Ipc draft

Infection prevention and control for COVID-19 2020
HARARI HEALTH BUREAU BY MARYE TILAHUN BSC IN EVIRONMENTALHEALTH
HARRI HEALTH BERUAEU
INFECTION PREVENTION AND CONTROL
(IPC) REFERENCE MANUAL
Adapted from national and
international sources

Contents
I. ACKNOWLEDGEMENTS................................................................................................................3
II. ABRIVATIONS..............................................................................................................................3
III. PREFACE.................................................................................................................................3
1. Back ground of COVID-19 Disease ...................................................................................................3
2. INTRODUCTION TO INFECTION PREVENTION AND CONTROL.............................................................5
2.1 Transmission characteristics of COVID-19 and principles of infection prevention and control ............8
3. Classifying Worker Exposure to COVID-19.......................................................................................11
3.1 Very High Exposure Risk...........................................................................................................12
3.2 High Exposure Risk ..................................................................................................................12
3.3 Medium Exposure Risk.............................................................................................................13
3.4 Lower Exposure Risk (Caution) .................................................................................................13
4. Infection prevention and control during health care when COVID-19 is suspected............................14
5. Home care forpatientswithCOVID-19presentingwithmildsymptomsandmanagementof their
contacts...........................................................................................................................................20
4.1 Where to manage COVID-19 patients.......................................................................................21
4.2 Home care for patients with suspected COVID-19 who presentwith mild symptoms...................21
5.3 Management of contacts.........................................................................................................25
6. Considerationsforquarantineof individualsinthe contextof containmentforcoronavirusdisease
(COVID-19).......................................................................................................................................26
7. InfectionPrevention and Control guidance for Long-Term Care Facilitiesin the context of COVID-19.32
8. Infection, prevention and control precautions................................................................................41
8.1 Standard Precaution................................................................................................................41
9. HAND HYGIENE AND COVID-19......................................................................................................54
10. PERSONAL PROTECTIVE EQUPMENTS FOR COVID-19.....................................................................58
10.1 How to put on (donning) put off (doffing) of personal protective equipment ............................65
11. Water, sanitation, hygiene and waste management for the COVID-19 virus....................................98
12. InfectionPreventionandControl forthe safe managementof adeadbodyinthe contextof COVID-
19.................................................................................................................................................. 104
12 ANNEXES...................................................................................................................................109
13. REFERENCES ............................................................................................................................. 115

I. ACKNOWLEDGEMENTS
II. ABRIVATIONS
III. PREFACE
Due to overuse of natural resource that cause environmental pollutionworldconfrontedwithemerging
and remergingdisease.
1. Back ground of COVID-19 Disease
First case of corona virus was notified as cold in 1960. According to the Canadian study 2001,
approximately 500 patients were identified as Flu-like system. 17-18 cases of them were confirmed as
infected with corona virus strain by polymerase chain reaction. Corona was treated as simple non fatal
virus till 2002. In 2003, various reports published with the proofs of spreading the corona to many
countries such as United States America, Hong Kong, Singapore, Thailand, Vietnam and in Taiwan.
Several case of severe acute respiratory syndrome caused by corona and their mortally more than 1000
patient was reported in 2003. This was the black year for microbiologist. When microbiologist was
started focus to understand these problems. After a deep exercise they conclude and understand the
pathogenesis of disease and discovered as corona virus. But till total 8096 patient was confirmed as
infected with corona virus. So in 2004, World health organization and centers for disease control and
prevention declared as “state emergency”. Another study report of Hong Kongwas confirmed 50 patient
of severe acute respiratory syndrome while 30 of them were confirmed as corona virus infected. In
2012, Saudi Arabian reports were presented several infected patient and deaths. COVID-19 was first
identifiedandisolatedfrompneumoniapatentbelongstoWuhan,china.

Large family of viruses that cause respiratory illness, Belongs to Coronaviridae family
firstisolated in the 1960s Circulates among animals and humans (zoonotic) Most commonly spread from
an infected person to others through: The air by coughing or sneezing ,Close personal contact, such as
touching or shaking hands, touching an infected object or surface commonly occurs in fall and winter,
but can occur year-round, young children are most likely to get infected, most people will get infected in
their lifetime. Named for the crown-like spikes on surface 4 sub groupings (alpha, beta, gamma, delta)
Seven coronaviruses that can infect humans Common HCoV: HCoV-229E (alpha), HCoV-OC43 (alpha),
HCoV-NL63 (beta), HCoV-HKU1 (beta) Other CoVs: SARS-CoV (beta), MERS-CoV (beta), 2019-nCoV, 2019
Novel Coronavirus.
According to a report published on 24 Jan 2020, corona virus infected patient have many common
features such as fever, cough, and fatigue while diarrhea and dyspnea were found to be as uncommon
feature. Many of them patient reported bilateral abnormalities. Corona virus was isolated from
bronchoalvelor lavage fluid in china in 2020. It is also detected in blood samples. Till now, corona virus
was notconfirmedinfeacesandurine sample of patent
Routes of Transmission

2. INTRODUCTION TOINFECTION PREVENTION AND CONTROL
A health care-associated infection is an infection that occurs in a patient as a result of care at a health
care facility and was not present at the time of arrival at the facility. The term “health care-associated
infection” (HAI) has replaced “nosocomial” or “hospital-acquired” infection as evidence has shown that
these infections can affect patients in any setting where they receive health care. To identify HAIs, a
timeframe for onset of an infection must be defined to differentiate an HAI from an infection acquired in
the community. The US Centers for Disease Control and Prevention (CDC) , defines HAIs as infections
that begin on or after Day 3 of hospitalization (the day of hospital admission is Day 1), on the day of
discharge,oron the day afterdischarge.(CDC2018; WHO 2011).
Health care-associated infections are the most frequent adverse events in health care delivery systems
worldwide. They are a major cause of preventable diseases, deaths, and higher health care costs. Many
HAIs are caused by microorganisms that are present on the patient’s body (resident flora) or from
OTHER HUMAN
HUMAN
HUMAN TO HUMAN
ANIMAL
ANIMAL TO HUMAN

transient sources such as HCWs’ hands, contaminated equipment, or the environment. The spread of
these organisms usually results from breaches in compliance with Standard Precautions, such as
inadequate hand hygiene and environmental cleaning, lapses in disinfection and sterilization, and
incorrect use of personal protective equipment, as well as inappropriately applied Transmission-Based
Precautions, namely Contact, Droplet, and Airborne Precautions. Such breaches result in transmission of
infectionstoandfrompatients.(WHO2011).
Infection prevention and control (IPC) is universally acknowledged as a vital component of a
comprehensive approach to patient and healthcare worker safety, quality improvement, and improved
health outcomes. The evolving landscape of emerging infectious diseases necessitates increased
awareness and attention to IPC. A strong health system, which includes a culture and infrastructure of
IPC, such as improved hygiene conditions, appropriate use and availability of personal protective
equipment (PPE), and improved healthcare waste management, will equip governments and
communities to respond to and manage outbreaks, and will prevent the spread of infectious diseases
includinghealthcare-associatedinfections(HAI).
HAIs may also occur;
Up to 48 hoursafterthe episode of care
Up to 3 days afterdischarge
Up to 30 daysafteran operation
Up to 1 year afteran operationwithanimplant

Everyon
e
WHO is at Risk?
Infection Prevention and Control and COVID-19
Limithuman-to-humantransmission
Reduce secondaryinfections
Preventtransmissionthroughamplificationandsuper-spreadingevents

Healthcare workers and COVID-19
2.1 Transmissioncharacteristics ofCOVID-19and principles of infection
preventionand control
2.1 Routes of transmission
Infection control advice is based on the reasonable assumption that the transmission characteristics of
COVID-19 are similar to those of the 2003 SARS-CoV outbreak. The initial phylogenetic and immunologic
similarities between COVID-19 and SARS-CoV can be extrapolated to gain insight into some of the
epidemiological characteristics. The transmission of COVID-19 is thought to occur mainly through
respiratory droplets generated by coughing and sneezing, and through contact with contaminated
surfaces. 1 The predominant modes of transmission are assumed to be droplet and contact. For SARS-
CoV, evidence suggests that use of both respirators and surgical face masks offer a similar level of
protection, both associated with up to an 80% reduction in risk of infection.During AGPs there is an
N=80 confirmed
case,COVID-19
,community(57.9
%)
N=17 confirmed
case,COVID-
19,during hospital
stay(12.3%)
N=138 confirmed
case COVID-19 on
a health care
facilities
n=40 confrimed
case,COVID-
19,healthcare
worker ((28.9%)

increased risk of aerosol spread of infectious agents irrespective of the mode of transmission (contact,
droplet, or airborne), airborne precautions must be implemented when performing AGPs, including
those carriedout ona suspectedorconfirmedcase of COVID-19.
In light of the above, the Department of Health and Social Care’s New and Emerging Respiratory Virus
Threat Assessment Group (NERVTAG) have recommended that airborne precautions should be
implemented at all times in clinical areas considered AGP ‘hot spots’ e.g. Intensive Care Units (ICU),
Intensive Therapy Units (ITU) or High Dependency Units (HDU) that are managing COVID-19 patients
(unless patients are isolated in a negative pressure isolation room/or single room, where only staff
enteringthe roomneedweararespirator).
In other areas a fluid-resistant (Type IIR) surgical mask (FRSM) is recommended; all general ward staff,
community, ambulance and social care staff should wear an FRSM for close patient contact (within 1
metre), unless performing an AGP, when a filtering face piece (class 3) (FFP3) respirator, eye protection,
a disposable longsleevedgownandglovesshouldbe worn.
Initial research has identified the presence of live COVID-19 virus in the stools and conjunctival
secretions of confirmed cases. All secretions (except sweat) and excretions, including diarrhoeal stools
frompatientswithknownorsuspectedCOVID-19,shouldbe regardedaspotentiallyinfectious.

