the event of transfer, do the following:

• Inform the receiving department over the phone with details of isolation precautions required

• The patient must wear a surgical mask during transfer

• Post appropriate isolation signs outside the patient’s room

• Healthcare staff do not need to wear PPE while transporting patients

• Once transferred, the patient should be moved directly to the intended IPD or EAR

room/procedure room etc.- patients must NOT be seated in the waiting area

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4. Room allocation for COVID-19 patients

• Single rooms must be allocated while patients are under investigation for COVID-19

• Patients with confirmed COVID-19 may be cohorted i.e. placed in the same room

5. COVID-19 patients requiring medical procedures

• All elective procedures must be cancelled to minimize transport and avoid unnecessary

exposure to hospital staff and other patients

• For patients requiring emergent/lifesaving procedures: i) schedule procedures at the end of list of possible ii) shift patients directly from the inpatient unit to the procedure room iii) bronchoscopies to be performed in negative pressure rooms iv) In addition to standard PPE required for the planned procedure, the following apply: →standard+ contact + airborne precautions + goggles/face shield for bronchoscopy → standard+ contact + droplet precautions + goggles/face shield for endoscopy/ radiology procedures/surgery; disposable shoe and hair covers may be worn if procedures entail the risk of splashes v) PPE guidelines must be followed by ALL staff members present inside the procedure rooms as well as housekeeping staff who clean these rooms following procedures vi) terminal cleaning of rooms to be performed as per hospital policy for contact and droplet/airborne isolation rooms

6. COVID-19 visitor policy • NO visitors will be allowed for adult patients

• Pediatric patients are allowed one attendant who will be treated as though infected. The attendant will wear a mask and will not be allowed to leave the room.

7. COVID-19 patients and cardiopulmonary resuscitation • Wear the appropriate PPE before participating in a code

8. When can isolation precautions be discontinued? The patient must meet the following criteria:

• it has been >7 days since diagnosis AND

• the patient has clinically improved and no longer requiring respiratory support AND

• PCR testing is negative on 2 consecutive nasopharyngeal swabs taken 24 hours apart

9. What if there is strong clinical suspicion for COVID-19 but the test results are negative?

• Continue isolation precautions and repeat nasopharyngeal PCR in 3 days

10. When can the patient be discharged?

• Once clinically stable and deemed fit for discharge by the evaluating physician

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• Patients do not need to be quarantined at the hospital if medically stable

11. What instructions must patients be given on discharge? • Patients with negative PCRs on 2 consecutive nasopharyngeal swabs taken at least 24 hours

apart →no further steps required

• Patients discharged without PCR testing on nasopharyngeal samples →may be contagious until at least 7 days following initial diagnosis of infection; and 3 days after complete resolution of symptoms →advise social distancing (avoid gatherings, maintain at least 1 meter distance from other individuals, frequent hand washing)

• Reinfection with SARS-CoV-2 has been reported in the literature. Patients with any worsening following discharge must return to the EAR for evaluation.

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Section 3: Personal Protective Equipment (PPE)

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PPE guidelines for EAR, IPD and ICU

Follow standard precautions and strictly adhere to the 5 moments of hand hygiene for patients in all

clinical areas

Emergency Assessment Room (EAR)

All Staff:

• Must wear surgical masks

• Follow the are below the elbows (BBE) policy:

→Must roll sleeves to an inch above the elbows

→No jewelry/rings/bracelets or wrist watches to be worn

→Trim nails to < 1/4 of an inch

→No nail paint or artificial nails to be worn

• May wear surgical scrubs. Use OR changing rooms. Must change out of scrubs before leaving the

hospital

Staff examining/assessing patients/performing vitals/collecting samples:

• Gloves, plastic apron, surgical mask

• Gloves and plastic aprons must be changed between patients

• Use the same surgical mask for the entire shift unless damaged or visibly soiled

If, upon evaluation, a patient in the EAR is suspected to have COVID-19:

• Immediately move to an isolation room and follow droplet and contact precautions; use eye

protection

• PPE includes gloves, gown, surgical mask, eye protection

Taking a COVID-19 nasopharyngeal sample in the EAR:

• Must be performed in a negative pressure room, following airborne precautions

• PPE includes gloves, gown, N-95 mask*, faceshield/goggles^

IPD

Suspected cases must be placed in individual isolation rooms

Confirmed COVID-19 patients may be cohorted (placed in the same room)

Staff caring for suspected/confirmed COVID-19 cases:

• Follow droplet and contact precautions; use eye protection

• PPE includes gloves, gown, surgical mask, faceshield/goggles^

Staff caring for suspected or confirmed COVID-19 patients undergoing aerosol generating

proceduresⴕ:

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• PPE includes gloves, gown, N-95 mask*, faceshield/goggles^

ICU

Staff caring for suspected or confirmed COVID-19 patients in the ICU:

• Require airborne+ contact precautions and eye protection

• PPE to be worn by all staff when entering patients’ rooms: gloves, gown, N-95 mask*,

faceshield/goggles^

• ICU staff must wear ICU scrubs. Use ICU changing rooms. Must change out of scrubs before

leaving the ICU.

