Outline of Presentation

• Part 1 - What is Novel Coronavirus ???

• Part 2 - Surveillance and Response in

relation to Case & Contacts (MoH)

…….…………………Discussion ………………………………

• Part 3 - Infection Prevention and Control

• Visit website:
https://www.moh.gov.om/en/corona
https://www.moh.gov.om/ar/corona
 Dr. Nilanjan Mitra
Epidemiologist- DGHSM
 PART ONE
novel coronavirus
New type of Coronavirus that has not
previously been found in humans
Now called 2019-nCoV
 Outside of China

As on Feb 9, 2020
In the second emergency meeting of the International Health Regulations (2005) on
January 30, 2020, WHO-Director-General declared that the outbreak of 2019-nCoV
constitutes a PHEIC (Public Health Emergency of International Concern)
Human to Human transmission of nCoV has been demonstrated by close contact and exposure
to respiratory droplets of an infected person , as in the context of family, workplace or in health-
care centers. Also by being exposed to the surfaces contaminated with respiratory droplets of
the infected person if not properly cleaned.

Symptoms may appear in as few as 2 days or as long as 14 days, during which

the virus is contagious
TRANSMISSION RATE (Ro) - 3-4 i.e. on average every case
of the Novel Coronavirus would create 3 to 4 new cases
 regular hand
washing before
and after touching
animals

Meat & Egg

2%
 PART TWO
Surveillance & Response
 Points of Entry Surveillance & Response in Khasab for
Human Infection with Novel Corona Virus (2019-nCoV)

• Ground crossing border (Darah), Khasab Airport and Seaport - International

travelers can’t enter directly - they reach indirectly via UAE or Muscat
• Before reaching Khasab, they have to pass through initial arrival screening
procedures of UAE or Muscat (Airport or Seaport).
• Still a Second point of Entry surveillance in operation all PoE of Khasab
• ROP will request travelers to declare travel history to affected country (China)
within past 14 days or enquire all persons with Chinese passports with exit
stamp from China within past 2 weeks - to complete declaration form and
submit to immigration.
• Information about High risk travelers will be communicated to Dept. of
Communicable Disease Surveillance -DGHSM and they will be transported in
ambulance for medical evaluation at Bukha / Khasab Hospital (whichever is
nearest).
• If found Symptomatic - notify and make arrangements for screening tests in
health institution.
• If found Asymptomatic - action following consultation with MoH
Self Declaration Form
 Suspect: A person with acute In the 14 days prior to onset of symptoms, at
respiratory infection (sudden onset least one of the following epidemiological
of at least one of the following: criteria:
fever, cough, shortness of breath)
For checking compatibility, Call Governorate Hotline: 91345394 /99820729
• Returning from countries with LOCAL TRANSMISSION OF COVID-19 OR
• Having HIGH RISK EXPOSURES in countries which has reported COVID-19 cases but no local
transmission.

Suspect case NOTIFY*

NOT Compatible of nCoV Fax: 26730147
Compatible

Triage (Assess for requirement of admission)

NO Yes No
Specific
Action
• Referral to Hospital / Admit • Treat as outpatient
• Lab Investigations Case follow (Supportive treatment)
• Infection control practices up & Contact • Lab Investigations
• Inpatient management management • Infection control practices
(Supportive treatment) • Home Quarantine
 Laboratory Investigation - collection and transport of specimen

• Collect respiratory samples

- Nasopharyngeal and oral pharyngeal swabs - should be placed in one VTM
tube
- Sputum
• All specimens collected - should be regarded as potentially infectious.
• Ensure that HCWs who collect respiratory specimen specimens should use
appropriate PPE (eye protection, a fit-tested N95 respirator, long-sleeved
gown, gloves).
• Deliver all specimens by hand whenever possible.
• Place specimens for transport in triple packing with the patient’s name label
on the specimen container (primary container), and a clearly written
laboratory request form.
• Use Al Shifa Laboratory code : SARS-CoV-2 RNA PCR
• Consider other differential diagnosis (Request for RVP, MERS-CoV, Atypical
bacterial PCR & and bacterial culture)
• Contact CPHL Hotline ( 91313316 ) prior to shipment
www.moh.gov.om/en/corona
or
www.moh.gov.om/ar/corona
For paper notification
 Home Quarantine/Isolation
Home Isolation Home Quarantine
separates and restricts the movement separates and restricts the movement
Definition:
of symptomatic suspect of asymptomatic contact.
Eligibility: symptomatic suspect not requiring - close contact of a suspect/confirmed
hospital admission nCoV case
- person arriving from China