Figure .1 chainof infection
2.2 Incubation and infectiousperiod
Assessment of the clinical and epidemiological characteristics of SARS-CoV-2 cases suggests that, similar
to SARS-CoV, patients will not be infectious until the onset of symptoms. In most cases, individuals are
usually considered infectious while they have symptoms; how infectious individuals are, depends on the
severity of their symptoms and stage of their illness. The median time from symptom onset to clinical
recovery for mild casesis approximately 2 weeks and is 3-6 weeks for severe or critical cases. There have
been case reports that suggest infectivity during the asymptomatic period, with one patient found to be
shedding virus before the onset of symptoms. Further study is required to determine the actual
occurrence and impact of asymptomatic transmission. From international data, the balance of evidence
isthat infectivityhassignificantlyreduced7daysafterthe onsetof symptoms

2.3 Survival in the environment
Human coronaviruses can survive on inanimate objects and can remain viable for up to 5 days at
temperatures of 22-25°C and relative humidity of 40-50% (which is typical of air-conditioned indoor
environments. Survival on environmental surfaces is also dependent on the surface type. Extensive
environmental contamination may occur following an aerosol generating procedure (AGP). The rate of
clearance of aerosols in an enclosed space is dependent on the extent of any mechanical/natural
ventilation – the greater the number of air changes per hour (ventilation rate), the sooner any aerosol
will be cleared. The time required for clearance of aerosols, and thus the time after which the room can
be entered without a filtering face piece (class 3) (FFP3) respirator, can be determined by the number of
air changes per hour (ACH) as outlined in WHO guidance; in general wards and single rooms there
should be a minimum of 6 air changes per hour, in negative-pressure isolation rooms there should be a
minimum of 12 air changes per hour.6 Where feasible, environmental decontamination should be
performed when it is considered appropriate to enter the room/area without an FFP3 respirator. A
single air change is estimated to remove 63% of airborne contaminants, after 5 air changes less than 1%
of airborne contamination is thought to remain. A minimum of 20 minutes i.e. 2 air changes, in hospital
settingswhere the majorityof these proceduresoccurisconsideredpragmatic.
3. Classifying Worker Exposure to COVID-19
Worker risk of occupational exposure to SARS-CoV-2, the virus that causes COVID-19, during an
outbreak may vary from very high to high, medium, or lower (caution) risk. The level of risk depends in
part on the industry type, need for contact within 6 feet of people known to be, or suspected of being,
infected with SARS-CoV-2, or requirement for repeated or extended contact with persons known to be,
or suspected of being,infected with SARS-CoV-2. To help employers determine appropriate precautions,
OSHA has divided job tasks into four risk exposure levels: very high, high, medium, and lower risk. The
Occupational Risk Pyramid shows the four exposure risk levels in the shape of a pyramid to represent
probable distribution of risk. Most workers will likely fall in the lower exposure risk (caution) or medium
exposure risklevels.
Occupational Risk Pyramid for COVID-19

3.1 Very High Exposure Risk
Very high exposure risk jobs are those with high potential for exposure to known or suspected sources
of COVID-19 during specific medical, postmortem, or laboratory procedures. Workers in this category
include
Healthcare workers (e.g., doctors, nurses, dentists, paramedics, emergency medical technicians)
performing aerosol-generating procedures (e.g., intubation, cough induction procedures,
bronchoscopies, some dental procedures and exams, or invasive specimen collection) on known
or suspectedCOVID-19patients.
Healthcare or laboratory personnel collecting or handling specimens from known or suspected
COVID-19patients(e.g.,manipulatingculturesfromknownorsuspectedCOVID-19patients).
Morgue workers performing autopsies, which generally involve aerosol-generating procedures,
on the bodies of people who are known to have, or suspected of having, COVID-19 at the time
of theirdeath
3.2 High Exposure Risk
Very High
High
Medium
Lower risk(caution)

High exposure risk jobs are those with high potential for exposure to known or suspected sources of
COVID-19.Workersinthiscategory include
 Healthcare delivery and support staff (e.g., doctors, nurses, and other hospital staff who must
enter patients’ rooms) exposed to known or suspected COVID-19 patients. (Note: when such
workersperformaerosol-generatingprocedures,theirexposure risklevelbecomesveryhigh.)
 Medical transport workers (e.g., ambulance vehicle operators) moving known or suspected
COVID-19patientsinenclosedvehicles
 Mortuary workers involved in preparing (e.g., for burial or cremation) the bodies of people who
are knowntohave,or suspectedof having,COVID-19atthe time of theirdeath
3.3 Medium Exposure Risk
Medium exposure risk jobs include those that require frequent and/or close contact with (i.e., within 6
feet of) people who may be infected with SARS-CoV-2, but who are not known or suspected COVID-19
patients. In areas without ongoing community transmission, workers in this risk group may have
frequent contact with travelers who may return from international locations with widespread COVID-19
transmission. In areas where there is ongoing community transmission, workers in this category may
have contact be with the general public (e.g., in schools, high-population-density work environments,
and some high-volume retail settings)
3.4 Lower Exposure Risk (Caution)
Lower exposure risk (caution) jobs are those that do not require contact with people known to be, or
suspected of being, infected with SARS-CoV-2 nor frequent close contact with (i.e., within 6 feet of) the
general public. Workers in this category have minimal occupational contact with the public and other
coworkers

4. Infectionpreventionand control during health care when COVID-19 is
suspected
4.1 PrinciplesofIPC strategiesassociated withhealth care for suspectedCOVID-19
IPCstrategiestopreventorlimittransmissioninhealthcare settingsinclude the following:
1. Ensuringtriage,earlyrecognition,andsource control (isolatingpatientswithsuspectedCOVID-19);
2. Applyingstandardprecautionsforall patients;
3. Implementingempiricadditional precautions(dropletandcontactand,wheneverapplicable,airborne
precautions) forsuspectedcasesof COVID-19;
4. Implementingadministrativecontrols;
5. Using environmental andengineeringcontrol
1. Ensuringtriage, early recognition,and source control
Clinical triage includes a system for assessing all patients at admission, allowing for early recognition of
possible COVID-19 and immediate isolation of patients with suspected disease in an area separate from
otherpatients(source control).
To facilitate the earlyidentificationof casesof suspectedCOVID-19,healthcare facilitiesshould:
 encourage HCWsto have a highlevel of clinicalsuspicion;
 establishawell-equippedtriage stationattheentrance tothe facility,
 supportedbytrainedstaff;
 institute the use of screeningquestionnairesaccordingtothe updatedcase definition
 postsignsin publicareasreminding symptomaticpatientstoalertHCWs
 Hand hygiene and respiratory hygiene are essential preventive measure
2. Applyingstandard precautions for all patients
Standardprecautionsinclude
 handand respiratoryhygiene
 the use of appropriate personal protective equipment(PPE) accordingtoa riskassessment

 injectionsafetypractices
Safe waste management
 properlinens
 environmental cleaning
 and sterilizationof patient-care equipment
Standard precautions………
Hand hygiene (water and soap or alcohol-based solutions)
Respiratory hygiene (or cough etiquette)
Safe injection practices
Sterilization / disinfection of medical devices
Environmental cleaning
Ensure that the followingrespiratoryhygiene measuresare used
Ensure that all patientscovertheirnose andmouthwitha tissue orelbow whencoughingor
sneezing
offera medical masktopatientswithsuspectedCOVID-19while theyare inwaiting/publicareas
or in cohortingrooms;
Performhandhygiene aftercontactwithrespiratorysecretions
HCWs shouldapplyWHO’s 5 MomentsforHand Hygiene approach
 before touchingapatient
 before anycleanor asepticprocedure isperformed
 afterexposure tobodyfluid
 aftertouchinga patient
 and aftertouchinga patient’ssurrounding

5 Moments of Hand Hygiene during
nCoV Public Health Emergencies
o Hand hygiene includes either cleansing hands with an alcohol-based hand rub
or with soap and water
o Alcohol-based hand rubs are preferred if hands are not visibly soiled
o wash hands with soap and water when they are visibly soiled
The rational,correct,and consistentuse of PPEalsohelpsreduce the spreadof pathogens.
PPE effectivenessdependsstronglyon
 Adequate andregularsupplies,
 Adequate staff training,
 Appropriate handhygiene
 Appropriate humanbehaviour.
 environmentalcleaninganddisinfectionproceduresare followedconsistentlyandcorrectly
 Thoroughlycleaningenvironmentalsurfaceswithwateranddetergentandapplyingcommonly
usedhospital level disinfectants(suchassodiumhypochlorite) are effectiveandsufficient
procedures
 Medical devicesandequipment,laundry,foodservice utensils, andmedical waste shouldbe
managedinaccordance withsafe routine procedures

3. Implementingempiricadditional precautions
3.1 Contact anddropletprecautions
o In additiontousingstandardprecautions,all individuals,includingfamilymembers, visitorsand
HCWs, shoulduse contactand dropletprecautionsbefore enteringthe roomof suspectedor
confirmedCOVID-19patients
o Patientsshouldbe placedinadequatelyventilatedsingle rooms.Forgeneral wardroomswith
natural ventilation,adequateventilationisconsideredtobe 60 L/s perpatient
o whensingle roomsare notavailable,patientssuspectedof havingCOVID-19shouldbe grouped
together
o all patients’bedsshouldbe placedatleast1metre apart regardlessof whethertheyare
suspectedtohave COVID-19
o where possible,ateamof HCWs shouldbe designatedtocare exclusivelyforsuspectedor
confirmedcasestoreduce the riskof transmission
o HCWs shoulduse a medical mask
o HCWs shouldweareye protection(goggles)orfacial protection(face shield) toavoid
contaminationof mucousmembranes
o HCWs shouldweara clean,non-sterile,long-sleevedgown
o HCWs shouldalsouse gloves
o the use of boots,coverall,andapronisnot requiredduringroutine car
o afterpatientcare,appropriate doffinganddisposalof all PPEandhand hygiene shouldbe
carriedout
o A newsetof PPE isneededwhencare isgiventoa differentpatient
o equipmentshouldbe eithersingle-useanddisposable ordedicatedequipment
o (e.g.stethoscopes,bloodpressure cuffsandthermometers). If equipmentneedstobe shared
amongpatients,cleananddisinfectitbetweenuse foreachindividual patient(e.g.byusing
ethyl alcohol 70%)
o HCWs shouldrefrainfromtouchingeyes,nose,ormouthwithpotentiallycontaminatedgloved
or bare hand
o Avoid movingandtransportingpatientsoutof theirroomorarea unlessmedicallynecessary.
Use designatedportable X-rayequipmentorotherdesignateddiagnosticequipment.If
transportis required,use predeterminedtransportroutestominimizeexposure for staff,other
patientsandvisitors,andhave the patientwearamedical mask
o ensure thatHCWs whoare transportingpatientsperformhandhygiene andwearappropriate
PPE as describedinthissection
o notifythe areareceivingthe patientof anynecessaryprecautionsasearlyaspossible before the
patient’sarrival
o routinelycleananddisinfectsurfaceswithwhichthe patientisincontact
o limitthe numberof HCWs,familymembers,andvisitorswhoare incontact withsuspectedor
confirmedCOVID-19patients
o maintaina recordof all personsenteringapatient’sroom, includingall staff andvisitors

