How Hospitals Can Protect Frontline Healthcare Workers From COVID-19

Lessons From Successful Model Countries

Ken Jung · Ron Li · Andrew Ng · Christian Rose · Eric Topol · Kelly Zhang · Ming Zhou · Sharon Zhou

Stanford University & Scripps Research Translational Institute

We need health-care workers to care for the sick, even though their jobs carry the greatest risk of exposure. How do we keep them seeing patients rather than becoming patients? — Atul Gawande, The New Yorker, 3/31/20

Healthcare workers (HCWs) are at high risk of becoming infected with COVID-19, and many are already falling ill or dying. We need to understand what hospitals in countries with low rates of HCW infections did right, and what lessons can be brought to frontline HCWs in the United States.

Their success comes not just from the availability of personal protective equipment (PPE), but also from the high level of rigor with which hospital infection control processes are applied, and a shared understanding that protecting HCWs is core to fighting COVID-19.

Sourcing information from documents and interviews with infection control experts from successful model countries, we summarize key lessons in hospital infection control for COVID-19:

Minimize the entry and movement of the virus within hospital walls High standards for PPE strategically tailored for different levels of exposure risk Comprehensive staff screening and management strategies that minimize transmission risk while maintaining a viable workforce

We believe the principles behind these lessons can inform how we approach infection control in the United States.

Source: Xihong Lin, Harvard & Broad Institute

Control movement of virus into/within the hospital

Hospitals can establish distinct regions that are physically separated based on risk of viral exposure. The purpose is to know and control how the virus moves within the hospital.

Low Risk : non-patient care areas, ambulatory care areas, and medical wards housing asymptomatic non-COVID patients. HCWs can assume a low risk of exposure to the virus.

: non-patient care areas, ambulatory care areas, and medical wards housing asymptomatic non-COVID patients. HCWs can assume a low risk of exposure to the virus. Moderate Risk : Screening and triage clinics, medical wards housing clinically stable suspected or confirmed COVID patients who are not receiving high risk procedures, such as intubation, bronchoscopy, and other intensive procedures that may aerosolize viral particles. HCWs can assume exposure to the virus primarily via droplet and fomite, but airborne transmission is less likely.

: Screening and triage clinics, medical wards housing clinically stable suspected or confirmed COVID patients who are not receiving high risk procedures, such as intubation, bronchoscopy, and other intensive procedures that may aerosolize viral particles. HCWs can assume exposure to the virus primarily via droplet and fomite, but airborne transmission is less likely. High Risk: Intensive Care Units (ICUs) and procedure rooms that house severely ill suspected or confirmed COVID patients. HCWs assume a high risk of exposure to aerosolized viral particles generated from procedures and patient symptoms such as severe cough, vomiting, and diarrhea.

Credit: Chris Chope

Moderate and high risk zones are geographically consolidated and isolated from the rest of the hospital. Establishing and maintaining distinct geographic zones based on risk of viral exposure limits the movement of the virus within hospitals and enables efficient allocation of PPE and HCW resources to where they are most needed.

Below we describe three key aspects infection control at these hospitals:

What policies and processes can minimize infection risk within and between zones?

and can minimize infection risk within and between zones? What kind of PPE is needed to protect HCWs in each zone?

is needed to protect HCWs in each zone? How are HCWs screened and monitored for COVID-19?

Policies and Processes for Each Risk Zone

Low Risk