ⴕ Aerosol-generating procedures: bronchoscopy, CPR, intubation, nasopharyngeal specimen collection,

noninvasive ventilation, airway suctioning

^Disinfect goggles with alcohol wipes before and after use. Following use, goggles must be placed in

designated drawers in isolation trolleys to be used by the next person

*N-95

→N-95 masks may be obtained from unit coordinators (UCs). UCs must maintain a record of employees

who have been issued N-95 masks with the date the mask was issued.

→Write your employee code on the mask prior to use

→Write employee code on a paper bag prior to use and leave on the isolation trolley. These may be

obtained from unit coordinators covering the shift (image on page 18)

→Wear a surgical mask on top of the N-95 to prevent mask contamination.

→Following use, discard the surgical mask

→Remove the N-95 mask carefully, without touching the front surface and place in the paper bag

→Masks may be reused for up to 7 days or unless visibly soiled or damaged. If your mask is damaged, or

visibly soiled or no long forms a tight seal around your face and mouth, you must notify the UC and

submit the used mask to obtain a new N-95 mask.

→N95 masks worn during intubation cannot be reused and must be discarded. Please note that CDC

currently recommends that masks not be reused following any aerosol generating procedures; however,

given the regional and global shortage of N-95 masks, you may continue to reuse N-95 masks worn

during aerosol generating procedures (other than intubation) as long as you wear a surgical mask on top

of the N-95.

Yellow bins for clinical waste must be placed inside and outside patients’ rooms

Items to be removed inside patients’ rooms:

→gloves, followed by gown

Items to be removed outside patients rooms:

→goggles, followed by mask

Each isolation room must have a dedicated stethoscope

→Disinfect with alcohol wipes before and after each use. Following use, leave stethoscopes inside the

room to be used by the next person

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If multiple patients with confirmed COVID-19 need to be seen:

→ do not remove goggles and mask between patients

→perform hand hygiene before and after seeing patients

→change gown and gloves between patients

Recommendations for PPE Reuse:

Items to be used ONCE only: i) Gloves ii) Gowns iii) Shoe covers, where applicable

Items that can be reused

i) Goggles

→Disinfect with alcohol wipes before and after use.

→ Following use, goggles must be placed in designated drawers in isolation trolleys to be used by the

next person

ii) N-95

→N-95 masks may be obtained from unit coordinators (UCs). UCs must maintain a record of employees

who have been issued N-95 masks with the date the mask was issued.

→Write your employee code on the mask prior to use

→Write employee code on a paper bag prior to use and leave on the isolation trolley. These may be

obtained from unit coordinators covering the shift (image on page 18)

→Wear a surgical mask on top of the N-95 to prevent mask contamination.

→Following use, discard the surgical mask

→Remove the N-95 mask carefully, without touching the front surface and place in the paper bag

→Masks may be reused for up to 7 days or unless visibly soiled or damaged. If your mask is damaged, or

visibly soiled or no long forms a tight seal around your face and mouth, you must notify the UC and

submit the used mask to obtain a new N-95 mask.

→N95 masks worn during intubation cannot be reused and must be discarded. Please note that CDC

currently recommends that masks not be reused following any aerosol generating procedures; however,

given the regional and global shortage of N-95 masks, you may continue to reuse N-95 masks worn

during aerosol generating procedures (other than intubation) as long as you wear a surgical mask on top

of the N-95.

iii) Surgical mask:

→The same surgical mask may be worn per shift unless visibly soiled or damaged

→Do not touch the front surface of the mask

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Section 4: Frequently Asked Questions (FAQs)

1. What resources are these guidelines based on?

• CDC, WHO, NHS

2. What is the policy for pregnant healthcare workers?

• Pregnant healthcare workers will not be required to come to work during the pandemic.