3.2 Airborne precautions for aerosol-generatingprocedures
Some aerosol-generating procedures, such as tracheal intubation, non-invasive ventilation,
tracheotomy, cardiopulmonary resuscitation, manual ventilation before intubation, and bronchoscopy,
have beenassociatedwithanincreasedriskof transmissionof coronaviruses.
Ensure that HCWs performingaerosol-generatingprocedure
 Perform procedures in an adequately ventilated room – that is, natural ventilation with air flow
of at least 160 L/s per patient or in negative- pressure rooms with at least 12 air changes per
hour andcontrolleddirectionof airflow whenusingmechanical ventilation
 use a particulate respirator at least as protective as a US National Institute for Occupational
Safety and Health (NIOSH)-certified N95, European Union (EU) standard FFP2, or equivalent.2,13
When HCWs put on a disposable particulate respirator, they must always perform the seal
check.13 Note that facial hair(e.g.a beard) maypreventaproperrespiratorfit
 use eye protection(i.e.gogglesoraface shield
 Wear a clean, non-sterile, long-sleeved gown and gloves. If gowns are not fluid-resistant, HCWs
should use a waterproof apron for procedures expected to create high volumes of fluid that
mightpenetrate the gown
 limit the number of persons present in the room to the absolute minimum required for the
patient’scare andsupport
4. Implementingadministrative controls
Administrative controls and policies for the prevention and control of transmission of COVID-19 within
the health care setting include, but may not be limited to: establishing sustainable IPC infrastructures
and activities; educating patients’ caregivers; developing policies on the early recognition of acute
respiratory infection potentially caused by COVID-19 virus; ensuring access to prompt laboratory testing
for identification of the etiologic agent; preventing overcrowding, especially in emergency departments;
providing dedicated waiting areas for symptomatic patients; appropriately isolating hospitalized
patients; ensuring adequate supplies of PPE; and ensuring adherence to IPC policies and procedures for
all aspectsof healthcare

4.1 Administrative measuresrelatedto health care workers
 Provisionof adequate trainingforHCWs;
 Ensuringan adequate patient-to-staffratio;
 Establishing a surveillance process for acute respiratory infections potentially caused by COVID-
19 virusamongHCWs
 ensuring that HCWs and the public understand the importance of promptly seeking medical
care;
 monitoring HCW compliance with standard precautions and providing mechanisms for
improvementasneeded
5. Usingenvironmental andengineeringcontrols
These controlsaddressthe basicinfrastructure of the healthcare facilityandaimtoensure
 Adequate ventilationinall areasinthe healthcare facility
 as well asadequate environmental cleaning
 separationof at least1 metre shouldbe maintained betweenall patients
 Both spatial separationandadequate ventilationcanhelpreduce the spreadof manypathogens
inthe healthcare setting
 Ensure that cleaninganddisinfectionproceduresare followedconsistentlyandcorrectly
 Cleaningenvironmentalsurfaceswithwateranddetergentandapplyingcommonlyused
hospital disinfectants(suchassodiumhypochlorite) iseffective andsufficient.8
 Manage laundry,foodservice utensilsandmedical waste inaccordance withsafe routine
procedures.
Collecting and handling laboratory specimens from patients with suspected COVID-19
All specimenscollectedforlaboratoryinvestigationsshouldbe regardedaspotentially
infectious.HCWsthatcollect,handle,ortransportclinical specimensshouldadhere rigorously to
the followingstandardprecautionmeasuresandbiosafetypracticestominimize the possibility
of exposure topathogens
 Ensure that HCWs who collect specimens use appropriate PPE (i.e. eye protection, a
medical mask, a long-sleeved gown, and gloves). If the specimen is collected during an
aerosol-generating procedure, personnel should wear a particulate respirator at least as
protective asa NIOSH-certifiedN95,an EU standardFFP2,or the equivalent
 ensure that all personnel who transport specimens are trained in safe handling practices
and spill decontaminationprocedures

 place specimens for transport in leak-proof specimen bags (secondary containers) that
have a separate sealable pocket for the specimen (a plastic biohazard specimen bag),
with the patient’s label on the specimen container (the primary container), and a clearly
writtenlaboratoryrequestform
 ensure that laboratories in health care facilities adhere to appropriate bio safety
practicesand transportrequirements,accordingtothe type of organismbeinghandled
 Deliver all specimens by hand whenever possible. DO NOT use pneumatic-tube systems
to transportspecimens
 Document clearly each patient’s full name, date of birth and “suspected COVID-19” on
the laboratory request form. Notify the laboratory as soon as possible that the specimen
isbeingtransported
Duration of contact and droplet precautionsfor patientswith COVID-19
Standardprecautionsshouldbe appliedatall times.
Additional contactanddropletprecautionsshouldcontinue untilthe patientisasymptomatic
More comprehensive information about the mode of virus transmission is required to define the
durationof additional precautions.
Recommendationfor outpatientcare
The basic principlesof IPCandstandardprecautionsshould be appliedinall healthcare facilities,
includingoutpatientcare andprimarycare.For COVID-19,the followingmeasuresshouldbe adopted
5. Home care for patients with COVID-19presenting with mild symptoms
and management of their contacts
This rapid advice has been updated with the latest information and is intended to guide public health
and infection prevention and control (IPC) professionals, health care managers and health care workers
(HCWs) when addressing issues related to home care for patients with suspected COVID-19 who present
withmildsymptomsandwhenmanagingtheircontacts.
This guidance is based on evidence about COVID-19 and the feasibility of implementing IPC measures at
home. For the purpose of this document, “caregivers” refers to parents, spouses, and other family
membersorfriendswithoutformal healthcare training

4.1 Where to manage COVID-19 patients
WHO recommends that all laboratory confirmed cases be isolated and cared for in a health care facility.
WHO recommends that all persons with suspected COVID-19 who have severe acute respiratory
infection be triaged at the first point of contact with the health care system and that emergency
treatment should be started based on disease severity. WHO has updated treatment guidelines for
patients with ARI associated with COVID-19, which includes guidance for vulnerable populations (e.g.,
older adults, pregnant women and children) .In situations where isolation in a health care facility of all
cases is not possible, WHO emphasizes the prioritization of those with highest probability of poor
outcomes: patients with severe and critical illness andthose with mild disease and risk for poor outcome
(age >60 years, cases with underlying co-morbidities, e.g., chronic cardiovascular disease, chronic
respiratory disease, diabetes, cancer) If all mild cases cannot be isolated in health facilities, then those
with mild illness and no risk factors may need to be isolated in non-traditional facilities, such as
repurposed hotels, stadiums or gymnasiums where they can remain until their symptoms resolve and
laboratory tests for COVID-19 virus are negative. Alternatively, patients with mild disease and no risk
factors can be managedat home
4.2 Home care for patients with suspected COVID-19 who present with mild
symptoms
 For those presenting with mild illness, hospitalization may not be possible because of the
burdenonthe healthcare system, orrequiredunlessthereisconcernaboutrapiddeterioration.
 If there are patients with only mild illness, providing care at home may be considered, as long as
they can be followed up and cared for by family members. Home care may also be considered
when inpatient care is unavailable or unsafe (e.g. capacity is limited, and resources are unable to
meetthe demandforhealthcare services)
 In any of these situations, patients with mild symptoms and without underlying chronic
conditions − such as lung or heart disease, renal failure, or immune compromising conditions
that place the patientat increased riskof developingcomplications−may be cared forat home.
 This decision requires careful clinical judgment and should be informed by an assessment of the
safetyof the patient’shome environment

 In cases in which care is to be provided at home, if and where feasible, a trained HCW should
conduct an assessmenttoverifywhetherthe residential settingissuitable forprovidingcare.
 The HCW must assess whether the patient and the family are capable of adhering to the
precautions that will be recommended as part of home care isolation (e.g., hand hygiene,
respiratory hygiene, environmental cleaning, limitations on movement around or from the
house) and can address safety concerns (e.g., accidental ingestion of and fire hazards associated
withusingalcohol-basedhandrubs)
 If and where feasible, a communication link with health care provider or public health
personnel, or both, should be established for the duration of the home care period – that is,
until the patient’ssymptomshave completelyresolved
 comprehensive information about COVID-19 and its transmission is required to define the
durationof home isolationprecaution
Patients and household members should be educated about personal hygiene, basic IPC
measures, and how to care as safely as possible for the person suspected of having COVID19
to prevent the infection from spreading to household contacts. The patient and household
members should be provided with ongoing support and education, and monitoring should
continue for the duration of home care. Household members should adhere to the following
recommendations
 Place the patient in a well-ventilated single room (i.e. with open windows and an open
door).
 Limit the movement of the patient in the house and minimize shared space. Ensure that
sharedspaces(e.g.kitchen,bathroom) are wellventilated(keepwindowsopen).
 Household members should stay in a different room or, if that is not possible, maintain a
distance of at least1 metre fromthe ill person(e.g.sleepinaseparate bed).
 Limit the number of caregivers. Ideally, assign one person who is in good health and has
no underlyingchronicorimmunocompromisingconditions
 Visitors should not be allowed until the patient has completely recovered and has no
signsor symptomsof COVID-19.
 Perform hand hygiene after any type of contact with patients or their immediate
environment.

