INFECTION PREVENTION AND

CONTROL TRAINING ON COVID-19

FOR HEALTHCARE PROFESSIANALS

Public Health Emergency Operations Center

 Module Learning objectives

At the end of this session participants will be able to:

• Take appropriate measures during CoVID-19 public health
emergency
• Properly perform IPC measures as per the WHO standard.

Public Health Emergency Operations Center

IPC in PUBLIC HEALTH EMERGENCY
MANAGEMENT

Public Health Emergency Operations Center

 Introduction

Brainstorming

 How do the world manage public health emergency like COVID-19

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 Principles of Public Health Emergency Management

 Public health emergencies should be planned for and responded

to using the primary principles of emergency management:
– Prevention and Mitigation,
– Preparedness/ Readiness
– Response, and
– Recovery.

Public Health Emergency Operations Center

 Principles of EM Cont’d …

Mitigation : These strategies should include activities that would

prevent or reduce the chance of an emergency or reduce
vulnerability of high-risk groups.
– Community mitigation is to help slow the spread of the virus infections
– Each community is unique, and appropriate mitigation strategies will vary
based on the level of community transmission, characteristics of the
community and their populations, and the local capacity to implement
strategies
Public Health Emergency Operations Center
 Principles of EM Cont’d …

Mitigation Measures
 Identify those at risk and take appropriate actions
 Implement personal protective measures (e.g. stay home when sick,
handwashing, respiratory etiquette, clean frequently touched surfaces daily)
 Create a household plan of action in case of illness in the household or
disruption of daily activities

 Know about emergency operations plans for schools/workplaces of household

members

Public Health Emergency Operations Center

 Principles of EM Cont’d …

 Prevention measures

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 Social Distancing

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 Principles of EM Cont’d …

Mitigation Measures

 Limit large work-related gatherings

– Cancel community and faith-based gatherings of any size.

 Limit non-essential work travel.
 Encourage staff to telework
 Cancel elective and non-urgent procedures

Public Health Emergency Operations Center

 Principles cont’d…

Preparedness: which take place before an emergency, increase a facility’s

ability to respond when an emergency occurs.
– Facilities preparedness assessment should be done for CoVID-19 infection

– IPC aspects of preparedness

• Inventory and stockpiling IPC supplies

• Training staff,

• Increasing compliance with recommended IPC practices during mitigation of CoVID-

19 infection.

Public Health Emergency Operations Center

 Principles Cont’d…

Preparedness:- In addition to performing a facility assessment, key

steps in the pre-emergency preparedness phase include:
1. Creating a strong disease surveillance system for CoVID-19 infection.
2. Reinforcing IPC practice
3. Coordinating with health ministries or other public health authorities
4. Partnering with the community for education, involvement, and
communication
5. Performing drills and tests of the system

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 Principles cont’d…

Response: These are activities in reaction to a known suspected event

 Mobilize resources

 Establish national coordination and operational support

 Risk communication and managing the info-demic

 Laboratory and diagnostics

 Technical expertise and guidance

 Pandemic supply chain coordination

 Travel and trade

Public Health Emergency Operations Center
 Principles Cont’d…

Recovery
 This is the stage where we evaluate the prevention, mitigation, preparedness
and response efforts.
 Facilities seek to return to “normal” or Build Back Better (BBB) situation.
 Develop an all-stakeholder, national-level recovery framework
 Enable pre-disaster recovery planning among all stakeholders

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 Principles Cont’d…

 Formalize processes and systems to enable effective assessment of post-

disaster damages and needs in order to more accurately quantify and
characterize recovery needs and to formulate broad recovery strategies.
 Institute or strengthen policies, laws, and programs that promote
(incentivize), guide (ensure), and support Build Back Better (BBB) in
Recovery, Rehabilitation, and Reconstruction (RRR) in both the public and
private sectors, and by individuals and households.

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INFECTION PREVENTION AND CONTROL

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 What is infection prevention and control?

 Infection prevention and control is:

• A scientific approach with…
o practical solutions designed to prevent harm, caused by infections, to patients
and health care workers
o grounded in principles of infectious disease, epidemiology, social science and
health system strengthening, and
o rooted in patient safety and health service quality

Public Health Emergency Operations Center

 Why is IPC important for COVID-19?

 When implemented and performed correctly, IPC practices can:

1. Reduce the transmission of COVID-19 in health care facilities and
communities​
2. Enhance the safety of healthcare workers, patients, patients’ networks,
and communities
3. Enhance the ability of the organization/health facility to respond to the
COVID-19 outbreak.

Public Health Emergency Operations Center

 Principles of infection prevention and control
strategies
• IPC strategies to prevent or limit transmission in health care settings
include the following:
1. Early recognition and source control.

2. Application of Standard Precautions for all patients.

3. Implementation Transmission based precautions (droplet, contact & airborne

precautions) for suspected cases.