Responsibility: Focal person of PHC and Public health staff

Implementation of home quarantine/isolation
• Determine the appropriate quarantine site (Home or alternative site)
- well-ventilated single room as far as possible
- home should have a separate functioning bathroom.
- Basic amenities should be available.
• Contact the MOIC -PHC in the respective catchment area of Quarantined/Isolated person
• Obtain the information of contacts and fill the quarantine follow up form.
• Ensure daily follow up for symptoms of fever and cough and should be documented in the follow up
form.
• Send daily feedback to Disease Surveillance and Control Department (DSCD).
• Provide the Quarantined/Isolated person with contact numbers of focal point at PHC.
• Provide the Quarantined/Isolated person with instruction card for Home quarantine /Home Isolation.
 Home Quarantine/Isolation - Process
• Only assigned family members should attend and take care of the quarantined
/isolated person
• Advice to keep 1 meter distance from others. If another family member needs to stay
in the same room, maintain a distance of at least 1m (e.g. sleep in a separate bed).
• Advice on respiratory etiquette and hand hygiene for quarantined /isolated person
and for family contacts
• Provide Surgical mask for home use.
• Person should avoid public places, gatherings & public transport and also restrict
his/her movement within the house.
• Visitors are not allowed
• Caregiver should wear surgical mask when attending the quarantined/isolated person,
and should dispose it after use and wash hands.
• Avoid sharing household items e.g., dishes, drinking glasses, cups, eating utensils,
towels, bedding, or other items with other people at home.
• Clean and disinfect frequently touched surfaces e.g. bed frames, tables etc.) /toilet
surfaces (daily with regular household bleach solution)
• Clean the clothes and other linen used by the quarantined/isolated person separately
using common household detergent and dry. Avoid shaking of the soiled linen.
• Use disposable gloves when cleaning the surfaces or handling soiled linen, wash hands
after removing gloves.
• Those who need extension of sick leave may kindly contact the health institution over
phone for necessary arrangements without visiting the institution.
 Respiratory Hygiene and
Cough Etiquette

• Cover your nose and mouth with a

tissue during coughing/sneezing
• Dispose the used tissue in the
waste bin
• Wash your hands with soap and
water / hand sanitizer after having
contact with respiratory secretions
and contaminated objects or
materials
• Inside the health care facility,
patient should be asked to put on
face mask to protect others
 Period of Home Isolation / Quarantine

Home Isolation for Suspect case

(symptomatic person but does not require admission)

Isolation to be continued till

• PCR for 2019- nCoV, negative AND
• 48 hours after completely asymptomatic (Confirmed cases to be reevaluated)

Home Quarantine for Asymptomatic contacts

• Period of quarantine will be up to 14 days from the date of exposure
• In between if he develops any symptoms, he should report to the nearest
health centre immediately while using a mask on the way.
 Contact Tracing & Management
Definition of contact: who had unprotected exposure to suspected or confirmed cases of
2019-nCoV
• Asymptomatic contact - currently not presenting symptoms
• Symptomatic contact - any individual who has close contact with a suspected or
confirmed case of nCoV in the last 14 days, develops symptoms (fever, cough,
difficulty in breathing)
Who are probable contacts:
- Health care facility : HCWs, patients, attendants, visitors
- Outside health care facility : family members, co-passengers
Types of contacts:
• Close contacts (High risk exposure)
- HCW or other person providing direct care
- Laboratory workers handling specimens
- A person living in the same household as a 2019-nCoV case
- A person having had face to face contact or was in the closed environment with nCoV case
• Casual contacts (Low risk exposure) - friend, relative, office colleague
Steps of contact management
• Contact identification and listing
• Classification of contacts into close contacts or casual contacts
• Contact tracing and assessment(i.e. communicate with the contact persons and
assess risk)
• Contact management and follow -up
 Contact Tracing & Management in Health Care Facility
- General consideration:
• Infection control team of the facility should trace all contacts within the HCF
• Follow them for symptoms (fever, cough and difficulty in breathing) for a
total of 14 days from last exposure with the case.
• List of contacts (HCWs & patients), should be shared with the CDIPC (MoH)
• Consider all HCW contacts of 2019-nCoV case as high- risk
• All HCWs who are close contacts - symptomatic and asymptomatic should
not be allowed to take care of patients and he/she should be on sick leave
for a period of 14 days or until they are cleared by infection control team.
• Testing should not be done before 24 hours of exposure
• Healthcare workers who test positive for 2019-nCoV can be CLEARED by IPC
team when;
- have a second PCR for 2019- nCoV, negative
- And have been asymptomatic for at least 48 hrs
 PART THREE
Infection Prevention & Control
IPC = Standard precaution