Hand hygiene shouldalsobe performed
before andafterpreparingfood
before eating,
afterusingthe toilet
Wheneverhandslookdirty
If hands are not visibly dirty, an alcohol-based hand rub can be used. For visibly dirty
hands, use soap and water.
 When washing hands with soap and water, it is preferable to use disposable paper towels to dry
hands.If these are not available,use cleanclothtowelsandreplace themfrequently
 To contain respiratory secretions, a medical mask should be provided to the patient and worn
as much as possible,andchangeddaily
 Individuals who cannot tolerate a medical mask should use rigorous respiratory hygiene; that is,
the mouth and nose should be covered with a disposable paper tissue when coughing or
sneezing.
 Materials used to cover the mouth and nose should be discarded or cleaned appropriately after
use (e.g.washhandkerchiefsusingregularsoapordetergentandwater).
 Caregivers should wear a medical mask that covers their mouth and nose when in the same
room as the patient,Masksshouldnotbe touchedor handledduringuse
 If the mask gets wet or dirty from secretions, it must be replaced immediately with a new clean,
dry mask.
 Remove the mask using the appropriate technique – that is, do not touch the front, but instead
untie it.Discardthe mask immediatelyafteruse andperformhandhygiene
 Avoid direct contact with body fluids, particularly oral or respiratory secretions, and stool. Use
disposable gloves and a mask when providing oral or respiratory care and when handling stool,
urine,andotherwaste.Performhandhygiene before andafterremovingglovesandthe mask
 Do not reuse masksor gloves
 Use dedicated linen and eating utensils for the patient; these items should be cleaned with soap
and waterafteruse and may be re-usedinsteadof beingdiscarded
 Daily clean and disinfect surfaces that are frequently touched in the room where the patient is
beingcaredfor, such as bedside tables,bedframes,andotherbedroomfurniture

 Regular household soap or detergent should be used first for cleaning, and then, after rinsing,
regular household disinfectant containing 0.1% sodium hypochlorite (i.e. equivalent to 1000
ppm) shouldbe applied.
 Clean and disinfect bathroom and toilet surfaces at least once daily. Regular household soap or
detergent should be used first for cleaning, and then, after rinsing, regular household
disinfectantcontaining0.1%sodiumhypochloriteshouldbe applied
 Clean the patient’s clothes, bed linen, and bath and hand towels using regular laundry soap and
water or machine wash at 60–90 °C (140–194 °F) with common household detergent, and dry
thoroughly
 Place contaminated linen into a laundry bag. Do not shake soiled laundry and avoid
contaminatedmaterialscomingintocontactwithskinandclothes.
Gloves and protective clothing (e.g. plastic aprons) should be used when cleaning surfaces or
handling clothing or linen soiled with body fluids. Depending on the context, either utility or
single-use gloves can be used. After use, utility gloves should be cleaned with soap and water
and decontaminated with 0.1% sodium hypochlorite solution. Single-use gloves (e.g. nitrile or
latex) should be discarded after each use. Perform hand hygiene before putting on and after
removinggloves
Gloves, masks, and other waste generated during home care should be placed into a waste bin
with a lid in the patient’s room before disposing of it as infectious waste. The onus of disposal of
infectiouswaste resideswiththe local sanitaryauthority
Avoid other types of exposure to contaminated items from the patient’s immediate
environment (e.g. do not share toothbrushes, cigarettes, eating utensils, dishes, drinks, towels,
washcloths,orbedlinen).
When HCWs provide home care, they should perform a risk assessment to select the
appropriate personal protective equipment and follow the recommendations for droplet and
contact precautions
For mild laboratory confirmed patients who are cared for at home, to be released from home
isolation, cases must test negative using PCR testing twice from samples collected at least 24
hours apart. Where testing is not possible, WHO recommends that confirmed patients remain
isolatedforanadditional twoweeksaftersymptomsresolve

5.3 Management of contacts
Persons(includingcaregiversandHCWs) whohave beenexposedtoindividualswithsuspectedCOVID-
19 are consideredcontactsandshouldbe advisedtomonitortheirhealthfor14 daysfrom the lastday
of possible contact. A contactis a personwhoisinvolvedinanyof the followingfrom2 daysbefore and
up to 14 daysafterthe onsetof symptomsinthe patient
Havingface-to-face contactwithaCOVID-19 patientwithin1meterandfor >15 minutes
Providingdirectcare forpatientswithCOVID-19disease withoutusingproperpersonal
protective equipment
Stayinginthe same close environmentasa COVID-19patient(includingsharingaworkplace,
classroomor householdorbeingatthe same gathering) foranyamountof time
Travellinginclose proximitywith(thatis,within1mseparationfrom) a COVID-19patientinany
kindof conveyance
and othersituations,asindicatedbylocal riskassessments
A way for caregivers to communicate with a health care provider should be established for the
duration of the observation period. Also, health care personnel should review the health of contacts
regularly by phone but, ideally and if feasible, through daily in-person visits, so specific diagnostic
tests can be performedas necessary
The health care provider should give instructions to contacts in advance about when and where to
seek care if they become ill, the most appropriate mode of transportation to use, when and where to
enterthe designatedhealthcare facility,and which IPC precautionsshould be followed.
If a contact develops symptoms, the following stepsshouldbe taken
Notifythe receivingmedical facilitythatasymptomaticcontactwill be arriving
While travelingtoseekcare,the contactshouldweara medical mask
The contact should avoid taking public transportation to the facility if possible; an ambulance
can be called, or the ill contact can be transported in a private vehicle with all windows open, if
possible

The symptomatic contact should be advised to perform respiratory hygiene and hand hygiene
and to stand or sit as far away from others as possible (at least 1 metre) when in transit and
wheninthe healthcare facility
Any surfaces that become soiled with respiratory secretions or other body fluids during
transport should be cleaned with soap or detergent and then disinfected with a regular
householdproductcontaininga0.5% dilutedbleachsolution
6. Considerations for quarantine of individuals in the context of
containment for coronavirus disease (COVID-19)
5.1 Quarantine of persons
The quarantine of persons is the restriction of activities of or the separation of persons who are not ill
but who may been exposed to an infectious agent or disease, with the objective of monitoring their
symptomsandensuringthe earlydetectionof cases
Quarantine is different from isolation, which is the separation of ill or infected persons from others to
prevent the spread of infection or contamination Quarantine is included within the legal framework of
the International HealthRegulations(2005),specifically
Article 30 − Travelers underpublichealthobservation
Article 31 − Healthmeasuresrelatingtoentryof
travelers
Article 32 − Treatmentof travelers
. Before implementing quarantine, countries should properly communicate such measures to reduce
panic and improve compliance
Authorities must provide people with clear, up-to-date, transparent and consistent guidelines,
and withreliableinformationaboutquarantine measures
Constructive engagement with communities is essential if quarantine measures are to be
accepted

Persons who are quarantined need to be provided with health care; financial, social and
psychosocial support; and basic needs, including food, water, and other essentials. The needs of
vulnerable populationsshouldbe prioritized.
Cultural, geographic and economic factors affect the effectiveness of quarantine. Rapid
assessment of the local context should evaluate both the drivers of success and the potential
barriers to quarantine, and they should be used to inform plans for the most appropriate and
culturallyacceptedmeasures
6.2 Whento use quarantine
Introducing quarantine measures early in an outbreak may delay the introduction of the disease
to a country or area or may delay the peak of an epidemic in an area where local transmission is
ongoing, or both. However, if not implemented properly, quarantine may also create additional
sourcesof contaminationanddisseminationof the disease
In the context of the current COVID-19 outbreak, the global containment strategy includes the
rapid identification of laboratory-confirmed cases and their isolation and management either in
a medical facilityorathome
WHO recommends that contacts of patients with laboratory-confirmed COVID-19 be
quarantinedfor14 days fromthe lasttime theywere exposedtothe patient
For the purpose of implementing quarantine, a contact is a person who is involved in any of the
followingfrom2 days before and up to 14 days after the onset of symptoms inthe patient
 Havingface-to-face contactwithaCOVID-19 patientwithin1meterandfor >15 minutes
 Providing direct care for patients with COVID-19 disease without using proper personal
protective equipment;
 Staying in the same close environment as a COVID-19 patient (including sharing a workplace,
classroomor householdorbeingatthe same gathering) foranyamountof time
 Travelling in close proximity with (that is, within 1 m separation from) a COVID-19 patient in any
kindof conveyance
 and othersituations,asindicatedbylocal riskassessments
6.3 Recommendationsfor implementingquarantine

If a decisiontoimplementquarantine istaken,the authoritiesshouldensure that
 The quarantine settingisappropriate andthatadequate food,water,andhygieneprovisions
can be made forthe quarantine period
 MinimumIPCmeasurescanbe implemented;
 Minimumrequirementsformonitoringthe healthof quarantinedpersonscanbe metduringthe
quarantine period.
6.4 Ensuring an appropriate settingand adequate provisions
The implementationof quarantine impliesthe use orcreationof appropriate facilitiesinwhichaperson
or personsare physicallyseparatedfromthe communitywhile beingcaredfor
Appropriate quarantine arrangements include the followingmeasures
Those who are in quarantine must be placed in adequately ventilated, spacious single rooms
with en suite facilities (that is, hand hygiene and toilet facilities). If single rooms are not
available,bedsshouldbe placedatleast1 meterapart
Suitable environmental infection controls must be used, such as ensuring are adequate air
ventilation,airfiltrationsystems,andwaste-managementprotocols
Social distance must be maintained (that is, distance of at least 1 metre) between all persons
whoare quarantined
Accommodationmustprovide anappropriate levelof comfort,including
- provisionof food,water,andhygienefacilities
- protectionforbaggage and otherpossessions
- appropriate medical treatmentforexistingcondition
- Communication in a language that those who are quarantined can understand, with an
explanation of their rights, services that will be made available, how long they will need to
stay and what will happen if they get sick; additionally, contact information for their local
embassyorconsularsupportshouldbe provided.
Medical assistance must be provided for quarantined travelers who are isolated or subject
to medical examinationsorotherproceduresforpublichealthpurposes
Those who are in quarantine must be able to communicate with family members who are
outside the quarantine facility
If possible,accesstothe internet,news,andentertainmentshouldbe provided
Psychosocial supportmustbe available