4. Administrative controls.

5. Environmental and engineering control

Public Health Emergency Operations Center

 1. Early Recognition and sources control

 Well-equipped triage is a system for assessing all patients at admission

allowing early recognition of possible CoVID-19 infection and immediate
isolation of patients with suspected infection (source control).
– Encourage HCWs to have a high level of clinical suspicion
– A standardized triage algorithm/questionnaire should be available for use
and should include questions that will determine if the patient meets the
COVID-19 case definition.

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 Early Recognition and sources control Cont’d…

 Healthcare facilities should prepare a private room as an isolation or waiting area for
patients with respiratory problems until COVID-19 is ruled out.
 Healthcare facilities without enough private room for isolation/waiting area or those
located in areas with high community transmission should designate a separate, well-
ventilated area where patients at high risk for COVID-19 can wait.
– This area should have benches, stalls or chairs separated by at least two meter
distance.
– Patients should be educated on physical distancing.
 Isolation/waiting areas should have dedicated toilet and hand washing facilities.
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 Early Recognition and sources control Cont’d…

 Post clear signs

– Informing patients of the location of “respiratory waiting areas”.

– There should be a clear warring sign indicating high risk area.
– Only authorized personnel should enter the room.
 All necessary cough etiquettes materials should be available in the health care
facility and all patient should be oriented on cough hygiene.
 HCWs in triage area who are conducting preliminary screening should wear
Medical Mask and maintain a physical distance of 2 meters
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2. Application of standard precaution for all patients

 Theses are set of guidelines designed to create physical, chemical and

mechanical barrier between microorganism and susceptible host.
 The basic level of IPC precautions
 These precautions are used for ALL patients at ALL times
 These precautions are the minimum prevention measures that always apply
to all patient care regardless of suspected or confirmed COVID-19 patient
status

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 Components of Standard Precaution

1. Hand hygiene
6. Environmental cleaning
2. Respiratory hygiene (etiquette)
7. Safe handling and cleaning of
3. PPE according to the risk
4. Safe injection practices, sharps soiled linen
management and injury prevention 8. Waste management
5. Safe handling, cleaning and
9. Food and water safety
disinfection of patient care
equipment 10. Client education

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24
 3. Implementing Additional Precautions

• Contact and droplet precautions for all patients with suspected or confirmed COVID-19.

• Airborne precautions are recommended only for aerosol generating procedures (i.e. open

suctioning of respiratory tract, intubation, bronchoscopy, cardiopulmonary resuscitation).

• All patients with respiratory illness should be in a single room, or minimum 2 m away from

other patients when waiting for a room

• A team of HCW should be dedicated to care exclusively for suspected patients

• HCW to wear PPE: a medical mask, goggles or face shield, gown, and gloves

• Hand hygiene

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 4. Administrative controls

• Ensuring resources for infection prevention and control (IPC) the development
of clear IPC policies
• Facilitated access to laboratory testing

• Appropriate triage and placement of patients

• Ensuring an adequate staff-to-patient ratios,

• Provision of adequate training for staffs

• Provide signs at all entrances that lists the symptoms compatible with COVID-
19 (fever, cough, shortness of breath)

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 Administrative controls cont’d…

• Restricting access to non-essential visits.

• Establishing a surveillance process for COVID-19 among HCWs

• Ensuring that HCWs and the public understand the importance of promptly seeking
medical care
• Monitoring HCW compliance with standard precautions and providing mechanisms
for improvement as needed.
• Ensure the availability of a preparedness plan for ambulance transfers of suspected
or confirmed COVID-19 cases, addressing the temporal and geographic coverage of
adequately trained staff and equipment

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 Administrative controls cont’d…

 Ensure that all patients cover their nose and mouth with a tissue or use elbow
when coughing or sneezing
 Offer a medical mask to patients with suspected CoVID-19 infection while they
are in waiting/public areas or in cohorting rooms
 Perform hand hygiene after contact with respiratory secretions.
 HCWs should apply the WHO’s My 5 Moments for Hand Hygiene approach

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 5. Environmental and Engineering Controls

 Address the basic infrastructure of the health care facility.

• Ensure there is adequate ventilation in all areas in the healthcare facility,

as well as adequate environmental cleaning.
• Maintained spatial separation of at least 1 meter between all patients.
• Ensure that cleaning and disinfection procedures are followed consistently
and correctly.
• Ensuring the availability of well-ventilated isolation rooms.

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 Historical Background

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 INFECTION PREVENTION MEASURES

1. Standard Precautions- a set of activities designed to prevent the transmission of

organisms between patients/staff for the prevention of health care-associated
infection.
• They must be applied to ALL patients who require health care, by ALL health
workers in ALL health settings.
2. Transmission-Based Precautions- Additional measures focused on the particular mode
of transmission of the microorganism and always used in addition to standard precautions
• They are primarily applied to hospitalized patients and/or suspected one.

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 Hierarchy of Control Approach

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 Transmission-based precaution

1. Airborne precaution- (<5 micorns)

 Mask, door closed, negative air flow ventilation, private room

2. Droplet Precaution: >5micron –transit 3 feets in air

 Private room, medical mask

3. Contact precaution (in/direct contact)

 Glove, gown, private room

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Public Health Emergency Operations Center
STANDARD PRECAUTIONS

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 Standard precaution

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 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.

