Infection Control

General COVID-19 Infection Control Guidelines for COVID-19 Positive, Presumptive Positive (PUI), or Presumptive Negative (PUI), or Non-COVID (not tested) patients


General Isolation Guidelines:

  • COVID-positive patients will be placed in droplet plus precautions until Screening Criteria for Resolution of COVID are met.
    • 24 hours afebrile without the use of fever-reducing medications, AND
    • Improving symptoms, AND
      • 10 days since onset symptoms or date of initial positive test (if asymptomatic) for mild to moderate illness
    • OR
      • 20 days since onset symptoms or date of initial positive test (if asymptomatic) for severe/critical illness (See Criteria for Severe/Critical Illness below) or severely immunocompromised (See Criteria for Severely Immunosuppressed below)
  • Isolation may be continued longer at the discretion of the physician or Infection Prevention
Criteria for Severe/Critical Illness:

  • ICU admission
  • Greater than 3 LPM oxygen
  • On COVID therapy (Remdesivir, plasma, Tocilizumab, steroids)
Criteria for Severely Immunosuppressed:

  • Cancer/on chemotherapy
  • Bone marrow transplant
  • Solid organ transplant
  • Stem cells for cancer treatment
  • Genetic immune deficiencies (ex: common variable immune deficiency, selective IgA deficiency, severe combined immunodeficiency, chronic granulomatous disease, and complement deficiencies.
  • HIV (CD4 Less than 200 and/or not on effective highly active anti-retroviral therapy)
  • Use of oral or intravenous corticosteroids or other medicines called immunosuppressants that lower the body’s ability to fight some infections (e.g., mycophenolate, sirolimus, cyclosporine, tacrolimus, etanercept, rituximab)
  • HIV diagnosis
  • On HIV medications
  • Type 2 Diabetes mellitus on Problem List
  • ESRD on Problem List
  • Receipt of prednisone greater than 20mg/day for greater than 14 days
  • Neutropenia (two separate days with ANC and/or WBC values less than 500)
  • DMARDs (Disease-modifying anti-Rheumatic drugs)
Isolation on Readmission:

  • Non-elective readmission for COVID-positive patients
    • Droplet Plus precautions until Screening Criteria for Resolution of COVID are met.
  • Elective readmission for COVID-positive patients (including procedures and therapy)
    • Postpone readmission until Screening Criteria for Resolution of COVID are met.
    • No isolation after Screening Criteria for Resolution of COVID are met
Isolation Guidelines for COVID Positive and PUI patients

  1. Place in negative pressure room, if available
    1. If negative pressure not available, place in private room with door closed
  2. Place patient in Droplet Plus precautions or Airborne Plus precautions as clinically indicated as follows:
    1. Droplet Plus precautions:
      1. Face mask
      2. Eye protection
      3. Gown
      4. Gloves
    2. Airborne Plus precautions:
      1. N95
      2. Eye protection
      3. Gown
      4. Gloves
  3. Use Airborne Plus precautions for aerosolizing procedures on COVID-19 Positive, or Presumptive Positive (PUI), or Presumptive Negative (PUI), or Non-COVID patient (not tested). In general, asymptomatic patients with Negative COVID-19 testing do NOT need Airborne Plus precautions during aerosolizing procedures (a notable exception would be patients residing in nursing homes or SNF-airborne plus precautions are still recommended in that population). Aerosolizing procedures include but are not limited to the following (see Appendix D for additional information):
    1. Intubation/Extubation
    2. Manual ventilation
    3. Anytime the ventilator circuit is broken
    4. CPR
    5. Bronchoscopy
    6. Autopsy
    7. Non-invasive Ventilation (BIPAP/CPAP/High Frequency Oscillatory Ventilation)
    8. Induction of Sputum
    9. Open suction catheter use (trach, oral, nasal)
    10. Placing or exchanging tracheostomy tubes
    11. Nebulization
    12. Continuous aerosol therapy
    13. TEE
    14. NG Tube Placement
    15. Swallow Studies
    16. Cauterizing Procedures
  4. Patient transport guidelines:
    1. Place a facemask on the patient
    2. Staff member transporting dons a facemask
    3. If patient needs care during transport, staff caring for patient wear Droplet Plus PPE or Airborne Plus as clinically indicated.
    4. If staff transporting is wearing Droplet Plus/Airborne Plus in order to provide care during transport, there must be a runner with facemask but no other PPE to access elevator buttons and doors.
  5. Consult with infectious disease/infection prevention prior to de-escalating or discontinuing isolation precautions
  6. Have a designated disposal area for PPE