The hierarchy of isolated treatment spaces is summarised in Figure 3 below. While patients with suspected or confirmed COVID-19 should ideally be managed in a negative pressure room, this may not be feasible as patient numbers escalate.
that, in the setting of a mismatch between the supply and demand for isolated treatment spaces, clinicians:
- Assess the infection control risks posed by a particular patient on an individual basis (see example below).
- Prioritise treatment spaces with a higher level of isolation for patients who pose the greatest risk of virus aerosolisation.
We recommend that, in order of priority, preference for treatment spaces with a high level of isolation is given to:
- Patients with suspected or confirmed COVID-19 who are undergoing, or are likely to undergo, an aerosol generating procedure (as listed in Table 1).
- Patients with suspected or confirmed COVID-19 receiving supplemental oxygen.
- Other patients with confirmed COVID-19.
- Other patients with suspected COVID-19.
An example of this individual approach to risk assessment is as follows:
- A 60-year-old patient with severe acute respiratory distress and a decreased conscious state is high risk and should be placed in the highest level of isolation.
- A 24-year-old patient with a limb injury who has had contact with a confirmed COVID-19 positive case (but is currently asymptomatic) would also be appropriate for a single room, but is much lower risk of transmitting the virus.
The flow-chart at Figure 4 outlines an approach that balances risk of virus transmission and the level of isolation required.
Figure 4. Example model of treatment space allocation based on transmission and clinical risk.
Note that risk stratification may change as the pandemic progresses
We align with the following resources:
- ASID Interim Guidelines for the Clinical Management of COVID-19 in Adults [Link]
- Australian Government Department of Health Interim advice on non-inpatient care of persons with suspected or confirmed Coronavirus Disease 2019 (COVID-19), including use of personal protective equipment (PPE) [Link]
- WHO Coronavirus disease (COVID-19) technical guidance: Infection prevention and control [Link]
- WHO Guidance on Natural Ventilation for Infection Control in Healthcare Settings [Link]
Table 1. Examples of aerosol generating procedures
Note: adapted from SAS guidelines [Link] and Department of Health guidance [Link]