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 Hand Hygiene

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 Hand washing
 It is THE SINGLE most important
measure in reducing the spread of
CoVID-19 infection!

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41
 Time to maintain hand hygiene

Think-pair-share:
What are the time to maintain hand hygiene generally?

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WHO’s Five Moments of Hand Hygiene

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 Other Opportunities for Hand Hygiene

 Time of hand washing for COVID-19

• After blowing cough and sneezing

• After visiting public space, (public transportation, market, places of worship)
• After touching sources, including money
• Before, during and after caring a sick person
• Before and after eating
• Before putting PPE
• Between doffing each PPE
• Immediately on arrival and before departure from work (the health facility).

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 Hand Hygiene Practices to Prevent CoVID-19 Infection

Think-Pair-share
What are the two common hand hygiene practices?

1. Hand washing using water and soap

2. Antiseptic Hand-rub/Alcohol based hand rub

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Frequently Missed Areas During Hand Washing

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 1. Hand Washing Steps

 On top of washing hands

frequently with proper technique,
we have to wash our hands with
adequate time
 40 seconds is the minimum time
recommended to wash our hands
 WHO. 2005. Guidelines on Hand
Hygiene in Health Care (Advanced
Draft): A Summary. WHO: Geneva
 https://youtu.be/IisgnbMfKvI
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 2. Antiseptic Hand Rub

 To inhibit or kill transient and resident flora.

 More effective than antimicrobial hand washing agents or plain soap and water,
 Sanitizers should not be used when the hands are visibly dirty or soiled
 Alcohol-Based Hand Rubs

• Require less time

• Act faster
• More effective for standard hand washing than soap
• Can even provide improved skin condition.
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 Hand Rub Steps

• Apply enough amount to cover the

entire surface of hands and fingers
• Continue rubbing for (15-30 seconds)
• Rub the solution vigorously into
hands, especially between fingers and
under the nails, until dry.

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PERSONAL PROTECTIVE EQUIPMENT
FOR COVID-19

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 Types of PPE used in CoVID-19

 The basic principle behind wearing PPE is to care for CoVID-19 infected/
suspected patients, to get physical barrier/protection from pathogenic
microorganisms.

Types of PPE Provides protection for

Goggle Eyes
Face Masks Nose, Mouth and Lower Jaw
Face Shield Face
Gloves Hand
Gowns Upper body, skin and cloth

Public Health Emergency Operations Center

 Rule for PPE Usage

 PPE is only one effective measure within

a package of administrative and
environmental and engineering controls

 PPE selection should be based on risk

assessment

 The current global stockpile of PPE is

insufficient, we have to use optimally by
applying the following strategies
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 Factors Influencing PPE Selection

 Type of exposure anticipated

– Splash/spray versus touch

– Category of isolation precaution
 Risk of exposure (e.g., type of activity)
 Transmission dynamics of the pathogen (e.g., contact, droplet or aerosol)
 Durability and appropriateness for the tasks
 Fit

Public Health Emergency Operations Center

 Goggles and Eye Wears

 Eye protection should be comfortable, allow for sufficient peripheral vision, and must be
adjustable to ensure secure fit.
 If reusable it should be decontaminated in accordance with the manufacturer’s guidelines.

 Put on eye protection after putting on the isolation gown and mask (if used) but before putting
on gloves
 Removal of face shield, goggles, and mask can be performed safely after gloves have been
removed.
 The front of a mask, goggles, and face shield is considered contaminated.

Public Health Emergency Operations Center

 Masks

 Should cover the nose, the lower part of the face, the jaw
and all of the facial hair
 When removing, one should handle the masks by the strings, do it
with great care as the center of the mask is the most
contaminated site of all other parts
 Masks made from synthetic materials provide protection from
large droplets (> 5 µm) spread by coughs or sneezes

Public Health Emergency Operations Center

 Types of Masks

 Respirators

– worn by healthcare personnel for protection against inhalation exposure to airborne infectious
agents that are < 5μm.

– It contain multiple layers of filter material- and must maintain its fit and function

– It can function within their design specifications for 8 hours of continuous or intermittent use

– Perform hand hygiene before and after touching or adjusting the respirator.

 Medical/Surgical Masks:

– Regulating bodies (such as The United States Food and Drug Administration [FDA], the
European Union, and WHO) require surgical masks to have fluid resistant properties.

Public Health Emergency Operations Center

 Gowns

 Gowns should fully cover the torso of the HCW, fit comfortably over the body,
and have long sleeves that fit snuggly at the wrists.

 There are three types of protective gowns used in health care facilities:

– Isolation gowns: Should be long-sleeved, fluid-resistant, single- use,

and preferably disposable.
– Surgical gowns, and
– Coverall suits

Public Health Emergency Operations Center

 How to wear and remove gowns

 Full coverage of the arms and body front, from the neck to the mid-thigh or
below, will ensure that clothing and exposed areas of the upper body are
protected.
 Isolation gowns are usually the first piece of PPE to be put on.
 HCWs should remove isolation gowns before leaving the patient care area to
prevent possible contamination of the environment outside of the patient care
area.

