Infection prevention and control for health care workers

Coronavirus disease (COVID-19):
Infection prevention and control for health care workers
31 March 2020
Q&A

How can you clean soiled bedding, towels and linens from patients with COVID-19?
All individuals dealing with soiled bedding, towels and clothes from patients with COVID-19 should:
     Wear appropriate personal protective equipment, which includes heavy duty gloves, mask, eye protection (face shield/goggles), long-sleeved gown, apron (if gown is not fluid resistant), boots or closed shoes before touching any soiled linen.
    Never carry soiled linen against body; place soiled linen in a clearly labelled, leak-proof container (e.g. bag, bucket)
    If there is any solid excrement on the linen, such as feces or vomit, scrape it off carefully with a flat, firm object and put it in the commode or designated toilet/latrine before putting linen in the designated container.
If the latrine is not in the same room as the patient, place soiled excrement in covered bucket to dispose of in the toilet or latrine;
    Wash and disinfect linen: washing by machine with warm water (60-90°C) and laundry detergent is recommended for cleaning and disinfection of linens.
If machine washing is not possible, linen can be soaked in hot water and soap in a large drum, using a stick to stir, avoiding splashing.
If hot water not available, soak linen in 0.05% chlorine for approximately 30 minutes.  
Finally, rinse with clean water and let linen dry fully in the sunlight.
Additional resources for best practices for environmental cleaning can be found in the following two documents:
1) Infection prevention and control of epidemic-and pandemic prone acute respiratory infections in health care
2) Best Practices for Environmental Cleaning in Healthcare Facilities in Resource-Limited Settings which was developed by CDC and ICAN in collaboration with WHO



What are the recommendation regarding disinfection of vehicles, goods and products coming from China or other COVID-19 affected countries?
To date there is no epidemiological information to suggest that contact with goods, products or vehicles shipped from COVID-19 affected countries have been the source of COVID-19 in humans.
For these reasons, there is no disinfection recommendations for any goods and products coming from COVID-19 affected countries given that there is no available evidence that these products pose a risk to public health. WHO will continue to closely monitor the evolution of COVID-19, and will update the recommendations as needed.

 

What personal protective equipment (PPE) should be used by healthcare workers (HCW) performing nasopharyngeal (NP) or oropharyngeal (OP) swabs on patients with suspected or confirmed COVID-19?
Health care workers collecting NP and OP swab specimens from suspected or confirmed COVID-19 patients should be well-trained on the procedure and should wear a clean, non-sterile, long-sleeve gown, a medical mask, eye protection (i.e., googles or face shield), and gloves.
Procedure should be conducted in a separate/isolation room, and during NP specimen collection health care workers should request the patients to cover their mouth with a medical mask or tissue.
Although collection of NP and OP swabs have the potential to induce fits of coughing from the patient undergoing the procedure, there is no currently available evidence that cough generated via NP/OP specimen collection leads to increased risk of COVID-19 transmission via aerosols.



Should blood centers routinely screen blood products for COVID-19 virus?
No, although RNA fragments of SARS-CoV-2 were detected in blood of symptomatic COVID-19 patients, this does not mean that the virus is viable/infectious.
In general, respiratory viruses are not known to be transmitted by blood transfusion.
Blood centers should have routine blood donor screening measures in place to prevent individuals with respiratory symptoms or fever from donating blood.  
As precautionary measures, blood centers might encourage self-deferral of those with travel history to an COVID-19 affected country in the previous 14 days, or of those who have been diagnosed with COVID-19 or are close contact with a confirmed COVID-19 case.  



Are boots, impermeable aprons, or coverall suits required as routine personal protective equipment (PE) for healthcare workers (HCW) caring for patients with suspected or confirmed 2019-nCoV infection?
No. Current WHO guidance for HCW caring for suspected or confirmed 2019-nCoV acute respiratory disease patients recommends the use of contact and droplet precautions, in addition to standard precautions which should always be used by all HCW for all patients.
In terms of PPE, contact and droplet precautions include wearing disposable gloves to protect hands, and clean, non-sterile, long-sleeve gown to protect clothes from contamination, medical masks to protect nose and mouth, and eye protection (e.g., goggles, face shield), before entering the room where suspected or confirmed 2019-nCoV acute respiratory disease patients are admitted.
Respirators (e.g. N95) are only required for aerosol generating procedures.



Can disposable medical face masks be sterilized and reused?
No.
Disposable medical face masks are intended for a single use only.
After use they should be removed using appropriate techniques (i.e. do no touch the front, remove by pulling the elastic ear straps or laces from behind) and disposed of immediately in an infectious waste bin with a lid, followed by hand hygiene.



Why does WHO recommend contact and droplet precautions and not routine use of airborne precautions for healthcare workers providing care to patients with suspected/confirmed 2019-nCoV infection?
WHO developed its rapid guidance based on the consensus of international experts who considered the currently available evidence on the modes of transmission of 2019-nCoV.
This evidence demonstrates viral transmission by droplets and contact with contaminated surfaces of equipment; it does not support routine airborne transmission.
Airborne transmission may happen, as has been shown with other viral respiratory diseases, during aerosol-generating procedures (e.g., tracheal intubation, bronchoscopy), thus WHO recommends airborne precautions for these procedures.



