How can we prevent or minimise COVID-19 transmission in a clinical primary care setting?

15 Feb 2021

What the research says:

The COVID-19 virus is spread primarily via respiratory droplets . Respiratory aerosols have also been implicated in viral transmission in medical settings, particularly from inhaler procedures. Droplets formed during talking, singing, coughing or sneezing remain the most common modes of transmission. The probability that brief exposure to infected but asymptomatic individuals results in viral transmission is low, although new variants may be more contagious. Prolonged (>15 minutes) and close (within 2 metres) exposure to an individual with COVID-19 infection (asymptomatic or symptomatic) is thought to more likely to result in viral transmission. Contact with surfaces contaminated with viral particles can result in transmission if the individual then touches their face. Up to 62% of transmission may occur via individuals who are asymptomatic, which includes those who are pre-symptomatic. Asymptomatic individuals and those who are post-symptomatic may remain infectious for many days.

Fomite, an object or material likely to carry infection.

What this means for your clinical practice:

Prevention of viral transmission is best achieved by reducing close face to face contact including maintaining at least a 2-metre distance when not conducting a physical examination, use of certified masks covering your face from the bridge of your nose to under your chin by both patients and healthcare professionals, appropriate use of personal protective equipment (PPE) including face shields or goggles, frequent hand washing and rigorous attention to ventilation and COVID-appropriate cleaning of clinical areas between patient consultations. These steps apply to all individuals presenting for healthcare. Remote healthcare consultations should be considered for all patients requiring continuing follow-up care during the COVID-19 pandemic.

Those requiring face to face consultation should be appropriately triaged to establish their risk for current COVID-19 infection. This may include remote (telephone) triaging of patients to determine likelihood of current COVID-19 infection, temperature screening prior to entry to a healthcare facility, use of PPE and social distancing. Individuals with, or at high risk for, current COVID-19 infection should be seen in a dedicated clinical area following local guidance on the use of PPE.

Resource information

Respiratory conditions

COVID-19

Respiratory topics

Transmission

Type of resource

IPCRG COVID-19 and respiratory Q&A

Disclaimer

Page last reviewed on the date shown above.

The content is drawn from the references listed above. Wording has been adapted for clarity and applicability for the primary care context. The content does not imply direction by the IPCRG nor does it form a position of the IPCRG on this subject. The content may be adapted as new evidence arises. This content is advisory; it is intended for general use and should not be regarded as applicable to a speciﬁc case.

The International Primary Care Respiratory Group produces a range of answers to questions raised by our Sentinel Network for clinicians working in community settings. These are called the IPCRG Questions and Answers. Where possible, these are published using Creative Commons licences under the Attribution-NonCommercial-ShareAlike CC BY-NC-SA licence. This licence lets others remix, tweak, and build upon our work non-commercially, as long as they credit IPCRG and license their new creations under the identical terms. This enables member countries to adapt and translate for use in their country. Further information on the fine print can be found by reading the Legal Code. We would appreciate it if you would ask your colleagues to visit our site to obtain documents, rather than you sending them copies. By doing this they will be better able to understand and accept the CCL. The IPCRG Answer Review Group coordinates the views of primary care colleagues with specific regard to these answers. The views expressed in these answers are not necessarily those of the International Primary Care Respiratory Group. Should any author have a conflict of interest in regard to an answer, then this will be clearly stated in the answer document.

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How can we prevent or minimise COVID-19 transmission in a clinical primary care setting?

What the research says:

What this means for your clinical practice:

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iQ&A top questions and answers

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For a person accessing primary care, how can I decide which symptoms are more likely to suggest a current COVID-19 infection in order to decide further which of them should be tested in preparation for a face to face consultation?

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