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Coronavirus infection control triaging of negative pressure and single roomsAn opinion piece – current 23/03/19Table 1: Infection Control Management Pending Coronavirus Testing ResultsAdmitted Patient Risk GroupRisk*Infection Control ManagementFever and/or respiratory symptomsANDContact with known COVID case ORReturn from overseas travel in past 14 daysVERY HIGHHighest priority for negative pressure room with airborne and contact precautionsBilateral severe community-acquired pneumonia (critically ill) where no other cause is identified, with recent international travel or with coronavirus exposureBilateral severe community-acquired pneumonia (critically ill) where no other cause is identified, without recent international travel and without coronavirus exposureHIGHSecond highest priority for negative pressure room with airborne and contact precautionsBilateral moderately severe community acquired pneumonia with where no other cause is identified without recent ravel or known coronavirus exposureMODERATENegative pressure room (if available) otherwise single room with droplet and contact precautions* Airborne precautions for aerosol generating proceduresHealthcare worker with direct patient care with respiratory symptoms AND feverAll other patients admitted with an acute respiratory infection, including exacerbation of COPDLOW-MODERATEDroplet precautions Single room or double/quadruple room with curtains closed, mask worn by patient and promotion of hand washing and respiratory hygiene by the patientPriority for single room given to patients with underlying comorbidities such as chronic lung and heart disease* risk will vary as incidence of community transmission increasesAllocation of Single RoomsNegative pressure rooms and single (non-negative pressure) rooms will need to be allocated according to risk as outlined in Tables 1 & 2. NOTE: This applies mainly to Phase 1. If hospital cases of suspected/confirmed COVID surpass the number of single rooms, cohorting of proven cases may occur in order to separate COVID patients from non-infected patients.Table 2: Prioritisation of Negative Pressure RoomsHighest PriorityLowest PriorityMeaslesChickenpox / Disseminated shinglesTuberculosisConfirmed COVID*Very High and High Risk COVID*Moderate Risk COVIDLow-Moderate Risk COVID* patients with more severe disease/pneumonia would be given priority due to likelihood of higher viral loadsTable 3: Prioritisation of Single Rooms (Non-Negative Pressure)Highest PriorityLowest Priority Any patient in Table 2 above unable to be accommodated in negative pressure roomSuspected/proven norovirusCrusted scabiesSuspected/proven C. difficileSuspected proven infective gastroenteritisNon-crusted scabiesAsymptomatic patients requiring quarantine because of COVID risk factors (eg, patients admitted from home quarantine)High shedding MRO (eg, incontinence, open wounds, diarrhea etc): CRE > MRSA > other Gram negative MRO > VRELow shedding MRO (eg, colonized): CRE > MRSA > other Gram negative MRO > VRE Contained shingles (discuss with infection control)Social/Behavioural/Personal indications ................
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