Public Health Emergency Operations Center

 Gloves

 Healthcare Workers Wear Gloves for the Following Three Reasons:

– To reduce the risk of acquiring infections to the staff from patients

– To reduce the risk of transmitting microorganisms including skin flora from
provider to clients/patients
– To reduce contamination of the hands of the staff by microorganisms which
are transmissible from one patient to another (cross-contamination).

Public Health Emergency Operations Center

 Types of gloves

 Surgical Glove - should be used when performing invasive medical or surgical

procedures.
 Clean Examination Gloves - provide protection to healthcare workers when
performing many of their routine duties. These gloves can be used whenever contact
with mucous membrane and non-intact skin is anticipated (e.g. during care for
suspected/conformed CoVID-19).
 Utility or Heavy-Duty Gloves - should be worn when processing instruments,
equipment and other items, for handling and disposing contaminated waste, and when
cleaning contaminated surfaces.

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 Donning and doffing of examination gloves

Wash hands before donning and after doffing of gloves

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 Donning PPE

• Things to consider
• Identify hazard and manage
risk.
• Gather the necessary
materials
• Plan where to put and take
off PPE
• Do you have a buddy?
• How you will deal wastes
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 Doffing PPE

• Avoid contamination of self

• Remove the most heavy
contaminated item, first
• Remove glove and gown- role
inside out
• Perform hand hygiene at every
step, hand may easily become
contaminated.

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 Rational use of PPE

 The overuse of PPE will have a further impact on supply shortages. Observing
the following recommendations will ensure that the use of PPE is rationalized.

– The type of PPE used when caring for COVID-19 patients will vary according
to the setting and type of personnel and activity.

– Healthcare workers involved in the direct care of patients should use the
following PPE: Long sleeved isolation, gowns, gloves, medical mask and eye
protection (goggles or face shield), Boots or covered work shoe.

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 Rational use of PPE Cont’d…

– Specifically, for aerosol-generating procedures (e.g., tracheal intubation,

non-invasive ventilation, tracheostomy, cardiopulmonary resuscitation,
manual ventilation before intubation, bronchoscopy) healthcare workers
should use respirators, eye protection, gloves and gowns; aprons should
also be used if gowns are not fluid resistant.

– For detailed information please refer “ Interim Guide for Rational use of
personal protective equipment for coronavirus disease 2019 (COVID-19)”.

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PPE utilization Recommendation in COVID-19 Treatment Centers (1/4)
Setting Target Staff or Patient Activity Type of PPE or Procedure
Healthcare Facilities

Out Patient

Triage Healthcare workers Preliminary screening not involving Maintain spatial distance of at least
(Contaminated Zone) direct contact 1 m.
Medical mask, Boots or closed work
shoes
Patients Any Maintain spatial distance of at least
1 m.
Provide medical mask if tolerated by
patient.

Waiting area Healthcare Providers Any Maintain spatial distance of at least

(Contaminated Zone) 2 m.
Medical mask, Boots or closed work
shoes
Patients Any Provide medical mask if tolerated.
Ensure spatial distance of at least 2
m from other patients

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 PPE utilization Recommendation (1/2)
Setting Target Staff or Patient Activity Type of PPE or Procedure
Inpatient Room
Patient Room Healthcare Worker Providing direct care to COVID-19 Medical mask, Long sleeved
(Contaminated Zone) patients isolation gown, Gloves, Eye
protection (goggles or face shield),
Boots or closed work shoes.
Aerosol-generating procedures Respirator N95 or FFP2 standard,
performed on COVID-19 patients or equivalent. Long sleeved isolation
gown, Gloves Eye protection Apron,
Boots or closed work shoes
Cleaners Entering the room of COVID-19 Medical mask, Long sleeved
patients. isolation gown, Heavy duty gloves,
eye protection in case of splash
Boots or closed work shoes
Laboratory Personnel Taking and Manipulation of N-95, Long sleeved isolation gown,
nasopharyngeal sample Gloves, Eye protection (if risk of
splash), Boots or closed work shoes
Visitor/Care givers Entering the room of COVID-19 Medical mask, Gloves
(mother of a child) patients

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 PPE utilization Recommendation (1/4)
Setting Target Staff or Patient Activity Type of PPE or Procedure
ICU All healthcare Aerosol Generating N-95, Cover all Suit, Gloves, Eye protection (if
(Contaminated Zone) professionals procedures risk of splash), Boots or closed work shoes

All healthcare Assisting Aerosol Generating N-95, Cover all Suit, Gloves, Eye protection (if
professionals procedures risk of splash), Boots or closed work shoes

All healthcare Non Aerosol Generating N-95, Long sleeved isolation gown, Glove, eye
professionals procedures protection in case of splash Boots or closed
work shoes
General Facility Cleaners Any Medical mask, Long sleeved isolation gown,
(Contaminated Zone) Apron, Heavy duty gloves, eye protection in
case of splash Boots or closed work shoes
Laundry Personnel Any Medical mask, Long sleeved isolation gown,
Apron, Heavy duty gloves, eye protection in
case of splash Boots or closed work shoes
Runners Any Medical mask, Long sleeved isolation gown,
Gloves, Eye protection (if risk of splash), Boots
or closed work shoes