3. What should employees with cough/cold symptoms do?

• Please note that all cough and cold symptoms must not be mistaken for COVID-19

• We are currently using the following case definition for COVID-19

Fever/cough/cold/sore throat

AND

ANY international travel OR exposure to anyone with known or suspected COVID-19 infection

• If you do not meet the case definition, you likely do not have the infection and will not be

offered testing.

• If you have cough/cold symptoms/fever or any other concerning signs/symptoms, please visit

the EHC

• If deemed necessary, the EHC physician will contact the ID team for input

• If symptoms persist or worsen, please do not email members of the ID team as these may not

be responded to in a timely manner. You are requested to follow up with EHC. We discourage

EAR visits unless you feel extremely unwell.

• Those cleared by EHC physicians to return to work must wear a simple surgical mask while at

work

4. How can hospital staff protect themselves from COVID-19?

• Adhere to hand hygiene policies

• Practicing good cough etiquette (cover your cough with your sleeve or tissue, appropriately

dispose of used tissues), avoid touching eyes and mouth

• Avoid crowds and gatherings. Social distancing.

• Please note that routine use of masks is NOT recommended unless you are caring for patients

requiring droplet/airborne precautions

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Appendix A: Patient Under Investigation (PUI) Form

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Patient Under investigation (PUI) Form: Coronavirus Disease (COVID-19)

Shaukat Khanum Memorial Cancer Hospital & Research Centre

PUI Criteria

Date of symptom onset___________________________________________________

Does the patient have the following signs and symptoms (check all that apply)?

☐ Fever1 ☐ Cough ☐ Sore throat ☐ Shortness of breath

Does the patient have these additional signs and symptoms (check all that apply)?

☐ Chills ☐ Headache ☐ Muscle aches ☐ Vomiting ☐ Abdominal pain ☐ Diarrhea ☐ Other, Specify_______________

Any International travel over the past 14 days before symptom onset

Country name:______________________________________

Date traveled to: ___________________ Date traveled from: _________________________ Date arrived in Pakistan: ______________________________

☐ Y ☐ N ☐ Unknown

Have close contact2 with a person under investigation for COVID-19? ☐ Y ☐ N ☐ Unknown

Have close contact2 with a laboratory-confirmed COVID-19 case? In which country was the case diagnosed with COVID-19? ______________________________


Have close contact2 with an individual returning from international travel? Which country did the contact return from? ______________________________


Additional Patient Information

Is the patient a health care worker? ☐ Y ☐ N ☐ Unknown

Have history of being in a healthcare facility (as a patient, worker, or visitor)? ☐ Y ☐ N ☐ Unknown

Care for a COVID-19 patient? ☐ Y ☐ N ☐ Unknown

Diagnosis (select all that apply): Pneumonia (clinical or radiologic) ☐ Y ☐ N Acute respiratory distress syndrome ☐ Y ☐ N

Comorbid conditions (check all that apply): ☐ None ☐ Unknown ☐ Pregnancy ☐ Diabetes ☐ Cardiac disease ☐ Hypertension

☐ Chronic pulmonary disease ☐ Chronic kidney disease ☐ Chronic liver disease ☐ Immunocompromised

☐ Cancer, specify type

☐ Other, specify

Vital Signs: Temp: __________ Pulse: _________ RR: __________BP: __________ SpO2:__________Chest exam: _________________

Does the patient have another diagnosis/etiology for their respiratory illness? ☐ Y, Specify______________ ☐ N ☐ Unknown

Specimens for COVID-19 testing

Specimen type Collected by (Name and Employee Code)

Transported by (Name and Employee Code)

Date collected

1 Fever may not be present in some patients, such as those who are very young, elderly, immunosuppressed, or taking certain medications. Clinical judgement should be used to guide testing of patients in such situations

2 Close contact is defined as: a) being within approximately 6 feet (2 meters) or within the room or care area for a prolonged period of time (e.g., healthcare personnel, household

members) while not wearing recommended personal protective equipment (i.e., gowns, gloves, respirator, eye protection); or b) having direct contact with infectious secretions (e.g.,

being coughed on) while not wearing recommended personal protective equipment. Data to inform the definition of close contact are limited. At this time, brief interactions, such as

walking by a person, are considered low risk and do not constitute close contact

Patient first name _______________ Patient last name ___________________ Patient date of birth ______________________

Sex ☐ M ☐ F Nationality ___________________Place of Residence ________________________________________________

Patient NIC number____________________________Contact # _____________________________Marital Status:_____________

MR # (if generated) _________________________________ Screening date______________________________________

Physician’s name ___________________________________ Employee Code number_____________________________

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