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. 2021 Jan 6;104(3_Suppl):25-33.
doi: 10.4269/ajtmh.20-1009.

Pragmatic Recommendations for Infection Prevention and Control Practices for Healthcare Facilities in Low- and Middle-Income Countries during the COVID-19 Pandemic

Natalie Cobb  1 , Alfred Papali  2 , Luigi Pisani  3   4 , Marcus J Schultz  4   5   6 , Juliana C Ferreira  7 ; COVID-LMIC Task Force and the Mahidol-Oxford Research Unit (MORU)
Affiliations

Pragmatic Recommendations for Infection Prevention and Control Practices for Healthcare Facilities in Low- and Middle-Income Countries during the COVID-19 Pandemic

Natalie Cobb et al. Am J Trop Med Hyg. .

Abstract

Infection prevention and control (IPC) strategies are key in preventing nosocomial transmission of COVID-19. Several commonly used IPC practices are resource-intensive and may be challenging to implement in resource-constrained settings. An international group of healthcare professionals from or with experience in low- and middle-income countries (LMICs) searched the literature for relevant evidence. We report on a set of pragmatic recommendations for hospital-based IPC practices in resource-constrained settings of LMICs. For cases of confirmed or suspected COVID-19, we suggest that patients be placed in a single isolation room, whenever possible. When single isolation rooms are unavailable or limited, we recommend cohorting patients with COVID-19 on dedicated wards or in dedicated hospitals. We also recommend that cases of suspected COVID-19 be cohorted separately from those with confirmed disease, whenever possible, to minimize the risk of patient-to-patient transmission in settings where confirmatory testing may be limited. We suggest that healthcare workers be designated to care exclusively for patients with COVID-19, whenever possible, as another approach to minimize nosocomial spread. This approach may also be beneficial in conserving limited supplies of reusable personal protective equipment (PPE). We recommend that visitors be restricted for patients with COVID-19. In settings where family members or visitors are necessary for caregiving, we recommend that the appropriate PPE be used by visitors. We also recommend that education regarding hand hygiene and donning/doffing procedures for PPE be provided. Last, we suggest that all visitors be screened for symptoms before visitation and that visitor logs be maintained.

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Conflict of interest statement

GROUP MEMBERS OF THE “COVID-LMIC TASK FORCE”

Heads: Alfred Papali (Atrium Health, Charlotte, NC, USA) and Marcus Schultz (Mahidol University, Bangkok, Thailand; University of Oxford, Oxford, United Kingdom; Amsterdam University Medical Centers, location “AMC”, Amsterdam, The Netherlands).

Advisors: Neill K. J. Adhikari (Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada); Emilie J. Calvello Hynes (University of Colorado School of Medicine, Department of Emergency Medicine, Denver, USA); Martin Dünser (Kepler University Hospital and Johannes Kepler University Linz, Linz, Austria) and Mervyn Mer (University of the Witwatersrand, Johannesburg, South Africa).

Subgroup members, in alphabetical order: Andrew Achilleos (Sunnybrook Health Sciences Centre, Toronto, Canada); Hanan Y. Ahmed (Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia); Kevan M. Akrami (Universidade Federal da Bahia, Faculdade de Medicina, Salvador, Brazil and Division of Infectious Disease, Department of Medicine, University of California San Diego, San Diego, USA); Lia M. Barros (University of Washington, Seattle, USA); B. Jason Brotherton (AIC Kijabe Hospital, Kijabe, Kenya); Sopheakmoniroth Chea (CalmetteHospital, Phnom Penh, Cambodia); William Checkley (The Johns Hopkins University School of Medicine and The Johns Hopkins University Center for Global Health, Baltimore, USA); Elif A. Cizmeci (Interdepartmental Division of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada); Natalie Cobb (University of Washington, Seattle, USA); Finot Debebe (Department of Emergency Medicine and Critical Care, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia); Juliana Ferreira (University of São Paulo, São Paulo, Brasil); Gabriela Galli (University of Pittsburgh School of Medicine, Pittsburgh, USA); Tewodros Haile (Department of Internal Medicine, College of Health Sciences, Addis Ababa University); Bhakti Hansoti (Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, USA); Madiha Hashmi (Ziauddin University, Karachi, Pakistan); Rebecca Inglis (Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Mahosot Hospital, Vientiane, Lao People's Democratic Republic and Department of Intensive Care, Oxford University Hospital Trust, Oxford, United Kingdom); Burton W. Lee (Critical Care Department, NIH, Bethesda, USA; Division of Pulmonary, Allergy and Critical Care, University of Pittsburgh School of Medicine, Pittsburgh, USA); Faith Lelei (AIC Kijabe Hospital, Kijabe, Kenya); Ganbold Lundeg (Mongolian National University of Medical Sciences, Ulan Bator, Mongolia); David Misango (The Aga Khan University, Nairobi, Kenya); Ary Serpa Neto (Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, Melbourne, Australia; Department of Intensive Care, Amsterdam University Medical Centers, location 'AMC', University of Amsterdam, Amsterdam, The Netherlands); Alfred Papali (Atrium Health, Charlotte, NC, USA); Casey Park (Interdepartmental Division of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada); Rajyabardhan Pattnaik (Ispat General Hospital, Rourkela, India); Jennifer L. Pigoga (Division of Emergency Medicine, University of South Africa, Cape Town, South Africa); Luigi Pisani (Department of Anesthesia and Intensive Care, Miulli Regional Hospital, Acquaviva delle Fonti, Italy; Doctors withAfrica – CUAMM, Padova, Italy; Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand); Elisabeth D. Riviello (Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA); Kristina E. Rudd (University of Pittsburgh School of Medicine, Pittsburgh, USA); Marcus Schultz (Mahidol University, Bangkok, Thailand; University of Oxford, Oxford, United Kingdom; Amsterdam University Medical Centers, location “AMC”, Amsterdam, The Netherlands); Varun U. Shetty (University of Pittsburgh Medical Center, Pittsburgh, USA); Gentle S. Shrestha (Tribhuvan University Teaching Hospital, Kathmandu, Nepal); Chaisith Sivakorn (Mahidol University, Salaya, Thailand); Shaurya Taran (Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada); T. Eoin West (University of Washington, Seattle, USA).

Group members of the subgroup “Organization”: Natalie Cobb (University of Washington, Seattle, WA); Juliana Ferreira (University of São Paulo, São Paulo, Brazil); Alfred Papali (Atrium Health, Charlotte, NC); Luigi Pisani (Doctors with Africa – CUAMM, Padova, Italy; Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand); and Marcus Schultz (Mahidol University, Bangkok, Thailand; University of Oxford, Oxford, United Kingdom; Amsterdam University Medical Centers, location “AMC,” Amsterdam, The Netherlands).

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