Public Health Emergency Operations Center

 PPE utilization Recommendation (4/4)
Setting Target Staff or Patient Activity Type of PPE or Procedure
Other areas of patient All staff including healthcare Any activity that does not Medical mask, Long sleeved
transit (e.g. wards, workers. involve contact with COVID-19 Isolation gown, Boots or closed
corridors) patients. work shoes
(Contaminated Zone)
Pharmacy Pharmacy Personnel Any Medical Mask, Gown, Boots or
(Clean Zone) closed work shoes

Laboratory Healthcare workers Taking and Manipulation of N-95, Long sleeved isolation gown,
(Clean Zone) nasopharyngeal sample Gloves, Eye protection (if risk of
splash), Boots or closed work shoes
Administrative areas All staff including health care Administrative tasks that do Medical Mask, Physical distancing
(Clean Zone) workers not involve contact with
COVID-19 patients.
Morgue All staff including healthcare Any activity that involve Medical Mask, Long sleeved
(Contaminated Zone) workers. coming in contact with COVID- isolation gown, Apron, Heavy duty
19 related death gloves, eye protection in case of
splash Boots or closed work shoes

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GENERAL HEALTHCARE SETTING
MANAGEMENT

Public Health Emergency Operations Center

 General Healthcare Setting Management

 Post signs in public areas reminding symptomatic patients to alert healthcare

professionals.
 Emergency services and primary care staff, including physicians, nursing and
administrative staff with patient contact, should be aware of CoVID-19
 All appropriate personal protective equipment (PPE) should be available for all
personnel at the point-of-care
 Risk assessment should be performed to assess the likelihood of COVID-19
infection
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 General Healthcare Setting Management

 A professional (e.g. Medical director) should be designate in each facility to be

the lead for COVID-19 preparedness and response at that facility.
• Limit visitor access and movement within the health facility
• Suspected cases of COVID-19 should be isolated, or at least separated, from
other patients.
• Suspected cases should be instructed to wear a surgical mask and practice
appropriate physical distancing and hand hygiene.

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 General Healthcare Setting Management

 Avail hand washing facilities with water and soap and alcohol based hand rubs
 Prevent overcrowding, especially in the emergency department.
 Provide IPC training to all staff.
 Monitor Healthcare professional’s compliance with standard precautions and
provide mechanisms for improvement as needed.
 Consider designing of the traffic flow and activity pattern.

– A unidirectional directional flow of movement of materials, staff and patient to

minimize cross contamination
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 Design of Facility

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 Design of Facility

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HANDLING AND MANAGEMENT OF
HEALTHCARE WASTES

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 Healthcare Waste Management

 There is no evidence that direct, unprotected human contact during the handling
of health care waste has resulted in the transmission of the COVID-19 virus.
 However, Waste generated during CoVID-19 case management should be
considered as medical waste or infection waste.
 So, all health care waste produced during the care of COVID-19 patients should
be collected safely in designated containers and bags, treated (If possible), and
then safely disposed of preferably on-site to protect clients, staff, and the
community.

Public Health Emergency Operations Center

 Healthcare Waste Management

 Personnel who handle waste should wear proper personal protective

equipment (boots, apron, long-sleeved gown, thick gloves (heavy duty),
mask, and goggles or a face shield) and wash their hands after removing it.
• The key to minimization and effective management of health-care waste is
segregation (separation) and identification of the waste.
• Appropriate handling (segregation, collection, transport, storage, treatment,
and disposal) of waste by type reduces costs and does much to protect
public health.

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 Waste Segregation

 Segregation- the key to minimization and effective management of

health-care waste
 Wastes should be segregated at the point of use
• Should be the responsibility of the waste producer,
• Should take place as close as possible to where the waste is generated

Public Health Emergency Operations Center

 Color Coding System for Segregation
Type of Waste Color of Container and Markings Type of Container
Strong, leak-proof plastic bag or
Highly infectious waste Yellow, marked “highly infectious”
container capable of being
(includes all pathological waste) with biohazard symbol/ Red
autoclaved
Other infectious waste Yellow with biohazard symbol Leak-proof plastic bag or container

Yellow, marked “SHARPS” with

Sharps Puncture-proof container
biohazard symbol

Brown, labeled with appropriate

Chemical and pharmaceutical waste Plastic bag or rigid container
hazard symbol

Radioactive waste Labeled with radiation symbol Lead box

General health care waste Black Plastic bag or container

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 Color Coding System for Segregation

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 Waste collection and transportation

 Wastes should:

• Not be accumulate at the point of production

• Should be collected daily (or as frequently as required) and transported to the
designated storage site.
• Container should be properly labeled to identify it as medical waste
 The bags or containers should be replaced immediately with new ones of the
same types

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 Waste collection and transportation

