Infection Control Guidance

  • Source control: Ensure universal masking; patients must remove own mask and don hospital mask; screen patients before and upon arrival.
  • Infection control/environment of care: Use hospital-approved disinfectants. COVID-19 requires no special products. Use Super Sani-Cloth, another hospital-approved substitute wipe, or Virex Plus depending on availability.
  • Cohort patients: Patients with a COVID-related infection status (COVID-19, CoV-Presumed, CoV-Exposed or CoV-Risk) may not be seen in regular clinics without Infection Control approval. Care teams see their patients who are COVID-19, CoV-Presumed, and CoV-Exposed in the RACC. CoV-Risk patients may be seen in approved MGH Primary Care locations or in Urgent Care.

Updated August 18, 2021.

  • Eye protection should be used for all clinical encounters: that is, when entering an enclosed patient area or having sustained face-to-face interactions within 6 feet of patients outside of an enclosed patient area. See the Universal Eye Protection Policy.
    • Refer to the policy for more information on extended use of eye protection, which is permitted under some circumstances.
  • See the Universal Mask Policy for the latest specific guidance on masking.
    • When employees remove their facemasks (only permitted in certain locations/situations, e.g. in a shared office, break room, or designated eating/drinking area), they must distance by ≥6 feet.
    • All employees must continue to wear facility-issued facemasks upon entry to the facility and when in all public/common spaces and all clinical locations. Outpatient visitors and their support persons must wear facility-issued facemasks throughout visits except when removal is necessary for clinical care. Exceptions are described in the policy.
  • Guidance from the Massachusetts Department of Public Health (MDPH) recommends that fully vaccinated individuals wear masks indoors in public whenever possible if they
    • are immunocompromised or at increased risk of severe disease
    • have a household member who is immunocompromised, at increased risk of severe disease, or is an unvaccinated adult.
  • Ambulatory patients may be accompanied by one visitor/support person (no pre-approval necessary).
    • If a patient asks to bring a second support person, follow departmental guidelines for approval, then use the Approved Support Person FYI Flag in Epic (see tip sheet).
  • Waiting room chairs are no longer required to be socially distant, and outside of routine cleaning by Environmental Services staff, only need to be wiped down when visibly soiled.
  • Online platforms should be used for meetings and gatherings whenever possible. For meetings and gatherings with any in-person attendance, online options should be provided to increase access for all.

Click on an area to expand for recommendations, tip sheets and tools.

  • Schedule care to occur virtually whenever clinically appropriate and possible (see Virtual Visit Toolkit).
  • At time of scheduling:
    • Review COVID status and implement COVID status resolution before visits (link to details).
      • Patients with a COVID-related infection status (COVID-19, CoV-Presumed, CoV-Exposed or CoV-Risk) may not be seen in regular clinics without Infection Control approval. Care teams see their patients who are COVID-19, CoV-Presumed, and CoV-Exposed in the RACC. CoV-Risk patients may be seen in approved MGH Primary Care locations or in Urgent Care.
    • Ensure Patient Gateway enrollment.
    • Advise patients of eCheck-in process.
    • Remind patients to contact your practice if they develop symptoms or test positive for COVID-19 before their appointment.
    • Remind patients to use the online COVID-19 prescreen tool prior to their visit to the MGH to receive a pass to enter the building.

Scheduling Tools

  • Screen patients for symptoms and review COVID-related infection status 72 hours before visit (link to details).
  • Re-emphasize eCheck-in to minimize necessary interactions during onsite check-in.
  • Ask patients to refrain from arriving to appointments early to cut down on waiting room density.

Pre-Visit Interaction Tools

  • To manage density, consider real-time communication to notify patients via call or text when it is time to present to the clinic.
  • Ensure patients have checked in using eCheck-in.
  • Ensure patients are wearing a hospital-issued mask; those who are unable to wear one should be prioritized for rooming.
  • Encourage patients to use hand sanitizer upon arrival to the waiting room and when transitioning from the waiting room to the exam room.
  • Re-screen patients/visitors for symptoms using the Pre-Visit Screening Tool at check-in if you are not in a facility that is screening patients and visitors upon entry. Follow established protocols if the patient or visitor screens positive (link to details).

