Title: Point of Care Risk Assessment & PPE Recommendations
Course: COVID CURRICULUM (Export) > Section: Module1: Infection Prevention & Control

All learners and health care providers should conduct a Point of Care Risk Assessment (PCRA) before every patient interaction. This includes a responsibility to assess the infectious risks posed to themselves, other healthcare workers (HCW), other patients and visitors from a patient, situation or procedure.

The PCRA is based on the HCWs professional judgment (i.e. knowledge, skills, reasoning and education) about the clinical situation as well as up-to-date information on how the specific acute healthcare facility has designed and implemented engineering and administrative controls and the use and availability of Personal Protective Equipment (PPE).

PCRA is typically an activity implemented by the HCW in any healthcare facility to:

- Evaluate the likelihood of exposure to them and others to infectious agents (e.g., COVID-19)
  - For a specific interaction;
  - For a specific task;
  - With a specific patient;
  - In a specific environment, and
  - Under available conditions.
- Select the appropriate actions and/or PPE to minimize the risk of exposure for the specific patient, other patients in the environment, the HCWs, visitors and others. (Government of Canada, 2020e)

A Point of Care Risk Assessment includes an assessment of the:

Together, the Point of Care Risk Assessment along with evidence-based guidelines will help to determine the selection of appropriate Personal Protective Equipment (PPE).

Here is what we know:

- Hands transmit infections
  - Perform hand hygiene. Alcohol-based hand rubs should contain 70-90% alcohol. 100% adherence with performance of hand hygiene (especially before and after contact with a patient or the patient care environment, before clean or sterile procedures, after risk of body fluid exposure, after removing gloves, and when hands are visibly soiled).
- SARS-CoV-2 spreads primarily through respiratory droplets
  - Mask and eye protection (e.g., goggles/face shield) -to prevent droplets from getting to your exposed mucous membranes – mouth, nose and eyes.
- SARS-CoV-2 can live on surfaces
  - Wear a gown for any interaction with those suspected or known COVID-19 patients
- SARS-CoV-2 can aerosolize during Aerosol Generating Medical Procedures (AGMP - see definition below)

Risk Assessments for COVID-19 typically include the decision to wear a mask, eye protection (face shield/goggles), gown and gloves.

Summary of PPE Recommendations

PPE Recommendations
Setting | Activity | Type of PPE
Patient room/Exam room/Patient care areas
Providing direct care to patients with suspected or confirmed COVID‑19, including nasopharyngeal and oropharyngeal swab collection
Droplet and Contact Precautions, including:

• Surgical/procedure mask

• Isolation gown

• Gloves

• Eye protection (goggles or face shield)
Aerosol-generating medical procedures (see definition below) performed on suspected or confirmed COVID‑19 patients
Airborne, Droplet and Contact Precautions, including:

• N95 respirator (fit-tested, seal checked)

• Isolation gown

• Gloves

• Eye protection (goggles or face shield)

•Negative pressure room, if available
Aerosol-generating dental procedures performed on patients | Refer to table 1 in the Royal College of Dental Surgeons of Ontario (RCDSO) document: COVID-19: Managing Infections Risks During In-Person Dental Care
Other areas of patient transit (e.g., wards, corridors, waiting rooms) | Any activity that does not involve contact with a patient suspected or confirmed COVID‑19 | Routine practices and Additional Precautions based on risk assessment.
Administrative areas | Administrative tasks that do not involve contact with patients | Routine practices and Additional Precautions based on risk assessment and organizational policy.

Table adapted from Public Health Ontario (2020, p.5). This document was adapted with the permission of Public Health Ontario. Public Health Ontario assumes no responsibility for the content of any publication resulting from translation/changes/adaptation of PHO documents by third parties.

Aerosol Generating Medical Procedures (AGMP)

Procedures Considered AGMPs
• Intubation, extubation and related procedures e.g. manual ventilation and open suctioning

• Tracheotomy/tracheostomy procedures (insertion/open suctioning/removal)

• Bronchoscopy

• Surgery* and post-mortem procedures involving high-speed devices

• Non-invasive ventilation (NIV) e.g. Bi-level Positive Airway Pressure (BiPAP) and Continuous Positive Airway Pressure ventilation (CPAP)

• High-Frequency Oscillating Ventilation (HFOV)

• Induction of sputum with nebulized saline

• High flow nasal oxygen (high flow nasal cannula therapy)

• Some dental procedures – see Royal College of Dental Surgeons of Ontario (RCDSO)

*Specifically for acute respiratory infections this pertains to surgery involving high speed devices in the respiratory tract.

Please note that Ontario Health suggests avoiding the following AGMPs:

• Sputum induction

• Large volume nebulizers for humidity

• High-flow oxygen therapy.

Table adapted from Public Health Ontario (2020). This document was adapted with the permission of Public Health Ontario. Public Health Ontario assumes no responsibility for the content of any publication resulting from translation/changes/adaptation of PHO documents by third parties.

Ontario Health (2020b); Public Health Ontario (2020)