Older persons and those with co morbid conditions require special attention because of
theirincreasedriskforsevere COVID-19.
Possible settings for quarantine include hotels, dormitories, other facilities catering to groups, or the
contact’s home. Regardless of the setting, an assessment must ensure that the appropriate conditions
for safe and effective quarantine are beingmet
When home quarantine is chosen, the person should occupy a well-ventilated single room, or if a
single room is not available, maintain a distance of at least 1 metre from other household members,
minimize the use of shared spaces and cutlery, and ensure that shared spaces (such as the kitchen and
bathroom) are well ventilated
6.5 Minimuminfectionpreventionandcontrol measures
6.5.1 Early recognitionand control
Any person in quarantine who develops febrile illness or respiratory symptoms at any point during the
quarantine periodshouldbe treatedand managedas a suspectedcase of COVID-19
Standard precautionsapply to all personswho are quarantined and to quarantine personnel
 Perform hand hygiene frequently, particularly after contact with respiratory secretions, before
eating, and after using the toilet. Hand hygiene includes either cleaning hands with soap and
water or with an alcohol-based hand rub. Alcohol-based hand rubs are preferred if hands are
not visiblydirty;handsshouldbe washedwithsoapandwaterwhentheyare visiblydirt.
 Ensure that all persons in quarantine are practicing respiratory hygiene and are aware of the
importance of covering their nose and mouth with a bent elbow or paper tissue when coughing
or sneezing and then immediately disposing of the tissue in a wastebasket with a lid and then
performinghandhygiene
 Refrainfromtouchingthe eyes,nose andmouth
 A medical mask is not required for persons with no symptoms. There is no evidence that
wearinga maskof anytype protectspeople whoare notsick

6.5.2. Administrative controls
Administrative controlsandpoliciesforIPCwithinquarantinefacilitiesincludebutmaynotbe limitedto
 Establishing sustainable IPC infrastructure (for example, by designing appropriate facilities)
and activities
 Educating persons who are quarantined and quarantine personnel about IPC measures. All
personnel working in the quarantine facility need to have training on standard precautions
before the quarantine measures are implemented. The same advice on standard
precautions should be given to all quarantined persons on arrival. Both personnel and
quarantined persons should understand the importance of promptly seeking medical care if
theydevelopsymptoms
 developing policies to ensure the early recognition and referral of a suspected COVID-19
case
6.5.3 Environmental controls
Environmental cleaning and disinfection procedures must be followed consistently and correctly.
Cleaning personnel need to be educated about and protected from COVID-19 and ensure that
environmental surfacesare regularlyand thoroughlycleanedthroughout the quarantine period
o Clean and disinfect frequently touched surfaces − such as bedside tables, bed frames and other
bedroom furniture − daily with regular household disinfectant containing a diluted bleach
solution (that is, 1-part bleach to 99 parts water). For surfaces that cannot be cleaned with
bleach,70% ethanol canbe used
o Clean and disinfect bathroom and toilet surfaces at least once daily with regular household
disinfectantcontainingadilutedbleachsolution(thatis,1-partbleachto99 parts water)
o Clean clothes, bed linens, and bath and hand towels using regular laundry soap and water or
machine washat 60-90 °C (140–194 °F) withcommonlaundrydetergent,anddrythoroughly
o Countries should consider implementing measures to ensure that waste is disposed of in a
sanitarylandfill andnotinanunmonitoredopenarea.
o Cleaning personnel should wear disposable gloves when cleaning surfaces or handling clothing
or linen soiled with body fluids, and they should perform hand hygiene before putting on and
afterremovingtheirgloves

6.2.4 Minimumrequirementsfor monitoringthe health of quarantinedpersons
Daily follow up of persons who are quarantined should be conducted within the facility for the duration
of the quarantine period and should include screening for body temperature and symptoms. Groups of
persons at higher risk of infection and severe disease may require additional surveillance owing to
chronic conditions or they may require specific medical treatment. Consideration should be given to the
resources and personnel needed and rest periods for staff at quarantine facilities. This is particularly
important in the context of an ongoing outbreak, during which limited public health resources may be
better prioritized for health care facilities and case-detection activities. Respiratory samples from
quarantined persons,irrespective of whether they have symptoms, should be sent for laboratory testing
at the endof the quarantine period

7. InfectionPreventionand Control guidance for Long-Term Care
Facilities in the context of COVID-19
COVID-19 is an acute respiratory illness caused by a novel human coronavirus (SARS-CoV-2, called
COVID-19 virus), which causes higher mortality in people aged ≥60 years and in people with underlying
medical conditionssuchascardiovasculardisease,chronicrespiratorydisease,diabetesandcancer.
Long-term care facilities (LTCFs), such as nursing homes and rehabilitative centers, are facilities that care
for people who suffer from physical or mental disability, some of who are of advanced age. The people
living in LTCF are vulnerable populations who are at a higher risk for adverse outcome and for infection
due to living in close proximity to others. Thus, LTCFs must take special precautions to protect their
residents, employees, and visitors. Note that infection prevention and control (IPC) activities may affect
the mental health and well-being of residents and staff, especially the use of PPE and restriction of
visitorsandgroupactivities
7.1 System and service coordinationto provide long-termcare
 Coordinate with relevant authorities(e.g. Ministry of Health, Ministry of Social Welfare, Ministry
of Social Justice,etc.) shouldbe inplace toprovide continuouscare inLTCFs.
 Activate the local health and social care network to facilitate continuous care (clinic, acute-care
hospital,day-care center,volunteergroup,etc.).
 Facilitate additional support (resources, health care providers) if any older person in LTCFs is
confirmedwithCOVID19.

7.2 Prevention
7.2.1 IPC focal point and activities
LTCFs shouldensure thatthere isanIPC focal pointat the facilitytoleadandcoordinate IPCactivities,
ideallysupportedbyanIPCteamwithdelegatedresponsibilitiesandadvisedbyamultidisciplinary
committee
At a minimum,the IPC focal point should
 Provide COVID-19IPCtraining toall employees,including
- An overviewof COVID-19
- Hand hygiene andrespiratoryetiquette;
- Standardprecautions
- COVID-19transmission-basedprecautions
 Provide informationsessionsforresidentsonCOVID-19toinformthemaboutthe virus,the
disease itcausesandhowto protectthemselvesfrominfection
 RegularlyauditIPCpractices(handhygienecompliance)andprovide feedbacktoemployees.•
Increase emphasisonhandhygiene andrespiratoryetiquette
 Ensure adequate suppliesof alcohol-basedhandrub(ABHR) (containingatleast60%
alcohol) andavailabilityof soapandcleanwater.Place thematall entrances,exitsand
pointsof care
 Postreminders,posters,flyersaroundthe facility,targetingemployees,residents,and
visitorstoregularlyuse ABHRor washhand
 Encourage hand washingwithsoapandwaterfor a minimumof 40 secondsorwith
ABHR for a minimumof 20 seconds
 Require employeestoperformhandhygienefrequently,inparticularatthe beginningof
the workday,before andaftertouchingresidents,afterusingthe toilet,before andafter
preparingfood,andbefore eating
 Encourage and supportresidentsandvisitorstoperformhandhygiene frequently,in
particularwhenhandsare soiled,before and aftertouchingotherpeople (althoughthis
shouldbe avoidedasmuchas possible),afterusingthe toilet,before eating,andafter
coughingor sneezing
 Ensure adequate suppliesof tissuesandappropriate waste disposal (inabinwithalid)
 Postreminders,posters,flyersaroundthe facility,targetingemployees,residents,and
visitorstosneeze orcoughintothe elbow or touse a tissue anddispose of the tissue
immediatelyinabinwitha lid.

 A guide tolocal productionof WHO-recommendedABHRisavailable
 Maintainhighstandardsof hygiene andsanitationpractice
 Guidance on water,sanitation,laundry,andwaste managementforCOVID-19is
available.
 Provide annual influenza vaccination and pneumococcal conjugate vaccines to
employees and staff, according to local policies, as these infections are important
contributorstorespiratorymortalityinolderpeople.
7.3 Physical distancingin the facility
Physical distancinginthe facilityshouldbe institutedtoreduce the spreadof COVID-19
Restrictthe numberof visitors
For groupactivitiesensure physical distancing,if notfeasible cancel groupactivities
Staggermealsto ensure physical distance maintainedbetweenresidentsorif notfeasible,close
dininghallsandserve residentsindividualmealsintheirrooms
Enforce a minimumof 1 meterdistance betweenresidents
Require residentsandemployeestoavoidtouching(e.g.,shakinghands,hugging,orkissing).
7.4 Visitors
In areas where COVID-19 transmission has been documented, access to visitors in the LTCFs should be
restricted and avoided as much as possible. Alternatives to in-person visiting should be explored,
including the use of telephones or video, or the use of plastic or glass barriers between residents and
visitors.
All visitors should be screened for signs and symptoms of acute respiratory infection or significant risk
for COVID-19 (see screening, above), and no one with signs or symptoms should be allowed to enter the
premises
A limited number of visitors who pass screening should be allowed entry to long-term care only on
compassionate grounds, specifically if the resident of the facility is gravely ill and the visitor is their next-
of-kin or other person required for emotional care. Visitors should be limited to one at a time to
preserve physical distancing. Visitors should be instructed in respiratory and hand hygiene and to keep

at least 1 meter distance from residents. They should visit the resident directly upon arrival and leave
immediatelyafterthe visit
Direct contact by visitors with residents with confirmed or suspected COVID-19 should be prohibited.
Note that in some settings, complete closure to visitors is under the jurisdiction of local health
authorities
7.5 Response
The response toCOVID-19in LTCFs settingsis basedonearlyrecognition,isolation,care,andsource
control (preventionof onwardspreadforan infectedperson).
7.5.1 Early recognition
Early identification,isolationandcare of COVID-19 casesisessential tolimitthe spreadof the disease in
the LTCFs
Prospective surveillance forCOVID-19amongresidentsandstaff shouldbe established:
 Assess healthstatusof anynewresidentsatadmissiontodetermine if the residenthassignsof
a respiratoryillnessincludingfeverandcoughor shortnessof breath
 Assesseachresidenttwice dailyforthe developmentof afever(≥38C), coughor shortnessof
breath
 Immediatelyreportresidentswithfeverorrespiratorysymptomstothe IPCfocal pointand to
clinical staff
Prospective surveillance for employees shouldbe established:
 Askemployeestoreportandstay at home if theyhave feverorany respiratoryillness
 Followuponemployeeswithunexplainedabsencestodetermine theirhealthstatus
 Undertake temperature checkforall employeesatfacilityentrance
 Immediately remove from service any employee who is visibly ill at work and refer them to their
healthcare provider
 Monitor employees and their contact with residents, especially those with COVID-19; use the
WHO risk assessment tool to identify employees who have been at high risk of exposure to
COVID-19

