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Transmission may occur through fomites in the immediate environment around the infected person, through contact with surfaces in the immediate environment or with objects used on the infected person (e.g. stethoscope or thermometer).
Airborne transmission may be possible in circumstances where procedures that generate aerosols are performed.
Aerosol generating procedures (AGPs, see Table 1 in Section 3) include endotracheal intubation, bronchoscopy, open suctioning, administration of nebulized treatment, non-invasive ventilation, manual bag-mask ventilation, turning the patient to the prone position, disconnecting the patient from the ventilator, tracheostomy, insertion of intercostal catheter and cardiopulmonary resuscitation.
There have been no reports of faecal−oral transmission of the COVID-19 virus to date. Further studies are needed to determine whether it is possible to detect COVID-19 virus in air samples from patient rooms where no procedures or support treatments that generate aerosols are ongoing.
Coronaviruses can survive on surfaces for many hours but are readily inactivated by cleaning and disinfection.

Community prevalence of COVID-19 and its influence on the possibility of health care worker (HCW) infection within EDs is related to a number of factors. These include the rate at which infections actually occur in the community (infectivity), the rate of removal of infection from the population by either recovery or death, and an individual’s susceptibility to the infection.
With ongoing suppression of virus transmission and eventual success in sustained absence (the timeframe being unclear at this time) of new cases in a community, the risk of a HCW encountering a patient who is infected and has the potential for COVID-19 transmission to others, is thought to be low. At this point, guidance for local PPE use should be reviewed by EDs, infectious disease and infection control and prevention experts.
The objective of any review of PPE guidance will always be to maintain the safety of HCW within their workplace, and then to ensure the rational use of PPE. Extended use strategies should be used where PPE supply concerns exist, and supply concerns alone are not a trigger for downgrading PPE guidance. EDs routinely encounter new and unknown patients where it is not possible to fully ascertain infection risk, therefore decisions to downgrade PPE use should be approached in a cautious manner.

  • General measures to limit COVID-19 transmission in the workplace
  • Infection control and prevention
  • PPE recommendations for Emergency Departments
  • PPE in specific clinical situations
  • General recommendations
  • PPE use in high-risk zones
  • International experience on PPE
  • Alignment with regional guidance
  • References
  • Resources
  • Section disclaimer