 Health-care waste should be transported within the hospital or other facility by

means of wheeled trolleys, containers, or carts that are not used for any other
purpose and meet the following specifications:
• Easy to load and unload;
• No sharp edges that could damage waste bags or containers during loading
and unloading;
• Easy to clean.
 If it is transported off-site, the waste should be adequately packed and labeled
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 Treatment and Disposal

 COVID-19 regulated medical waste, after treatment, can be managed as routine

municipal solid waste and placed in a municipal solid waste.
 Dispose all left over foods in a pit, that is fenced and kept clean at all times, and
limit the traffic follow to authorized personnel only.
 Other wastes should be burnt in incinerators made for medical waste.
 If not available burn wastes in a pit by adding some flaming agent (eg.
Kerosene), ensure that visual conformation of that all wastes are burnt.

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LINEN PROCESSING AND LAUNDERY
SERVICE

Public Health Emergency Operations Center

 Linen processing

 All linens should be considered as potentially infectious during CoVID-19 public

health emergency
 All personnel who handle linen should wear full PPE.
 Soiled linen should be placed in clearly labelled, leak-proof bags or containers.
 Wash linens either through machine washing or hand washing

Public Health Emergency Operations Center

 Linen processing

 Machine washing with warm water at 60−90° C with laundry detergent is

recommended.
 Remove items from the bag and put them directly into the washing machine
(unless using a dissolvable bag, which can be placed directly into the washing
machine).
 The laundry can then be dried according to routine procedures.

Public Health Emergency Operations Center

 Linen processing

 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% chlorine for
approximately 30 minutes.
 Do not soak lines in in a 0.5% chlorine solution unless contaminated with blood
and body fluid.
 Store clothing in a clean and dry place until they are ready to be used again

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ENVIRONMENTAL CLEANING

Public Health Emergency Operations Center

 Environmental Cleaning

 At this time, there is no evidence that the COVID-19 is spread through

environmental exposures, such as coming into contact with contaminated surfaces.
However precaution is necessary
 Existing recommended cleaning and disinfection procedures for health care
facilities should be followed consistently and correctly
 Surfaces in all environments in which COVID-19 patients receive care (treatment
units, community care centers) should be cleaned at least twice a day and when a
patient is discharged.

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 Environmental Cleaning

 Regular cleaning followed by disinfection is recommended, using hospital

disinfectants active against viruses; cleaning in patient rooms is particularly
important for frequently touched surfaces
 Cleaning/disinfecting the environment including frequently touched surfaces such
as bed tables, bed rails, the arms of chairs, sinks, call bells, door handles and
push plates, and any area/piece of equipment that may potentially be
contaminated

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 Environmental Cleaning

 Staff engaged in environmental cleaning and waste management should wear

appropriate PPE
 Many disinfectants are active against enveloped viruses, such as the COVID-19
virus, including commonly used hospital disinfectants.
 Currently, WHO recommends using:

– 70% ethyl alcohol to disinfect small areas between uses, such as reusable
dedicated equipment (for example, thermometers);
– sodium hypochlorite at 0.5% (equivalent to 5000 ppm) for disinfecting surfaces.

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DECONTAMINATION OF EQUIPMENTS

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 Instrument processing

 Equipment used by patients can be contaminated with the COVID19

 Use disposable or dedicated patient care equipment (e.g., blood pressure cuffs)
and clean and disinfect equipment using 70% Alcohol before reuse on other
patients.
 Critical equipment's should follow the routine procedure.

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FOOD AND WATER SAFETY

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 Food Safety

 The number of patients might overwhelm the routine food services during
CoVID-19 public health emergency.
 Prior preparation activates should be conducted to prior to public health
emergencies.
 All food handing staff should implement proper food hygiene
 The food should be kept safe by implementing food safety principles

Public Health Emergency Operations Center

 Water Safety

 The COVID-19 virus has not been detected in drinking-water supplies, and based
on current evidence, the risk to water supplies is low.
 Laboratory studies of surrogate coronaviruses that took place in well-controlled
environments indicated that the virus could remain infectious in water
contaminated with feces for days to weeks
 Preventative, risk-based approach to managing water supplies (built on HACCP
principles)
 Catchment-to-consumer risk assessment and management
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 Water Safety

• Water safety measures should be taken (protecting the source,

treating water at the point of distribution, collection or consumption;
and ensuring that treated water is safely stored at home in regularly
cleaned and covered containers)
• Availability of safe water is mandatory to practice proper hygiene

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 Food and Water Safety

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 Food and Water Safety

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TRANSMISSION BASED PRECATUTION

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 Overview

 Transmission-based precautions must be used in conjunction with the Standard

Precautions.
 Transmission-Based Precautions are for patients who are known or suspected to
be infected or colonized with infectious agents including epidemiologically
important pathogens which require additional control measures to effectively
prevent transmission such as CoVID-19 infection.