Does WHO recommend routine wearing masks for healthy people during the 2019 nCoV outbreak?
No. WHO does not recommend that asymptomatic individuals (i.e., who do not have respiratory symptoms) in the community should wear medical masks, as currently there is no evidence that routine use of medical masks by healthy individuals prevents 2019-nCoV transmission.
Masks are recommended to be used by symptomatic persons in the community.
Misuse and overuse of medical masks may cause serious issues of shortage of stocks and lack of mask availability for those who actually need to wear them.
In health care facilities where health care workers are directly taking care of suspect or confirmed 2019-nCoV acute respiratory disease patients, masks are an important part of containing 2019-nCoV spread between people, along with other PPE and hand hygiene.



Can patients with suspected and confirmed nCoV infection be cohorted in the same room?
Ideally, suspected and confirmed 2019-nCoV acute respiratory disease patients should be isolated in single rooms.
However, when this is not feasible (e.g., limited number of single rooms), cohorting is an acceptable option.
Some patients with suspected 2019-nCoV infection may actually have other respiratory illnesses, hence they must be cohorted separately from patients with confirmed 2019-nCoV infection.
A minimum of 1-meter distance between beds should be maintained at all times.



Do patients with suspected or confirmed 2019-nCoV need to be hospitalized if they have mild illness?
No.
For patients who have mild illness, e.g., low-grade fever, cough, malaise, rhinorrhoea, sore throat without any warning signs, such as shortness of breath or difficulty in breathing, increased respiratory (i.e. sputum or haemoptysis), gastro-intestinal symptoms such as nausea, vomiting, and/or diarrhoea and without changes in mental status, hospitalization may not be required unless there is concern for rapid clinical deterioration.
All patients discharged home should be instructed to return to hospital if they develop any worsening of illness.



Are specialized or referral hospitals required for patients with suspected or confirmed 2019-nCoV infection when hospitalization is needed?
No. Current WHO recommendations do not include a requirement for exclusive use of specialized or referral hospitals to treat suspected or confirmed 2019-nCoV acute respiratory disease patients.
However, countries or local jurisdictions may choose to care for patients at such hospitals if those are deemed the most likely to be able to safely care for patients with suspected or confirmed 2019-nCoV infection or for other clinical reasons (e.g., availability of advanced life support).
Regardless, any healthcare facility treating patients with suspected or confirmed 2019-nCoV patients should adhere to the WHO infection prevention and control recommendations for healthcare to protect patients, staff and visitors.



What are the disinfectants recommended for environmental cleaning in healthcare facilities or homes housing patients with suspected or confirmed 2019-nCoV infection?
Environmental cleaning in healthcare facilities or homes housing patients with suspected or confirmed 2019-nCoV infection should use disinfectants that are active against enveloped viruses, such as 2019-nCoV and other coronaviruses.
There are many disinfectants, including commonly used hospital disinfectants, that are active against enveloped viruses.
Currently WHO recommendations include the use of:
    70% Ethyl alcohol to disinfect reusable dedicated equipment (e.g., thermometers) between uses
    Sodium hypochlorite at 0.5% (equivalent 5000ppm) for disinfection of frequently touched surfaces in homes or healthcare facilities



How long the 2019-nCoV can survive on a dry surface?
There is currently no data available on stability of 2019-nCoV on surfaces.  
Data from laboratory studies on SARS-CoV and MERS-CoV have shown that stability in the environment depends on several factors including relative temperature, humidity, and surface type.
WHO continues to monitor existing evidence around nCoV and will update when such evidence is available.



Is there a special procedure regarding waste produced by patients with suspected or confirmed 2019-nCoV?
No.
Waste produced during the health care or home care of patients with suspected or confirmed 2019-nCoV infection should be disposed of as infectious waste.



Are there special procedures for the management of bodies of persons who have died from 2019-nCoV?
No, there are no special procedures for the management of bodies of persons who have died from 2019-nCoV.
Authorities and medical facilities should proceed with their existing policies and regulations that guide post-mortem management of persons who died from infectious diseases.



Is there a model for setting up an isolation ward and types and products and health requirements?
A model for setting up an isolation ward is currently under development.
PPE specifications for healthcare workers caring for nCoV patients can be found  in the disease commodity package at:
https://www.who.int/publications-detail/disease-commodity-package---novel-coronavirus-(ncov)



Can chlorine solutions also be used?
Chlorine solutions are strongly discouraged as they carry a higher risk of hand irritation and ill health effects from making and diluting chlorine solutions, including eye irritation and respiratory problems.
In addition, there is a risk of loss of antimicrobial effect if exposed to sunlight or heat.  
Preparing chlorine solutions requires training to reach the correct dose of 0.05% with varying strengths of bleach available in the private sector.  
Even if stored at a cool dry place with a lid away from sunlight, they have to be renewed daily.  
In comparison simple soapy water solution do not have any of the above-mentioned health risks and complications including loss of antiviral effect due to heat or sunlight.  
The antiviral effect of soapy water is due to the oily surface membrane of the COVID-virus that is dissolved by soap, killing the virus.

Source:
https://www.who.int/news-room/q-a-detail/coronavirus-disease-covid-19-infection-prevention-and-control-for-health-care-workers