Interim Considerations for Disposition of Hospitalized Patients with 2019-nCoV Infection

[ad_1]

Currently, limited information is available to characterize the spectrum of clinical illness, transmission efficiency, and the duration of viral shedding for 2019-nCoV infection. Interim guidance for disposition of hospitalized patients with 2019-nCoV infection has been developed based on available 2019-nCoV information and what is known about related coronaviruses (MERS-CoV and SARS-CoV). This guidance is subject to change as additional information becomes available.

The following is intended to serve as a framework for patient disposition. All patients should be evaluated on a case-by-case basis and their disposition discussed with health care providers and public health departments.

  • Currently, hospitalized patients with confirmed 2019-nCoV infection should be cared for in an Airborne Infection Isolation Room (AIIR) using Standard, Contact, and Airborne Precautions with eye protection.
  • If an AIIR is not immediately available, consideration should be given to transferring the patient to a facility that has an available AIIR. If transfer is impractical or not medically appropriate, the patient should be cared for in a single-person room and the door should be kept closed.  The room should ideally not have exhaust that is recirculated within the building without high-efficiency particulate air (HEPA) filtration.  Healthcare personnel should still use gloves, a gown, respiratory and eye protection and follow all other recommended infection prevention and control practices when caring for these patients.
  • If there are not enough AIIRs to care for patients with confirmed 2019-nCoV infection, existing AIIRs should be prioritized for the care of patients who are symptomatic with severe illness (e.g., those requiring ventilator support).
  • The decision to discontinue Transmission-Based Precautions for hospitalized 2019-nCoV patients should be made on a case-by-case basis in consultation with clinicians, infection prevention and control specialists, and public health officials and should consider disease severity, illness signs and symptoms, and results of laboratory testing for 2019-nCoV in respiratory specimens. Considerations to discontinue Transmission-Based Precautions include meeting all of the following:
  • Patients can be discharged from the healthcare facility whenever clinically indicated.
  • Isolation should be maintained at home if the patient returns home before the decision is made to discontinue Transmission-Based Precautions. The decision to send the patient home should be made in consultation with the patient’s clinical care team and local or state public health departments and should include considerations of: the home’s suitability for and patient’s ability to adhere to home isolation recommendations, and potential risk of secondary transmission to household members with immunocompromising conditions. See CDC Interim Guidance for Home Care of patients with confirmed nCoV infection and persons under investigation for infection with nCoV and Interim Guidance for Preventing 2019-nCoV from Spreading to Others in Homes and Communities.

References

Al-Abdely HM, Midgley CM, Alkhamis AM, Abedi GR, Lu X, et al. Middle East respiratory syndrome coronavirus infection dynamics and antibody responses among clinically diverse patients, Saudi Arabia. Emerg Infect Dis. 2019 Apr;25(4):753-766.

Al-Abdely HM, Midgley CM, Alkhamis AM, Abedi GR, Tamin A et al. Infectious MERS-CoV Isolated From a Mildly Ill Patient, Saudi Arabia. Open Forum Infect Dis. 2018 May 15;5(6):ofy111.

Chan JF, Yuan S, Kok KH, To KK, Chu H et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet. 2020 Jan 24. pii: S0140-6736(20)30154-9. doi: 10.1016/S0140-6736(20)30154-9. [Epub ahead of print]

Chan KH, Poon LL, Cheng VC, Guan Y, Hung IF et al. Detection of SARS coronavirus in patients with suspected SARS. Emerg Infect Dis. 2004 Feb;10(2):294-9.

Cheng PK, Wong DA, Tong LK, Ip SM, Lo AC et al. Viral shedding patterns of coronavirus in patients with probable severe acute respiratory syndrome. Lancet. 2004 May 22;363(9422):1699-700.

Corman VM, Albarrak AM, Omrani AS, Albarrak MM, Farah ME, et al. Viral Shedding and Antibody Response in 37 Patients With Middle East Respiratory Syndrome Coronavirus Infection. Clin Infect Dis. 2016 Feb 15;62(4):477-483.

Holshue ML, DeBolt C, Lindquist S, Lofy KH, Wiesman J et al. First Case of 2019 Novel Coronavirus in the United States. N Engl J Med. 2020 Jan 31. doi: 10.1056/NEJMoa2001191. [Epub ahead of print]

Huang C, Wang Y, Li X, Ren L, Zhao J, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020 Jan 24. [Epub ahead of print]

Hung IF, Cheng VC, Wu AK, Tang BS, Chan KH et al. Viral loads in clinical specimens and SARS manifestations. Emerg Infect Dis. 2004 Sep;10(9):1550-7.

Liu W, Tang F, Fontanet A, Zhan L, Zhao QM et al. Long-term SARS coronavirus excretion from patient cohort, China. Emerg Infect Dis. 2004 Oct;10(10):1841-3.

Memish ZA, Assiri AM, Al-Tawfiq JA. Middle East respiratory syndrome coronavirus (MERS-CoV) viral shedding in the respiratory tract: an observational analysis with infection control implications. Int J Infect Dis. 2014 Dec;29:307-8.

Zhu N, Zhang D, Wang W, Li X, Yang B, et al; China Novel Coronavirus Investigating and Research Team. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020 Jan 24. [Epub ahead of print]

[ad_2]

Read more…