COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

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Primary Prevention Lynch JB, Davitkov P, Anderson DJ, et al. Infectious Diseases Society of America Guidelines on Infection Prevention for Health Care Personnel Caring for Patients with Suspected or Known COVID-19. Clin Infect Dis. 2020 Jul 27. pii: 5876809. doi: 10.1093/cid/ciaa1063.

BACKGROUND: SARS-CoV-2 is a highly transmissible virus that can infect health care personnel and patients in health care settings. Specific care activities, in particular aerosol-generating procedures, may have a higher risk of transmission. The rapid emergence and global spread of SARS-CoV-2 has created significant challenges in health care facilities, particularly with severe shortages of personal protective equipment (PPE) used to protect health care personnel (HCP). Evidence-based recommendations for what PPE to use in conventional, contingency, and crisis standards of care are needed. Where evidence is lacking, the development of specific research questions can help direct funders and investigators.

OBJECTIVE: Develop evidence-based rapid guidelines intended to support HCP in their decisions about infection prevention when caring for patients with suspected or known COVID-19.

METHODS: IDSA formed a multidisciplinary guideline panel including front-line clinicians, infectious disease specialists, experts in infection control and guideline methodologists with representation from the disciplines of preventive care, public health, medical microbiology, pediatrics, critical care medicine and gastroenterology. The process followed a rapid recommendation checklist. The panel prioritized questions and outcomes. Then a systematic review of the peer-reviewed and grey literature was conducted. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence and make recommendations.

RESULTS: The IDSA guideline panel agreed on eight recommendations and provided narrative summaries of other interventions undergoing evaluations.

CONCLUSIONS: Using a combination of direct and indirect evidence, the panel was able to provide recommendations for eight specific questions on the use of PPE for HCP providing care for patients with suspected or known COVID-19. Where evidence was lacking, attempts were made to provide potential avenues for investigation. There remain significant gaps in the understanding of the transmission dynamics of SARS-CoV-2 and PPE recommendations may need to be modified in response to new evidence.

Discipline / Specialty Area Score
Pediatrics (General)
Surgery - Gastrointestinal
Surgery - Vascular
Surgery - Cardiac
Oncology - Genitourinary
Surgery - Ear Nose Throat
Pediatric Neonatology
Occupational and Environmental Health
Infectious Disease
Intensivist/Critical Care
Hospital Doctor/Hospitalists
Internal Medicine
Surgery - Orthopaedics
Surgery - Head and Neck
Emergency Medicine
Pediatric Hospital Medicine
Oncology - Gynecology
Surgery - Thoracic
Oncology - Gastrointestinal
Oncology - Pediatric
Oncology - Hematology
Oncology - General
Family Medicine (FM)/General Practice (GP)
General Internal Medicine-Primary Care(US)
Surgery - Neurosurgery
Surgery - Ophthalmology
Public Health
Surgery - Colorectal
Surgery - General
Surgery - Plastic
Tropical and Travel Medicine
Oncology - Breast
Oncology - Radiation
Oncology - Lung
Oncology - Palliative and Supportive Care
Surgery - Oncology
Surgery - Urology
Pediatric Emergency Medicine
Comments from MORE raters

Anesthesiology rater

The information is fairly well known. For the anesthesiologist, the use of N95 during intubation and extubation is further emphasized. In fact, it is better to use a reprocessed N95 than a surgical face mask. These guidelines should be read and enforced by all healthcare workers.

Cardiology rater

This is important reading material for all healthcare providers and administrators.

Dermatology rater

Important and still timely information that hopefully will become less important when vaccines are widespread.

Emergency Medicine rater

This is an honest and well done COVID review.

Emergency Medicine rater

This is such a complex area and in great need of clarification and simplification - love the algorithm - will use.

Emergency Medicine rater

GRADE provides rigor and transparency to balance research evidence against medical expertise. A nearly year-long global pandemic in conjunction with intermittent shortfalls in personal protective equipment availability intermingling with an unfortunate political milieu in some areas create a desperate need to minimally biased publications like this IDSA guideline. This review provides important justification for front-line healthcare providers to demand proactive healthcare system responses to appropriate personal protective equipment.