- based precautions

Droplet & Airborne precautions Contact precautions

 Standard Precautions
Routinely applied for all patients

COMPONENTS:
Hand hygiene - to remove or kill microorganisms that colonize the hands
Use of personal protective equipment (PPE) - to create a barrier between HCWs
and patient’s blood, body fluids, secretions (including respiratory secretions) and
non-intact skin.
Aseptic technique
Respiratory Hygiene and Cough Etiquette
Prevention of needle-prick or sharps injury
Linens
Infectious waste disposal
Cleaning and disinfection of equipment between patients
Cleaning of environment
Patient placement
Hand hygiene (HH) -Steps
 Sequence for Sequence of
donning PPE removing PPE
► Hand wash ► Gloves

► Hand wash
► Gown

Goggles
► Hand or after
Hygiene faceremoval
shieldof
► Mask (Surgical or N95) gloves, masks, goggles and face
shield as their outside is usually
► Gown contaminated.
► Goggles or face shield
(for eye protection) ► Mask or respirator

► Hand wash
► Gloves (non-sterile)
 What is N95 fit test?
• A “fit test” tests the seal between the respirator's facepiece and your face.
• A fit test should not be confused with a user seal check.
• A user seal check - a quick check performed by the wearer each time the
respirator is put on. It determines if the respirator is properly seated to the
face or needs to be readjusted.
• There are two types of fit tests: qualitative and quantitative.
• Qualitative fit testing is a pass/fail test method that uses your sense of taste
to an irritant in order to detect leakage into the respirator facepiece.
• After passing a fit test with a respirator, you must use the exact same make,
model, style, and size respirator on the job.
• Qualitative fit testing does not measure the actual amount of leakage.
• Quantitative fit testing uses a machine to measure the actual amount of
leakage into the facepiece and does not rely upon your sense of taste in order
to detect leakage.
Infection prevention and control
measures

At Triage
A Suspect patient
• Provide surgical mask
• Suspected patient in separate area
or isolation if available
• 1 m distance between suspected
patient and others
• Ensure cough hygiene/etiquette
• Ensure hand hygiene

Apply Droplet & contact precautions:

• for suspected or confirmed cases not
critically ill
Infection prevention and control
measures

Apply Airborne & contact precautions:

• for critically ill and
• for critically ill and not critically ill
when performing aerosol
generating procedures (AGP) for
suspected or confirmed cases.
 Performing Aerosol-Generating Procedures (AGP)
• Performing AGP can generate higher concentrations of infectious respiratory
aerosols than coughing, sneezing, talking, or breathing. These procedures
potentially put HCWs at an increased risk for 2019-nCoV exposure.
• Examples of aerosol generating procedures: Bronchoscopy / Sputum induction /
Intubation and/or extubation / Cardiopulmonary resuscitation / Open suctioning of
airways / Manual ventilation via ambu bagging through a mask before intubation
• Perform these procedures only if they are medically necessary and cannot be
postponed.
• Limit the number of HCWs present during the procedure to only those essential for
patient care and support.
• HCWs should wear gloves, a gown, and either a face shield that fully covers the
front and sides of the face or goggles and a fitted N95 respirator during aerosol-
generating procedures.
• Unprotected HCWs should not be in a room during aerosol-generating procedure
• Conduct environmental surface cleaning following procedures.
Patient Placement
• Patient who is not critically ill in a single isolation room with dedicated toilet facility.
• Critically ill patient (e.g. pneumonia with respiratory distress) in an Airborne Infection
Isolation Rooms (Negative Pressure Rooms)
• When single rooms are not available, cohort patients with the same diagnosis BUT
suspected 2019-nCoV cases are not mixed with confirmed ones.
• Put the isolation sign so that it is visible and clear for all HCWs, patients and visitors.
• Ensure availability of PPE by the patient isolation room.
• Use either disposable equipment or dedicated equipment (e.g. stethoscopes, blood
pressure cuffs and thermometers). If sharing equipment is unavoidable, clean and
disinfect it after each patient use.
• Use the log sheet for all persons who enter the isolation room
Patient Transport
• Patients should wear a surgical mask to contain secretions (N95 mask is not required for
this purpose).
• Ensure that healthcare workers (HCWs) who are transporting patients wear appropriate
PPE and perform hand hygiene when appropriate.
• Family members and close relatives to be discouraged from travelling in the same
vehicle. If this is not possible, they must be evaluated for fever and lower respiratory
symptoms and either is present they must wear a surgical mask during transport.
• Clean and disinfect the vehicle according to the housekeeping policy
 Managing the Visitor to the Patient
• Consider visitors who have been in contact with the patient before and
during hospitalization a possible source of 2019‐ nCoV for other patients,
visitors, and staff.
• Facilities should develop visitor restriction policy
• Visits to patients in isolation for 2019-nCoV should be scheduled and
controlled
• In circumstances, such as end-of-life situations, where exemptions to the
restriction may be considered at the discretion of the facility.
• All visitors should follow precautions for respiratory hygiene and cough
etiquette.
• Screening visitors for symptoms of acute respiratory illness before
entering the hospital.
• Instruct visitors before entering patients’ rooms, on hand hygiene, use of
PPE and to limit touching surfaces
• Visitors/attendants should not be present during aerosol-generating
procedures.
 Log sheet for all contacts of
patients in health care setting
 Environmental Cleaning and Disinfection

• Housekeeping personnel should wear PPE

• Use MOH-approved disinfectant, follow manufacturer's recommendations for
dilution (i.e., concentration) and contact time
• The patient isolation room or cohort area to be cleaned and disinfected at
least daily and more often when visible soiling/contamination occurs.
• Give special attention to frequently touched surfaces (e.g., bedrails, bedside
and over-bed tables, TV control, call button, lavatory surfaces including
doorknobs, commodes) in addition to floors and other horizontal surfaces.
• Wipe external surfaces of portable equipment in the patient's room with a
MOH -approved disinfectant
• After an aerosol-generating procedure (e.g., intubation), clean and disinfect
horizontal surfaces around the patient.
• Privacy curtains are to be removed after patient discharge and placed in a bag
for transport to the laundry.
• After discharge, follow standard procedures for terminal cleaning of an
isolation room.
Linen and Laundry
• Place soiled linen directly into a red laundry bag in the patient's room. Close
the bag securely

• Wear gloves and gown when directly handling soiled linen and laundry (e.g.,
bedding, towels, personal clothing).

• Do not shake soiled linen in a manner that might aerosolize infectious

particles.

• Wash and dry linen per the Laundry services Policy.

Medical Waste
• Dispose of 2019-nCoV contaminated medical waste in yellow bag.

• Wear disposable gloves when handling waste.

• Perform hand hygiene after removal of gloves.

 Administrative Interventions in Health care facilities
• Availability of instructions for patients and persons who accompany them (e.g., family,
friends) - to inform health care personnel of symptoms of acute respiratory illness (fever,
cough, sore throat, breathing difficulty) and DISPLAY them in the outpatient departments
and registration counter.
• All persons with symptoms of a respiratory infection should adhere to respiratory hygiene
and cough etiquette, hand hygiene. DISPLAY POSTERS
• Provide space and encourage persons with symptoms of respiratory infections to sit as far
away from others as possible.
• Provide supplies to perform hand hygiene to all patients upon arrival to facility (e.g., at
entrances of facility, waiting rooms, at patient check-in)
• Special attention for healthcare worker training and ensure their competency in hand
hygiene, the proper use and disposal of PPE including N95. N95 mask fit test to ensure
their proper size and shape and they should be trained on donning and doffing procedure
for PPE, case definition of n CoV and surveillance algorithm
• One sensible step is to focus on the flu vaccine coverage of HCWs and persons at risk,
which will reduce the burden on health services.
 Infection
prevention and
control messages
to the public