Prospective surveillance for visitors should be established:
 All visitors should be screened before being allowed to see residents, including for fever,
respiratoryillnessandif theyhave had recentcontactwithsomeone infectedwithCOVID-19
 Visitorswithfeveroranyrespiratoryillnessshouldbe deniedaccesstothe facility
 Visitors with significant risk factors for COVID-19 (close contact to a confirmed case, recent
travel to an area with community transmission [applies only to those areas that do not have
currentcommunitytransmission] shouldbe deniedaccesstothe facility
7.5.2 Source control (care for the COVID-19 patient and preventionofonward transmission)
If a resident is suspected to have, or is diagnosed with, COVID-19, the following steps should
be taken:
 Notify local authorities about any suspected case and isolate residents with onset of respiratory
symptoms
 Place a medical maskonthe residentandonothersstayinginthe room
 Ensure that the patient is tested for COVID-19 infection according to local surveillance policies
and if the facility has the ability to safely collect a biological specimen for testing Promptly notify
the patientandappropriate publichealthauthoritiesif the COVID-19testispositive
 WHO recommends that COVID-19 patients be cared for in a health facility, in particular patients
with risk factors for severe disease which include age over 60 and those with underlying co-
morbidities
 Employees should use contact and droplet precautions (see below) when tending to the
resident,enteringthe room,orwhenwithin1m of the resident
 If possible,move the COVID-19patienttoa single room

 If no single rooms are available, consider cohorting residents with suspected or
confirmed COVID-19
o Residents with suspected COVID-19 should be cohorted only with other residents with
suspectedCOVID-19;
o Theyshouldnotbe cohortedwithresidentswithconfirmedCOVID-19.
o Do not cohort suspectedorconfirmedpatients nexttoimmune compromisedresident
 Indicatingdropletandcontactprecautions,atthe entrance of the room.5
 Dedicate specific medical equipment (e.g. thermometers, blood pressure cuff, pulse oximeter,
etc.) for the use of medical professionalsforresident(s) withsuspectedorconfirmedCOVID-19
 Cleananddisinfectequipmentbefore re-usewithanotherpatient
 Restrict sharing of personal devices (mobility devices, books, electronic gadgets) with other
residents.
75.3 Precautionsand personal protective equipment(PPE)
When providing routine care for a resident with suspected or confirmed COVID-19, contact precaution
and dropletprecautionsshouldbe practiced?
PPE should be put on and removed carefully following recommended procedures to avoid
contamination.
Hand hygiene shouldalwaysbe performedbefore puttingonandafterremovingPPE.
Contact and droplet precautionsinclude the following PPE: medical mask, gloves, gown, andeye
protection(gogglesorface shield).
Employeesshouldtake off PPEjustbefore leavingaresident’sroom.
Discard PPEin medical waste binand performhandhygiene
When caring for any residents with suspected or confirmed COVID-19 practice contact plus airborne
precautions during any aerosol-generating procedures (e.g. tracheal suctioning, intubation; refer to

Infection prevention and control during health care). Airborne precautions include the use of N95, FFP2,
or FFP3 respiratorsorequivalentlevel mask,gloves,gownandeye protection(gogglesorface shield).
Note: use N95 mask only if the LTCFs has a programme to regularly fit-test employees for the
use of N95 masks
Cleaners and those handling soiled bedding, laundry, etc., should wear PPE, including mask, gloves, long
sleeve gowns, goggles or face shield, and boots or closed toe shoes. They should perform hand hygiene
before puttingonandafterremovingPPE
7.5.4 Environmental cleaningand disinfection
Hospital-grade cleaning and disinfecting agents are recommended for all horizontal and frequently
touched surfaces (e.g., light switches, door handles, bed rails, bed tables, phones) and bathrooms being
cleanedatleasttwice dailyandwhensoiled.
Visibly dirty surfaces should first be cleaned with a detergent (commercially prepared or soap and
water) and then a hospital-grade disinfectant should be applied, according to manufacturers’
recommendations for volume and contact time. After the contact time has passed, the disinfectant may
be rinsedwithcleanwater
If commercially prepared hospital-grade disinfectants are not available, the LTCFs may use a diluted
concentration of bleach to disinfect the environment. The minimum concentration of chlorine should be
5000 ppm or 0.5% (equivalenttoa1:9 dilutionof 5% concentratedliquidbleach).
7.5.5 Laundry
Soiled linen should be placed in clearly labeled, leak-proof bags or containers, after carefully removing
any solidexcrementandputtingitina coveredbuckettobe disposedof ina toiletorlatrine.
Machine washing with warm water at 60−90°C (140−194°F) with laundry detergent is recommended.
The laundrycan thenbe driedaccordingtoroutine procedures.
If machine washing is not possible, linens can be soaked in hot water and soap in a large drum using a
stick to stir and being careful to avoid splashing. The drum should then be emptied, and the linens
soaked in 0.05% (500 ppm) chlorine for approximately 30 minutes. Finally, the laundry should be rinsed
withcleanwaterand the linensalloweddryingfullyinsunlight

7.5.6 Restriction of movement/transport
 If a residenthassuspectedorconfirmedCOVID-19infection,the LTCFsshould:
 Confirmedpatientsshouldnotleavetheirroomswhile ill
 Restrictmovementortransportof residentstoessential diagnosticandtherapeutictestsonly
- Avoidtransfertootherfacilities(unlessmedicallyindicated)
 If transport is necessary, advise transport services and personnel in the receiving area or facility
of the required precautions for the resident being transported. Ensure that residents who leave
theirroomfor strictlynecessaryreasonswearamaskand adhere to respiratoryhygiene
 Isolate COVID-19 patients until they have two negative laboratory tests for COIVID-19 taken at
least 24 hours apart after the resident’s symptoms have resolved. Where testing is not possible,
WHO recommends that confirmed patients remain isolated for an additional two weeks after
symptomsresolve
LTCFs should be prepared to accept residents who have been hospitalized with COVID-19, are
medically stable and are able to care for the patients in isolated rooms. LTCFs should use the same
precautions, patient restrictions, environmental cleaning, etc., as if the resident had been
diagnosedwith COVID-19 in the LTCFs
7.5.7 Reporting
Any suspected or confirmed COVID-19 cases should be reported to relevant authorities as required by
lawor mandate
7.5.8 Minimizingthe effectof IPCon mental healthof residents,employees,andvisitors
Considerations for care
Guidance forthe clinical care for COVID-19patientsisavailable

 Older people, especially in isolation and those with cognitive decline, dementia, and those who
are highly care-dependent, may become more anxious, angry, stressed, agitated, and withdrawn
duringthe outbreakor while inisolation.
 Provide practical and emotional support through informal networks (families) and health care
providers.
 Regularlyprovide updatedinformationaboutCOVID-19toresidents,employees,andstaff
7.5.9 Support healthcare workers and caregivers
• As much as possible, protect staff from stress both physically and psychologically so they can
fulfill their roles, in the context of a high workload and in case of any unfortunate experience as
a resultof stigmaor fearintheirfamilyorcommunity
• Regularly and supportively monitor all staff for their wellbeing and foster an environment for
timelycommunicationandprovisionof care withaccurate updates
• Mental health and psychosocial support10 and psychological first aid training11 can benefit all
staff in having the skills to provide the necessary support in the LTCFs Consider rest and
recuperationandalternate arrangementsasneeded
• Staff needs to ensure that safety measures are in place to prevent excessive worries or anxiety
withinthe LTCFs

8. Infection,prevention and control precautions
Standardinfectioncontrol precautions(SICPs) andtransmissionbasedprecautions(TBPs)mustbe used
whenmanagingpatientswithsuspectedorconfirmedCOVID-19
8.1 Standard Precaution
“(…) A set of practices that are applied to the care of patients, regardless of the state of infection
(suspicionor confirmation),inany place where health servicesare provided.(…)”
Standard infection control precautions (SICPs) are the basic infection prevention and control measures
necessary to reduce the risk of transmission of infectious agents from both recognized and unrecognized
sources. Sources include blood and other body fluids, secretions and excretions (excluding sweat), non-
intact skin or mucous membranes, and any equipment or items in the care environment. SICPs should
be usedby all staff,inall care settings,atall times,forall patients.
Patients must be promptly assessed for infection risk on arrival at the care area and, if possible, prior to
accepting a patient from another care area. Patients should be continuously reviewed throughout their
inpatient stay. In all healthcare settings, patients with symptoms of COVID-19 should be segregated
fromnon-symptomaticpatientsaspromptlyaspossible.
Key Principles of Standard Precaution
Consider every client and patient as potentially infectious or susceptible to infection.
Apply to all patients and clients attending health care facility
Apply to all blood, body fluid, secretion, execration (except sweat), mucous membrane
and no intact skin

A. Hand hygiene
Hand hygiene is essential to reduce the transmission of infection in health and other care settings and is
a critical element of standard infection control precautions (SICPs). All staff, patients and visitors should
decontaminate their hands with alcohol based hand rub (ABHR) when entering and leaving areas where
care for –suspected and confirmed COVID-19 patients is being delivered. Hand hygiene must be
performed immediately before every episode of direct patient care and after any activity or contact that
potentially results in hands becoming contaminated, including the removal of personal protective
equipment(PPE),equipmentdecontaminationandwaste handling
Before performinghand hygiene:
Expose forearms(bare below the elbows)
Remove all hand and wrist jewellery (a single, plain metal finger ring is permitted but should be
removed(ormovedup) duringhandhygiene)
Ensure fingernailsare clean,shortandthat artificial nailsornail productsare not worn;
Coverall cuts or abrasionswitha waterproof dressing
Technique for hand washing and rubbing
 Hand hygiene includes the use of ABHR for routine hand hygiene and hand washing with soap
and water,includingthoroughdrying,if handsare visiblysoiledordirty.
 The technique for hand washing must be carried out thoroughly and for a time period sufficient
to inactivate the virusi.e.40to 60 seconds
 ABHR must be available for all staff as near to point of care as possible, where this is not
practical, personal dispensers should be used. The technique for use of ABHR to decontaminate
hands must be carried out thoroughly and for a time period sufficient to inactivate the virus i.e.
20 to 30 seconds
 Where no running water is available or hand hygiene facilities are lacking, such as in a patient’s
home, staff may use hand wipes followed by ABHR and should wash their hands at the first
available opportunity

Hand hygiene with soap andwater
Wet hands with
water
apply enough
soap to cover all
hand surfaces
rub hands palm to
palm
palm to palm with
fingers
interlaced
backs of fingers to
opposing
palms with fingers
interlocked
rotational rubbing of
left
thumb clasped in right
palm and vice versa
rotational rubbing,
backwards and
forwards with
clasped fingers of
right hand in left
palm and vice versa
rinse hands with
water
right palm over left
dorsum with interlaced
fingers and vice versa
dry thoroughly with
a single use towel
2019 nCoV Outbreak -prevention and control
34 |
use towel to turn
off faucet
…and your hands
are safe.