Clinic Front Desk Tools

  • Wherever possible, room patients directly after check-in to minimize waiting room use.
  • Place hospital-approved signage on walls reminding patients and visitors about masking, cough etiquette, and other infection control practices.
  • Whenever possible, ensure that furniture is wipeable (especially arms of patient chairs).
  • Ensure patients are wearing a hospital-issued mask; those who are unable to wear one should be prioritized for rooming.
  • Waiting rooms are cleaned per the MGH Environment Equipment and Supplies and Environmental Cleaning Policy (section III, E). COVID-19 requires no special products. Use Super Sani-Cloth, another hospital-approved substitute wipe, or Virex depending on availability. Beyond the regular cleaning provided by Environmental Services, chairs only need to be wiped down when visibly soiled.

Waiting Room Tools

  • Clean rooms between patients.
    • After a patient leaves, wipe down high-touch surfaces and any equipment used in the exam room per the MGH Environment Equipment and Supplies and Environmental Cleaning Policy. Note that cleaning between each patient is in addition to daily Environmental Services cleanings (exam table, blood pressure cuffs, etc).
    • Use hospital-approved disinfectants. COVID-19 requires no special products. Use Super Sani-Cloth, another hospital-approved substitute wipe, or Virex depending on availability.
  • To cut down on cleaning effort, remove unnecessary items and use wipeable surfaces whenever possible.
  • Ask patients to use hand hygiene when they enter the exam room.
  • Remind patients to remain masked unless instructed to remove the mask by a clinician.

Exam Room Tools

  • Per the Universal Mask Policy as of August 11, 2021:
    • Employees may remove their masks in private offices when working alone.
    • They can also be unmasked in the following places and situations, as long as they can maintain a distance of at least 6 feet from others:
      • Shared offices 
      • Locations where eating and drinking are specifically permitted (i.e., private offices, work rooms, breakrooms, cafeterias, conference rooms)
      • During in-person administrative, research, and other meetings (see the Facility Density and In-Person Gatherings Policy)
    • Exception: Employees who are immunocompromised or at increased risk for severe disease – or who have a household member who is immunocompromised, at increased risk for severe disease, or is an unvaccinated adult – should remain masked indoors whenever possible. (See Massachusetts Mask Advisory here.)
  • When employees remove their masks to eat or drink, they should comply with the following steps:
    1. Perform hand hygiene with soap and water or an alcohol-based hand rub.
    2. Remove the facemask and place it on a clean surface such as a paper towel, paper bag or paper tray.
    3. Perform hand hygiene with soap and water or an alcohol-based hand rub before eating; soap and water is recommended before eating.
    4. After finishing eating or drinking, replace the facemask, taking care to avoid touching face or eyes.
    5. Perform hand hygiene with soap and water or an alcohol-based hand rub.
  • Make hand sanitizer available in staff areas.
  • Routine cleaning of break rooms should take place.

Standard Precautions

These are the minimum infection prevention practices that apply to all patient care, regardless of suspected or confirmed infection status of the patient:

  • Treat all blood and body fluids as infectious.
  • Wear gloves for contact with blood, body fluids, mucus membranes, non-intact skin, secretions, excretions and other contaminated items.
  • Use Personal Protective Equipment (PPE) per Infection Control guidance.
  • Disinfect hands before and after every patient contact, even if gloves are used.
  • Between seeing patients, disinfect equipment and surfaces (exam tables, blood pressure cuffs, etc) with hospital-approved products.

View the Prevention of Healthcare Associated Infections Standard Precautions Policy.

Enhanced Respiratory Isolation

View the Enhanced Respiratory Isolation Policy (COVID-19, CoV-Risk, CoV-Presumed, and CoV-Exposed).

MGH and Mass General Brigham Policies Related to COVID-19

View the policies.

PPE/Infection Control Tools

Infection Control Champions

Infection Control Refresher Training – updated 6/2021 (also available to assign in HealthStream)

PPE

Other

Per the Facility Density and In-Person Gatherings During the COVID-19 Pandemic policy, as of September 7, 2021:

  1. Non-employees who are hosted by Mass General Brigham facilities as part of formal educational programs where on-site work is necessary to complete their academic requirements, degree requirements, or certification are permitted within the scope of their role (i.e., if their role does not include on-site activities in clinical locations, they are not permitted in those locations).
  2. Non-employees who are not part of formal educational programs such as student observers are not permitted.
  3. On-site educational activities for non-employees (i.e., clinical courses or conferences) are not permitted.
  4. Non-employees who are invited as visiting scholars, lecturers, or instructors are considered visitors to employees and are subject to the Visitor Policy During the COVID-19 Pandemic.

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