Providing a Safe Working Environment – Engineering Controls
Additional Considerations and Recommendations
Intensive care heating, ventilation and air-conditioning (HVAC) systems are critical to maintaining good ‘indoor air quality’ and reducing the transmission of airborne disease. Older intensive care units may not meet current standards with lower number of air changes per hour (ACR) and ventilation systems with re-circulation.
We recommend that hospital engineering advice should be sought to explore configuring HVAC systems to increase the air changes per hour (ACR) with the outside and avoiding air recirculation, incorporating HEPA filters within existing HVAC systems and changing indoor airflow patterns e.g. vertical rather than laminar flow. Temporary negative pressure rooms could be set up with the use of portable negative air units fitted with a high efficiency particulate air (HEPA) filter.
We recommend the use of portable HEPA air cleaners in high traffic areas such as changing rooms, tea rooms and doffing areas.
Administrative controls change the way health care workers work to reduce the risk of COVID-19 infection. These workflows include ways to minimise viral exposure and reduce the risk of HCW and patient infection.
We recommend that all patients are assessed for potential COVID-19 infection. Patient screening should be in line with the latest national recommendations for COVID-19 case definition and should include determination of clinical history, contact and travel history. Patients deemed at risk should be isolated and tested for COVID-19.
We recommend that workflows be established to minimise the number of staff and minimise the duration and frequency of entry into a COVID-19 room or area. This may involve the bundling of clinical activities and the use of video monitoring.
We recommend in ICU, that all HCWs not directly involved in patient care (e.g., dietary, administrative staff, students) where possible be excluded.
We also recommend that other medical teams use teleconferencing preferentially and only visit intensive care if absolutely necessary, and with the absolute minimum of staff.
If feasible, ICU staff should be rostered between clean and COVID-19 teams, with provision for standby staff.
To reduce cross infection, we recommend cancelling face-to-face meetings as much as possible. For meetings with operational, clinical or education value we recommend that secure video-conferencing applications are provided and utilised.
As the incidence of COVID-19 increases, there is a risk of a HCW becoming infected while caring for a patient with unrecognised COVID-19 or having contact with an asymptomatic or minimally symptomatic HCW with COVID-19. We recommend a staff log for staff rest areas or clinical areas be maintained to ensure contact tracing controls can be easily established if required.
We recommend rest and work areas be compliant with social distancing guidelines. In rest areas where compliance with social distancing is not possible, we recommend adjusting the physical environment to ensure social distancing.
Depending on the prevalence of community transmission, the recommendations for staff wearing surgical masks in non-clinical areas will change.
During periods of increased community transmission we recommend enhanced infection control measures such as the blanket use of Tier 3 PPE (N95 mask or equivalent and eye protection) in all clinical areas.
We recommend regular surveillance testing for staff who are working in COVID areas.
To avoid environmental cross-contamination the following is recommended to minimise the risk of contamination of staff via equipment:
Avoid sharing ICU equipment and preferentially use only single-use equipment
Minimise personal effects taken to the workplace
Any personal devices taken into a COVID-19 area are subject to infection control cleaning as per local guidelines
Stethoscope use should be minimised.
We recommend that:
Clean scrubs are available to change into before each shift
Staff have access to change areas and showering facilities.
We recommend that cleaning of clinical and non-clinical areas complies with national and jurisdictional standards for COVID-19 infection control. We recommend that staff providing cleaning and ancillary services are provided with appropriate training and supervision in PPE.
Given the stress on families with a loved one in intensive care, processes around patient visits must be communicated clearly and compassionately to visitors with an emphasis on the protection of patients, families and staff. All visitors to ICU must be screened for potential COVID-19 infection. Criteria for safe visitation should be based on jurisdictional public health advice, with consideration towards clinical, contact and travel history, vaccination status and evidence of a negative COVID-19 test.
If visitors are entering COVID-19 areas, we recommend they wear appropriate PPE consistent with airborne precautions.
We recommend hospitals maintain a hospital visitor log to allow for contact tracing and activity mapping of confirmed cases e.g. QR code check in system. Communication to families and visitors should include posting visual alerts (e.g. posters) at the entrance and strategic places (e.g. waiting areas, lifts) advising visitors not to enter the facility when ill.