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 Transmission Based Precaution
Isolation Precaution
Airborne Droplet Contact

Transmission can occur

Transmission of
either through airborne Infectious agent
pathogens spread wholly
droplet nuclei or dust transmitted directly or
or partly by droplets
particles containing the indirectly from one
larger than 5μm in size.
infectious infected or colonized
Remain in the air briefly
microorganisms. person to a susceptible
and can travel about 1
Airborne particles do not person
meter (3 feet) or less.
land on and contaminate
surfaces.

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 Transmission based precautions
 Transmission-based precautions must be used in
conjunction with the Standard Precautions.
 Transmission-Based Precautions are for patients who are
known or suspected to be infected or colonized with
infectious agents including epidemiologically important
pathogens which require additional control measures to
effectively prevent transmission such as CoVID-19 infection.

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Transmission based precaution and CoVID-19

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 Patient Placement

Suspected cases
 If private room is available place the patients in a private room

 Patients should wear a medical surgical mask in waiting rooms and when outside of
the patient room.
 If private room is not available, maintain over 2 meter (6 feet) spatial separation
between patient beds and use of a physical barrier, such as a curtain or divider and
patients should were medical/surgical masks.
 And also ensure not to mix stable and unstable patients in the same room.

Public Health Emergency Operations Center

 Patient Placement

Confirmed Cases
 If private room is available place the patients in a private room
 Patients should wear a medical surgical mask in waiting rooms and when
outside of the patient room.
 If private room is not available, maintain over 2 meter (6 feet) spatial
separation between patient
 And also ensure not to mix stable and unstable patients in the same room.

Public Health Emergency Operations Center

 Patient Transport

 Limit transport of patient to essential reasons only.

 Alert the department or facility where the patient is being transported so they can
prepare to receive a patient on Transmission-Based Precautions.
 Use PPE appropriately

– Patients wear a surgical mask

– Cover wounds with appropriate dressings

– Clean and disinfect the wheelchair or coach after transportation.

– Remove PPE and perform hand hygiene once the patient has been transported

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 Patient Care Equipment

 If possible use disposable or dedicated patient care equipment (e.g., blood

pressure cuffs) to a single patient
 If not possible clean and disinfect equipment before reuse on other patients as
per the recommendation.

Public Health Emergency Operations Center

 Use of PPE

 Wear Long sleeved gown, eye protection, medical mask and glove mask, before entry into the
patient care area.
 Wear a particulate respirator such as a fit-tested N95 and conduct a seal check before entering
the patient’s room when performing aerosol generating procedures such as tracheal intubation,
non-invasive ventilation, tracheotomy, cardiopulmonary resuscitation, manual ventilation before
intubation, and bronchoscopy and should be preformed adequately ventilated room(natural
ventilation or in negative pressure rooms)
 Limit number of persons in the room to the absolute minimum required for the patient’s care
and support

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 Use of PPE Cont’d…

 Remove PPE on the dedicated doffing area.

 If PPE is to be re-used, it must be cleaned and disinfected according to the
recommendation before each reuse.
 Always perform hand hygiene before and immediately after patient care and
after touching any PPE.

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 Cleaning

 Ensure that rooms of patients are frequently cleaned and disinfected (at least
twice a day, on patient discharge prior to use by another patient).
 Focus cleaning on toilets, frequently touched surfaces, and equipment in the
immediate patient area.
 Personnel who clean patient care area should were full PPE.

Public Health Emergency Operations Center

 Transmission of CoVID-19

Public Health Emergency Operations Center

 COVID -19 Death Care and Burial Management

 Health workers and persons involved on preparing the dead body for funeral should
always follow Standard Infection Prevention and Control (IPC) practice.
 Before attending to a body, people should ensure that the necessary hand hygiene and
personal protective equipment (PPE) supplies are available (that include: water
resistant Gown, Gloves, Google/Face Shield and Surgical Masks, cloth to cover the
dead body (cotton), chlorine solution and sprayer)
 The dignity of the dead person, his/her cultural and religious traditions, and his/her
families’ concern should be respected and protected throughout.
 Dead Body Management involves appropriate consultations and engagement
Public Health Emergency Operations Center
 Dead body handling in case of death due to COVID-19

 The major steps are:

1. Preparing of the body at patient room/Isolation Room

2. Handling of dead body at morgue
3. Transportation
4. Conducting Burial
5. Before return to home after burial

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1. Preparing of the body at patient room/Isolation room

 After the physician declares death, the nurse on duty is responsible to make sure that staffs
perform the following tasks:

• Always adhere to standard precautions and use appropriate personal protective equipment
(PPE).

• Notify the family and provide grief counseling according to the ethical standards

 Perform the following tasks to prevent exposure to blood and body fluid during transportation

to protect morgue personnel:

• Remove all disposable tubes and lines appropriately.

• Dress all wounds (resulting from removal of catheter, drains, and tubes).

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 Preparing of the body Cont’d…

 Keep both the movement and handling of the body to a minimum

 Wrap body in cloth and transfer it as soon as possible to the mortuary area;

– There is no need to disinfect the body before transfer to the mortuary area

– Body bags are not necessary, although they may be used for other reasons (e.g. excessive body
fluid leakage); and

– No special transport equipment or vehicle is required.

