Coronavirus Disease 2019 (COVID-19) Triage Precautions FAQ

Standard Precautions assume that every person is potentially infected or colonized with a pathogen that could be transmitted in the healthcare setting.[1, 2, 3, 4, 5]

Ensure rapid, safe triage and isolation of patients with symptoms of suspected coronavirus disease 2019 (COVID-19) or other respiratory infection (eg, fever, cough). Prioritize triage of patients with respiratory symptoms.

Triage personnel should have facemasks and tissues for patients with symptoms of respiratory infection. These should be provided at check-in. Put a facemask over the mouth and nose of a symptomatic patient to help prevent transmission.

At patient check-in, all patients should be asked about symptoms of respiratory infection and history of travel to areas with COVID-19 or contact with COVID-19 patients.

Isolate the patient in an examination room with the door closed. If a room is not available, ensure that the patient is not allowed to wait with other patients.

Find a separate, well-ventilated space where waiting patients can be separated by 6 ft or more.

Monitor for and evaluate fevers and respiratory illnesses. Place any patient with unexplained fever or respiratory symptoms on appropriate Transmission-Based Precautions and evaluate. The full description is provided in the Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings.

Standard Precautions assume that every person is potentially infected or colonized with a pathogen that could be transmitted in the healthcare setting.[1, 2, 3, 4, 5]

Healthcare professionals (HCPs) who enter the room of a patient with known or suspected coronavirus disease 2019 (COVID-19) should adhere to Standard Precautions and use a respirator or facemask, gown, gloves, and eye protection. 

When available, respirators (instead of facemasks) are preferred; they should be prioritized for situations where respiratory protection is most important and for the care of patients with pathogens requiring Airborne Precautions (eg, tuberculosis, measles, varicella). Information about the recommended duration of Transmission-Based Precautions is available in Discontinuation of Transmission-Based Precautions and Disposition of Patients with COVID-19 in Healthcare Settings (Interim Guidance).

HCPs should perform hand hygiene before and after all patient contact and contact with potentially infectious material, as well as before putting on and after removing personal protective equipment (PPE), including gloves. 

HCPs should perform hand hygiene by using alcohol-based hand rub (ABHR) with 60-95% alcohol or washing hands with soap and water for at least 20 seconds. If hands are visibly soiled, use soap and water before returning to ABHR.

Healthcare facilities should ensure that hand hygiene supplies are readily available to all personnel in every care location.

Employers should select appropriate PPE and provide it to HCPs in accordance with OSHA PPE standards (29 CFR 1910 Subpart I).

Put on a respirator or facemask (if a respirator is not available) before entry into the patient room or care area.

N95 respirators or respirators that offer a higher level of protection should be used instead of a facemask when performing or present for an aerosol-generating procedure (AGP). For guidance on extended use of respirators, refer to Strategies for Optimizing the Supply of N95 Respirators.

Put on eye protection (ie, goggles or a disposable face shield that covers the front and sides of the face) upon entry to the patient room or care area. Personal eyeglasses and contact lenses are NOT considered adequate eye protection. Remove eye protection before leaving the patient room or care area.

Put on clean, non-sterile gloves upon entry into the patient room or care area. Change gloves if they become torn or heavily contaminated. Remove and discard gloves when leaving the patient room or care area, and immediately perform hand hygiene.

Put on a clean isolation gown upon entry into the patient room or area. Change the gown if it becomes soiled. Remove and discard the gown in a dedicated container for waste or linen before leaving the patient room or care area. Disposable gowns should be discarded after use. Cloth gowns should be laundered after each use.

Any reusable PPE must be properly cleaned, decontaminated, and maintained after and between uses. 

Some procedures performed on patients with known or suspected coronavirus disease 2019 (COVID-19) could generate infectious aerosols—in particular, procedures likely to induce coughing (eg, sputum induction, open suctioning of airways)—and therefore should be performed cautiously and avoided if possible.[1, 2, 3, 4, 5]

Healthcare professionals (HCPs) in the room should wear an N95 or higher-level respirator, eye protection, gloves, and a gown.

The number of HCPs present during the procedure should be limited to only those essential for patient care and procedure support. Visitors should not be present for the procedure.

Aerosol-generating procedures (AGPs) should ideally take place in an airborne infection isolation room (AIIR).

Clean and disinfect procedure room surfaces promptly. Information about recommended practices for terminal cleaning of rooms and personal protective equipment (PPE) to be worn by environmental services personnel is available in Healthcare Infection Prevention and Control FAQs for COVID-19.

Specimen collection should be performed in a normal examination room with the door closed.

A study by Soltan et al indicates that artificial intelligence (AI)–driven systems can effectively be used for the triage of patients with COVID-19. The benefit of such systems would be to determine an individual’s severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection status more quickly than can be derived using a polymerase chain reaction (PCR) assay and with greater sensitivity than can be achieved with a lateral flow device. The CURIAL-Lab model employs patient data that are quickly available, including vital signs and blood test results (for full blood count; urea, creatinine, and electrolytes; liver function test; and C-reactive protein), while the CURIAL-Rapide model uses only vital signs and the full blood count. Sensitivities at one of the participating facilities were determined to be 84.1% and 83.5%, for CURIAL-Lab and CURIAL-Rapide, respectively. The specificities at this facility—71.3% and 63.6%. respectively—were higher elsewhere. Following patient arrival at the emergency department, results from the CURIAL-Rapide system were derived at a median 45 minutes.[6]