FM/GP/Obstetrics rater

I have two problems with being asked to evaluate this article: 1) an entire guideline is a large document addressing many issues, outside the scope of MORE in my experience; 2) this manuscript was submitted in April 2020. Our knowledge of what works in Covid has evolved so much since then that I do not feel comfortable assuming the guidance is sufficiently current.

FM/GP/Obstetrics rater

This is extremely important and topical. It comes from a well respected body.

Gastroenterology rater

These guidelines are timely and appropriate for all health care professionals during this pandemic. These guidelines should also be forwarded to all public health agencies and state legislatures. The refusal of several states to enforce masking and physical distancing diminishes the work of these experts.

General Internal Medicine-Primary Care(US) rater

In the HC setting, I am thinking we should always wear an N95 given the number of asymptomatic positives we are seeing in our mass screenings.....

Genetics rater

According to these recommendations, use of shoe cover is not considered as important part of PPE. The evidence is still sketchy in regards to the presence of coronavirus in the amniotic fluid of positive patients. However, in the intrapartum situation with a lot of amniotic fluid and blood, I believe that wearing shoe cover should be considered essential part of PPE to avoid exposing HCP to these fluids that can potentially increase their risk of infection.

Genetics rater

Timely and thorough.

Geriatrics rater

Although based on weak evidence, the evidence extrapolated using probability models does demonstrate the value of proper PPE and the relative risk of a variety of aerosol-producing procedures.

Geriatrics rater

This is an excellent article reviewing and summarizing what we need to know to keep health care personnel safe while caring for patients possibly ill with coronavirus. There is nothing terribly surprising. The paper is clearly written and it differentiates carefully between what we know for sure and what we assume to be true. The authors remind us that our own individual practices when we don and doff PPE and do, or do not, wash our hands are probably extremely important but difficult to ascertain.

Gynecology rater

Although this report does not include any definitively new information and given the emphasis on the evaluation of the evidence that it places and the inclusiveness of the reviewing panel, this report is a reasonable one for distribution to healthcare providers.

Gynecology rater

Worthwhile guidelines from an authoritative group, although the recommendations seem similar to those that have been widely publicized.

Gynecology rater

Critical reading for the current time.

Hospital Doctor/Hospitalists rater

After 8 months of community spread, most hospitalists are well-acquainted with local policies regarding PPE during the COVID-19 pandemic. Fortunately, most are already compatible with these evidence-based recommendations. While there remain important questions to answer, this document supported my current practice instead of significantly changing it.

Infectious Disease rater

This is an excellent summary of confusing data. It appears that face shields are only recommended in crisis settings (respirator shortage) as an added layer to cover N95 respirator. Whether face shields & eye goggles offer similar protection needs clarification.

Intensivist/Critical Care rater

The IDSA has summarized the relevant data (as of April 2020) and established a reasonable scientific baseline with appropriate knowledge gap identification. Most practitioners probably already know this. Decision-makers in the health care enterprise may NOT know this data and may be making decisions based on media mentions, incomplete data, political issues, or supply chain-limitations. This data is out-of-date at the time of publication. The CDC and WHO maintain more up to date guidelines in this rapidly-changing and new-data-every-month disease process.

Intensivist/Critical Care rater

Official statement from IDSA for protecting health care providers in the setting of Covid-19. Gives clear recommendations that are pertinent to all concerned.

Internal Medicine rater

Most of the recommendations were made and implemented 5 months ago in all dialysis units we serve. If the purpose of publishing is to increase PPE purchase at hospitals and clinics, then we should include it. If only directed at doctors, they have already been informed.

Obstetrics rater

This is timely. Thank you.

Occupational and Environmental Health rater

These are the type of guidelines that are practical and important at this time.

Oncology - Breast rater

Interesting work that developed evidence-based rapid guidelines intended to support healthcare providers in their decisions about infection prevention when caring for patients with suspected or known COVID-19. The guideline panel recommends that in conventional settings, healthcare personnel caring for confirmed or suspected COVID-19 patients use a surgical mask or an N95 or higher-grade respirator (such as an N99 or PAPR). Mask use or respirators must be in conjunction with other recommended PPE and appropriate hand hygiene. The panel recommends that healthcare personnel should not be exposed to suspected or confirmed COVID-19 patients without a mask or respirator.