Hand hygiene with alcohol–based rub
Apply a palmful of the
product in a cupped
hand and cover all
surfaces.
35 |
Rub hands palm to
palm
Right palm over left
palm to palm with
fingers interlaced
backs of fingers to
opposing palms with
fingers interlocked
rotational rubbing of left
palm
and vice versa
rotational rubbing,
backwards and forwards
with clasped fingers of
right hand in left
palm and vice versa
…once dry, your hands
are
safe.
B. Respiratory and cough hygiene – ‘Catch it, bin it, and kill it’
 Patients, staff and visitors should be encouraged to minimize potential COVID-19 transmission
throughgood respiratoryhygiene measures:
 Disposable, single-use tissues should be used to cover the nose and mouth when sneezing,
coughing or wiping and blowing the nose. Used tissues should be disposed of promptly in the
nearestwaste bin
 Tissues, waste bins (lined and foot operated) and hand hygiene facilities should be available for
patients,visitorsandstaff

 Hands should be cleaned (using soap and water if possible, otherwise using ABHR) after
coughing, sneezing, using tissues or after any contact with respiratory secretions and
contaminatedobjects
 Encourage patientstokeephandsawayfrom the eyes,mouthandnose
 Some patients (e.g. the elderly and children) may need assistance with containment of
respiratory secretions; those who are immobile will need a container (e.g. a plastic bag) readily
at hand forimmediate disposal of tissues
 In common waiting areas or during transportation, symptomatic patients may wear a fluid-
resistant (Type IIR) surgical face mask (FRSM), if tolerated, to minimize the dispersal of
respiratorysecretionsandreduce environmental contamination
C. Personal Protective Equipment (PPE)
Before undertaking any procedure staff should assess any likely exposure and ensure PPE is worn that
provides adequate protection against the risks associated with the procedure or task being undertaken.
All staff shouldbe trainedinthe properuse of all PPE thattheymay be requiredtowear
In addition:
Staff who have had and recovered from COVID-19 should continue to follow infection control
precautions,includingthe PPErecommended
Disposable apron/gown
Disposable plastic aprons must be worn to protect staff uniform or clothes from contamination when
providingdirectpatientcare andduringenvironmental andequipmentdecontamination.
Fluid-resistant gowns must be worn when a disposable plastic apron provides inadequate cover of staff
uniform or clothes for the procedure/task being performed and when there is a risk of extensive
splashing of blood and/or other body fluids e.g. during aerosol generating procedures (AGPs). If non
fluid-resistantgownsare used,adisposableplasticapronshouldbe wornunderneath.
Disposable aprons and gowns must be changed between patients and immediately after completion of
a procedure/task.

Disposable gloves
Disposable gloves must be worn when providing direct patient care and when exposure to blood and/or
other body fluids is anticipated/likely, including during equipment and environmental decontamination.
Glovesmustbe changedimmediatelyfollowingthe care episode orthe taskundertaken
Eye protection/Face visor
Eye/face protection should be worn when there is a risk of contamination to the eyes from splashing of
secretions (including respiratory secretions), blood, body fluids or excretions. An individual risk
assessmentshouldbe carriedoutpriorto/atthe time of providingcare.
Disposable,single-use,eye/face protectionisrecommended.
Eye/face protectioncanbe achievedbythe use of any one of the following:
Surgical maskwithintegratedvisor
Full face shield/visor;
Polycarbonate safetyspectaclesorequivalent
Regular corrective spectaclesare not consideredadequate eye protection.
Safe management of linen (laundry)
No special procedures are required; linen is categorized as ‘used’ or ‘infectious’. All linen used in the
direct care of patients with suspected and confirmed COVID-19 should be managed as ‘infectious’ linen.
Linen must be handled, transported and processed in a manner that prevents exposure to the skin and
mucousmembranesof staff,contaminationof theirclothingandthe environment:
Disposable glovesandanapronshouldbe wornwhenhandlinginfectiouslinen
All linen should be handled inside the patient room/cohort area. A laundry receptacle should be
available asclose aspossible tothe pointof use forimmediate linendeposit.

Whenhandlinglinendonot:
 rinse,shake orsort linenonremoval frombeds/trolleys;
 place used/infectiouslinenonthe floororany othersurfacese.g.a locker/tabletop;
 re-handle used/infectiouslinenonce bagged;
 ●overfill laundryreceptacles;or
 Place inappropriate itemsinthe laundryreceptacle e.g.usedequipment/needles.
Whenmanaginginfectiouslinen:
 Place directlyintoawater-soluble/alginate bagandsecure
 Place the water-soluble baginside aclearpolythene bagandsecure
 Place the polythene bag into in the appropriately colored (as per local policy) linen bag
(hamper).
All linen bags/receptacles must be taggede.g. ward/care area and date. Store all used/infectious linen in
a designated, safe, lockable area whilst awaiting uplift. Organisational preparedness plans should
consider the safe storage of excess linen awaiting collection and for maintaining supplies of clean linen
for patientuse.
Staff uniforms/clothes
The appropriate use of personal protective equipment (PPE) will protect staff uniform from
contamination in most circumstances. Healthcare facilities should provide changing rooms/areas where
staff can change intouniformsonarrival at work.
Organizations may consider the use of theatre scrubs for staff who do not usually wear a uniform but
whoare likelytocome intoclose contactwithpatientse.g.medical staff.
Healthcare laundry services should be used to launder staff uniforms. If there is no laundry facility
available, then uniforms should be transported home in a disposable plastic bag. This bag should be
disposedof intothe householdwaste stream.

Uniformsshouldbe laundered:
Separatelyfromotherhouseholdlinen
In a loadnot more than half the machine capacity
At the maximumtemperaturethe fabriccantolerate,thenironedortumbled-dried.
NB. It is best practice to change into and out of uniforms at work and not wear them when travelling;
this is based on public perception rather than evidence of an infection risk. This does not apply to
community healthworkers who are requiredto travel betweenpatientsinthe same uniform.
8.1 transmission based precaution
Transmission-based precautions
Contact precaution
Droplet precaution
Airborne precaution

As a reminder, transmissionofCOVID-19
Contact precautions: Used to prevent and control infection transmission via direct contact or indirectly
from the immediate care environment (including care equipment). This is the most common route of
infectiontransmission
Droplet precautions: Used to prevent and control infection transmission over short distances via
droplets (>5μm) from the respiratory tract of one individual directly onto a mucosal surface or
conjunctivae of another individual. Droplets penetrate the respiratory system to above the alveolar
level. The maximum distance for cross transmission from droplets has not been definitively determined,
although a distance of approximately 1 metre (3 feet) around the infected individual has frequently
beenreportedinthe medical literature asthe areaof risk.
Airborne precautions: Used to prevent and control infection transmission without necessarily having
close contact via aerosols (≤5μm) from the respiratory tract of one individual directly onto a mucosal
surface or conjunctivae of another individual. Aerosols penetrate the respiratory system to the alveolar
level.

Interrupting transmission of COVID-19 requires both droplet and contact precautions; if an
aerosol generating procedure (AGP) is being undertaken then airborne precautions are
required in addition tocontact precautions
Transmission-based precautions and COVID-19
In addition to standard infection control precautions (SICPs), droplet precautions should be used for
patientsknown orsuspectedtobe infectedwithCOVID-19inall healthcare settings.
 COVID-19 virus is expelled as droplets from the respiratory tract of an infected individual (e.g.
during coughing and sneezing) directly onto a mucosal surface or conjunctiva of a susceptible
individual(s) orenvironmental surface(s).
 Droplets travel only short distances through the air; a distance of at least 1 metre has been used
for deploying droplet precautions. However, this distance should be considered as the minimum
rather thanan absolute:
 Transmission based precautions (TBPs (droplet) should be continued until the resolution of the
patient’sfeverandrespiratorysymptoms
A. Duration of precautions
Patients should remainin isolation/cohort with TBPs applied until the resolution of fever and respiratory
symptoms. The duration of TBPs may require modification based on the intelligence gathered about
COVID-19
The decision to modify the duration of, or ‘stand down’ TBPs should be made by the clinical team
managing the patient(s); based on patient condition and in agreement with the local Infection
PreventionandControl Team(IPCT).
B. Segregationand cohorting(inpatientsettings)
a. Negative pressure isolationrooms
Special environmental controls, such as negative pressure isolation rooms, are not necessary to prevent
the transmission of COVID-19. However, in the early stages, and in high risk settings, patients with
suspectedorconfirmedCOVID-19maybe isolatedinnegativepressure rooms.

