Infection control in the intensive care unit: expert consensus statements for SARS-CoV-2 using a Delphi method

Abstract

During the current COVID-19 pandemic, health-care workers and uninfected patients in intensive care units (ICUs) are at risk of being infected with SARS-CoV-2 as a result of transmission from infected patients and health-care workers. In the absence of high-quality evidence on the transmission of SARS-CoV-2, clinical practice of infection control and prevention in ICUs varies widely. Using a Delphi process, international experts in intensive care, infectious diseases, and infection control developed consensus statements on infection control for SARS-CoV-2 in an ICU. Consensus was achieved for 31 (94%) of 33 statements, from which 25 clinical practice statements were issued. These statements include guidance on ICU design and engineering, health-care worker safety, visiting policy, personal protective equipment, patients and procedures, disinfection, and sterilisation. Consensus was not reached on optimal return to work criteria for health-care workers who were infected with SARS-CoV-2 or the acceptable disinfection strategy for heat-sensitive instruments used for airway management of patients with SARS-CoV-2 infection. Well designed studies are needed to assess the effects of these practice statements and address the remaining uncertainties.

Conflict of interest statement

Declaration of interests PN reports honoraria for lectures and other educational events from Tabuk Pharmaceuticals, and is a member of Edward Lifesciences Advisory Board Panel, outside of the submitted work. JVD reports personal fees (paid to institution) from Edwards India, outside the submitted work. MB reports honoraria for lectures and another educational event from Angelini, Bayer, bioMérieux, Cipla, Gilead Sciences, Menarini, Merck Sharp & Dohme (MSD), Pfizer, and Shionogi; grants from Pfizer and MSD, outside of the submitted work; and is on the advisory board of Cidara Therapeutics. JDW reports honoraria (paid to institution) for lectures and other educational events from MSD and Pfizer, outside of the submitted work. BD reports research grants from Ministry of Science and Technology, People's Republic of China (research grant 2020YFC0841300), and Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences (2020-I2M-2-005 and 2019-I2M-1-001), outside of the submitted work. LE reports consulting fees (paid to institution) for the National Emerging Special Pathogen Training and Education Centre, outside of the submitted work. SJ reports academic consultation fees from Drager, Fisher-Paykel, Medtronic, Baxter International, and Fresenius–Xenios; and honoraria for lectures and other educational events from Fisher-Paykel and Baxter, outside of the submitted work. MK reports honoraria from Merck and Pfizer for lectures and other educational events, outside of the submitted work. JM reports research grants (paid to institution) from Covidien (Medtronic) and Canadian Institutes of Health Research; personal consultation fees from Janssen Pharmaceuticals and Faron Pharmaceuticals; honoraria from Medtronic for lectures and other educational events; and a consulting agreement signed with Vyaire, outside of the submitted work. MSN reports personal consulting fees from Abbvie, outside of the submitted work. AP reports research grants from Novo Nordisk Foundation, Pfizer, and Fresenius Kabi, outside of the submitted work. MS reports research grants and advisory board fees from NewB; research grants from DSTL, Critical Pressure, and Apollo Therapeutics; speaking fees (paid to institution) from Amormed, advisory board fees from Biotest, GE, Baxter, Roche, and Bayer; and honoria from Shionogi, outside of the submitted work. BV reports research grants and honoraria for the guest lecture and other educational events from Baxter, outside of the submitted work. All other authors declare no competing interests.

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Figures

Figure

Clinical practice statements on infection control of SARS-CoV-2 in ICUs AIIR=airborne infection isolation room. AGP=aerosol generating procedure. ICU=intensive care unit. PPE=personal protective equipment.