Oncology - Gastrointestinal rater

This info is very useful as COVID-19 is currently the most serious problem affecting our work, but I think gastroenterologists (and probably most physicians in general) already know these recommendations. It is, however, important to show the level of evidence that has been reported thus far.

Oncology - Gastrointestinal rater

The COVID-19 pandemic remains the most significant problem today. The question of healthcare workers` protection is a basic and vital issue, so every study about infection prevention in medical staff should be encouraged.

Oncology - General rater

Eight simple guidelines that are helpful.

Oncology - Genitourinary rater

This essay provided useful information on how to protect HCPs who provided care for patients with suspected or known COVID-19.

Oncology - Hematology rater

Good summary of evidence that is mostly sensible recommendations.

Oncology - Palliative and Supportive Care rater

A welcome concise set of guidelines with supporting data and commentary. This article should be read by every physician.

Oncology - Radiation rater

These guidelines lay out recommendations and their corresponding levels of evidence for healthcare personnel caring for patients with COVID-19. The IDSA panel additionally lay out areas of additional investigation that may aid further data-gathering and guideline development.

Pediatric Neonatology rater

This is an excellent review.

Pediatric Neonatology rater

Great review. I suspect virtually all practicing NEO's working in hospitals are aware of the requirements for PPE. Nevertheless, this is a nice succinct compilation of the latest recommendations, and ALL should know them.

Pediatrics (General) rater

As Neonatologist, I find the results of this study are very beneficial. The study ended with recommendations for use of PPE during aerosol-generating procedures. It also provided the different circumstances that HCWs may face during daily work.

Public Health rater

These are American recommendations on use of PPE among healthcare workers exposed to COVID. As an Australian physician, I find these recommendations are of peripheral interest to our practice as we have our own local guidance.

Public Health rater

It's good to have these guidelines, but the difficulty for providers is that they have guidelines from multiple sources: various professional associations, various national guidelines, international guidelines, their own institution's guidelines, and, and of course, the guidelines run smack up against resource limitations.

Rheumatology rater

These are highly relevant and evidence based recommendations for clinicians who see patients.

Surgery - Cardiac rater

This is a great overview of the PPE recommendations in Covid-19. There are many areas of patient care that can have increased risk and the appropriate deployment and use of specific PPE may not be uniformly known. This article is a very useful overview.

Surgery - Colorectal rater

The Infectious Diseases Society of America reviewed the literature and made recommendations for conventional, contingency and crisis settings regarding the appropriate use of PPE in the care of patients with or suspected to have Covid-19. The strength of the evidence supporting each recommendation is provided.

Surgery - Colorectal rater

Evidence-based guidelines for PPE in emergency and non-emergency patient interactions.

Surgery - Gastrointestinal rater

This is a high-quality and trustworthy clinical practice guideline with important clinical implications.

Surgery - Gastrointestinal rater

The evidence is poor but practical guidance is needed now while the evidence comes. A helpful statement.

Surgery - General rater

Among the best article of its kind. This must be read by all healthcare providers!

Surgery - Ophthalmology rater

This is an evidence-based review of current research on personal protection against COVID-19. This guideline provides information on clinical questions about PPE.

Surgery - Ophthalmology rater

This is an extremely extensive review of current studies on infection control. In ophthalmology, we have very few AGP; and limited contact with very ill patients. But the guidelines are very useful.

Surgery - Ophthalmology rater

Wearing of mask by both patients and HCP is the most important way to prevent transmission of COVID 19. Aerosol generating procedures have a higher risk of transmission. It was also good to identify knowledge gaps such as double gloving and shoe covers.

Surgery - Plastic rater

General precautionary guidelines.

Surgery - Plastic rater

This was a useful CPG as it was produced with robust methods. I think they should have addressed the issue whether testing should be done before any elective surgery or not.

Surgery - Urology rater

These guidelines are what I would have expected.

Surgery - Vascular rater

Very relevant article!

Surgery - Vascular rater

This IDSA committee evaluated 84 references to develop 8 recommendations addressing utility of PPE in preventing transmission of SARS-CoV-2 to heath care workers. There is little evidence supporting N95 over standard surgical masks. The likelihood of transmission with common aerosol-generating procedures is ranked. The risk for transmission to unprotected healthcare workers is estimated at 30%.