b. Single rooms
Wherever possible, patients with suspected or confirmed COVID-19 should be placed in single rooms. In
an escalating situation there is however likely to be a lack of single rooms/isolation facilities. Where
single/isolation rooms are in short supply, and cohorting is not yet considered possible (patient(s)
awaiting laboratory confirmation), priorities patients who have excessive cough and sputum production
for single/isolationroomplacement.
Single rooms in COVID-19 segregated areas should, wherever possible, be reserved for performing
aerosol generatingprocedures(AGPs).
Single rooms in non-COVID-19 areas should be reserved for patients requiring isolation for other (non-
influenza-like illness)reasons.
The prioritizing of patients for isolation other than suspected or confirmed COVID-19 patients should be
decidedlocally,basedonpatientneedandlocal resources.
c. Cohort areas
If a single/isolation room is not available, cohort confirmed respiratory infected patients with other
patients confirmed to have COVID-19. Ensure patients are physically separated; a distance of at least 1
metre. Use privacy curtains between the beds to minimise opportunities for close contact. Where
possible, a designated self-contained area or wing of the healthcare facility should be used for the
treatmentandcare of patientswithCOVID-19.Thisareashould.
1. Include a reception area that is separate from the rest of the facility and should, if feasible, have
a separate entrance/exitfromthe restof the building;
2. not be used as a thoroughfare by other patients, visitors or staff, including patients being
transferred,staff goingformeal breaks,andstaff andvisitorsenteringandexitingthe building;
3. be separatedfromnon-segregatedareasbycloseddoors
4. have signage displayedwarningof the segregatedareatocontrol entry
Hospitals should consider creating cohort areas which differentiate the level of care required. It may
also be prudent to consider:
- The needforcohortingin single/mixedsex wards/bays

- underlyingpatientcondition(immunocompromised);
Age groupswhencohortingchildren;
- Routine childhoodvaccinationstatuswhencohortingchildren.
d. Staff cohorting
Assigning a dedicated team of staff to care for patients in isolation/cohort rooms/areas is an additional
infection control measure. This should be implemented whenever there are sufficient levels of staff
available (so as not to have a negative impact on non-affected patients’ care). Where possible, staff who
have had confirmed COVID-19 and recovered should work in the cohort areas and care for COVID-19
patients. Such staff should continue to follow the infection control precautions, including personal
protective equipment(PPE).
e. Visitorsto segregated/cohortareas
Visitors to all areas of the healthcare facility should be restricted to essential visitors only, such as
parents of pediatrics patients or an affected patient’s main career. Local risk assessment and practical
management should be considered, ensuring this is a pragmatic and proportionate response, including
the consideration of whether there is a requirement for visitors to wear PPE or respiratory protective
equipment(RPE).
Visiting may be suspended if considered appropriate. All visitors entering a segregated/cohort area must
be instructed on hand hygiene. They must not visit any other care area. Signage to support restrictions is
critical. Visitors with COVID-19 symptoms must not enter the healthcare facility. Visitors who are
symptomatic should be encouraged to leave and must not be permitted to enter areas where there are
immune compromisedpatients.

8.2 Patient transfers and transport
8.2.1 Intra-hospital transfers:
The movement and transport of patients from their single room/cohort area should be
limited to essential purposes only. Staff at the receiving destination must be informed
that the patienthasor is suspectedtohave COVID-19
The movement and transport of patients from their single room/cohort area should be
limited to essential purposes only. Staff at the receiving destination must be informed
that the patienthasor is suspectedtohave COVID-19
Patients must be taken straight to and returned from clinical departments and must not
waitin communal areas.If possible,patientsshouldbe placedatthe endof clinical lists.
8.2.2 Transfer from primary care/community settings:
If transfer from a primary care facility or community setting to hospital is required, the
ambulance service shouldbe informedof the infectiousstatusof the patient
Staff of the receiving ward/department should be notified in advance of any transfer and must
be informedthatthe patienthasor is suspectedtohave COVID-19
8.3 Inter-hospital transfers
 Patient transfer from one healthcare facility to another should be avoided; transfer may be
undertaken if medically necessary for specialist care arising out of complications or concurrent
medical events (for example, cardiac angioplasty, and renal dialysis). If transfer is essential, the
ambulance service and receiving hospital must be advised in advance of the infectious status of
the patient

Transmission-based precautions and COVID-19
Scenario Precaution
For any suspected
or confirmed case of
COVID-19
Standard
contact
dropletprecautions
For any suspected
or confirmed case of
COVID-19 and
aerosol generating
procedure(AGP)
Standard
contact
airborne precautions
9. HANDHYGIENE AND COVID-19
Hand hygiene isageneral termreferringtoanyactionof hand cleansing,Reduces the numberof
disease-causingmicroorganismsonhandsandarms, Minimize cross-contamination(e.g.,fromhealth
workerto patient).Itisthe mostimportantwayto reduce the spreadof infectionsinthe healthcare
settingincludingnCoV publichealthemergencies.
Hand hygiene is the single most important infection prevention and control (IPC) precaution and one of
the most effective means to prevent transmission of pathogens within health care services. Hand
hygiene isageneral termthatincludeshandwashing,antiseptichandrub incase of COVID-19
Hand washing - action of performing hand hygiene for the purpose of physically or mechanically
removingdirt,organicmaterial,and/ormicroorganisms.
Alcohol hand rub – applying an antiseptic hand rub to reduce or inhibit the growth of microorganisms
withoutthe needfora watersource and requiringnorinsingordryingwithtowelsorotherdevices.

WHO RECOMMENDED 5 MOVMENTS OF HAND HYGIENE
Other opportunitiesforhand hygiene
 Immediatelyonarrival and before departure from work (the healthfacility).
 Immediatelyaftertouching contaminatedinstrumentsor articles
 Before putting on glovesand after removingthem
 Wheneverthe handsbecome visiblysoiledafternasal blowingor followinga coveredsneeze
 Before touching the face (eyes,nose or mouth)
 Before and after cleaning the environment
 Before and after preparingfood
 Before eating and drinkingor servingfood
 After visitingthe toilet

9.1 Methods Used for Hand Hygiene
1. Alcohol handrubs(minimum60%alcohol)
2. Soap and water
Although chlorine solution rub (0.05%; 500 ppm) has been widely used in Sierra Leone during the
Ebola emergency where standard hand hygiene products were unavailable it is not a standard hand
hygiene method.It is no longerrecommended
1. Alcohol hand rubs (minimum 60% alcohol)
Alcohol handrub is the firstchoice forhand hygiene if handsnotvisiblysoiledasitis:
 More effective in killing microorganisms than antimicrobial hand-washing agents or plain soap
and water
 Fasterto performthanhand washing
 Can to be placeddirectlyatpointof care
 Can to be usedwithoutsink,water,ortoweling
 Kindertohandsthan othermethods
Hand hygiene with alcohol–based rub
Apply a palmful of the
product in a cupped
hand and cover all
surfaces.
35 |
Rub hands palm to
palm
Right palm over left
palm to palm with
fingers interlaced
backs of fingers to
opposing palms with
fingers interlocked
rotational rubbing of left
palm
and vice versa
rotational rubbing,
backwards and forwards
with clasped fingers of
right hand in left
palm and vice versa
…once dry, your hands
are
safe.

2. Soap and Water
Mechanically remove soil and debris from skin and reduce the number of transient
microorganisms, It is THE SINGLE most important measure in reducing the spread of nCoV
infection.
Hand Washing Technique

Hand hygiene with soap andwater
Wet hands with
water
apply enough
soap to cover all
hand surfaces
rub hands palm to
palm
palm to palm with
fingers
interlaced
backs of fingers to
opposing
palms with fingers
interlocked
rotational rubbing of
left
palm and vice versa
rotational rubbing,
backwards and
forwards with
clasped fingers of
right hand in left
palm and vice versa
rinse hands with
water
right palm over left
dry thoroughly with
a single use towel
34 |
use towel to turn
off faucet
…and your hands
are safe.
10. PERSONALPROTECTIVEEQUPMENTS FOR COVID-19
Healthcare workers are confronted each day with the difficult question of how to work safely within the
potentially hazardous environment of health care facilities especially caring for patients with highly
infectious diseases such as nCoV, this exposure to pathogens increases risk of getting are Healthcare
Associated Infections and possible death, use of risk appropriate personal protective equipment (PPE) is
one of the components of Standard Precautions, which refers to wearing of protective barriers or
clothing.
The basic principle behind wearing personal protective equipment to care for nCoV infected/ suspected
patients is to get physical barrier/protection from pathogenic micro organisms, PPE’s includes: gloves,
masks/respirators,eyewear(face shields,gogglesorglasses) andlongsleevedgowns.
The most effective barriers are made of treated fabrics or synthetic materials that do not allow water or
other liquids (blood or body fluids) to penetrate them. These fluid-resistant materials are not, however
widelyavailablebecause theyare expensive

General principles
of PPE
Hand hygiene should always be
performed despite PPE use
Remove and replace if necessary
any damaged or broken pieces of
re-usable PPE as soon as you
become aware that they are
not in full working order
Discard all items of PPE carefully and
perform hand hygiene immediately
afterwards
List of PPE and Area of Protection
Types of PPE Provides protection
Goagle Eyes
Face Masks Nose, Mouth and Lower Jaw
Face Shield Face
Gloves Hand
Gowns Upper body, skin and cloth

A. Protective Eye Wear
 There are four different types of eye protection that are effective in preventing infection in
healthcare facilities
– Goggles
– SafetyGlass
– Masks attachedshield
– Face shield
B. MASK
There are many different types of masks used to cover the mouth and nose. Masks made from cotton or
paper are comfortable but are not fluid-resistant (do not protect from splashes) and are not an effective
filter to prevent inhalation of microorganisms transmitted via droplet nuclei (≤ 5 µm). Masks made from
synthetic materials provide protection fromlarge droplets(> 5 µm) spread by coughs or sneezes, the use
of masks during patient care is part of Standard Precautions when there is a potential for splashes or
droplettransmissionandispart of DropletPrecautions.
Health-care workers who have direct close contact with COVID-19 patients should wear a particulate
respirator, if available or a tightly-fitting surgical mask and eye protection or a tightly-fitting scarf or a

Ipc draft

Empfohlen

Empfohlen

Weitere ähnliche Inhalte

Was ist angesagt?

Was ist angesagt? (18)

Ähnlich wie Ipc draft

Ähnlich wie Ipc draft (20)

Kürzlich hochgeladen

Kürzlich hochgeladen (20)

Ipc draft