• Use impermeable material respectively to prevent oozing of body fluids or bleeding from wounds or
previous catheter sites.

• Ensure that any body fluids leaking from orifices are contained; by plugging oral, nasal, anal orifices
of the dead body to prevent leakage of body fluids.
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 Cleaning and Disinfection

 All used/ soiled linen should be handled with standard precautions (wrap-up from out
to inside, with minimum agitation).

 Used equipment (re-usable) should be autoclaved or decontaminated with disinfectant

solutions in accordance with national infection prevention control guide line.

 All used/ soiled linen should be handled with standard precautions (wrap-up from out
to inside, with minimum agitation),

 All medical waste must be handled and disposed of in accordance with infectious waste
management rules.

Public Health Emergency Operations Center

 Cleaning and Disinfection Cont’d…

 Disinfect hospital bed, rooms, bed linens and mattress properly as per the
national IPC standard.

 Remove personal protective equipment’s as per IPC guidance and perform hand
hygiene.

 All surfaces of the room area (floors, bed, railings, side tables, IV stand, etc.)
should be cleaned first with soap and water or detergent and then wiped with
0.5% Sodium Hypochlorite solution; allow a contact time of 5 to 10 minutes, and
then allowed to air dry.
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 2. In the Morgue
 All morgue staff must be oriented and provided training on COVID-19 regarding
the proper infection control practices
• Hand Hygiene
• Mode of disease transmission
• PPE utilization
 Always use standard precautions and appropriate personal protective equipment
(PPE) at all times.
 Avoid direct contact with blood and body fluids.
 Use PPE (mask, goggles, latex/vinyl gloves, boots, and water proof full-length
apron) to prevent splashing and contamination with body fluids. Remove
disposable PPE and discard immediately after the task is completed.

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 In the Morgue Cont’d…

 Avoid Autopsy examination unless required for mandatory medical or legal

purpose.
• If it is done, it has to be carried out under strict IPC procedure and only a
minimum number of staff should be involved in the autopsy.
 Do standard body preparation, put the body in coffin, seal and disinfect the
coffin with disinfectant.
 Hand over to the burial team using stretcher or metallic bed

Public Health Emergency Operations Center

 In the Morgue Cont’d…

 Until the burial time and place is fixed, dead bodies should be stored in cold
chambers maintained at approximately 4°C. If cold chamber is not available,
body should stay at cold area of the morgue and advice to conduct the burial as
early as possible.
 The mortuary must be kept clean. Environmental surfaces, instruments and
transport stretcher/metallic bed should be cleaned first with soap and water or
detergents and then properly disinfected with 0.5% Hypochlorite solution.
 NOTE: Embalming of dead body should not be allowed.

Public Health Emergency Operations Center

 Cleaning and Disinfection

 Human coronaviruses can remain infectious on surfaces for up to 9 days. COVID-

19 virus has been detected after up to 72 hours in experimental conditions.

Therefore, cleaning the environment is paramount.

• The mortuary must be kept clean and properly ventilated at all times;

• Lighting must be adequate;

• Instruments used during the autopsy should be cleaned and disinfected

immediately after the autopsy, as part of the routine procedure;

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 Cleaning and Disinfection Cont’d…

• Environmental surfaces, where the body was prepared, should first be cleaned with soap and

water;

• After cleaning, a disinfectant with a minimum concentration of 0.5% sodium hypochlorite

(bleach), or 70% ethanol should be placed on a surface for at least 1 minute for sensitive

materials that can be easily damaged by bleach.

• Personnel should use appropriate PPE, including respiratory and eye protection, when preparing

and using the disinfecting solutions; and

• Items classified as clinical waste must be handled and disposed of properly according to legal

requirements.

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 3. Transportation

 Make sure that the body, secured in a coffin or stretcher or metallic bed, exterior of which
is decontaminated. So that it minimize the risk to the staff or team transporting the dead
body.
 The coffin or metallic-bed carrying body is placed (delicately) on the platform of the car
that will serve as a means of transport, usually the head towards the front
 The personnel handling the body should follow standard precautions (use gloves, face
mask and hand hygiene).
 The vehicle, after the transferring the body to burial site, will be decontaminated with
0.5% Sodium Hypochlorite.

Public Health Emergency Operations Center

 4. Burial Process

 It is recommended that bodies of suspected or probable COVID-19 infection shall

be buried as soon as practicable.
 All burial team members should wear appropriate PPE like (glove and face
mask). Finally use hand hygiene or Alcohol based hand rub.
 Religious ceremony may be conducted at the mortuary with minimal attendees
with strict physical distancing but coffin should not be opened.
 A minimum number of people (below 20 families) should attend the burial
process.

Public Health Emergency Operations Center

 Burial Process Cont’d…

 Ensure anyone tasked with placing the body in the grave, wear gloves and wash
hands with soap and water after removal of the gloves once the burial is
complete.
 Kissing, hugging, etc. of the dead body should not be allowed.
 Law enforcement officers are required to observe the process.
 Regular burial sites can be used to bury bodies of patients died from COVID-19.

Public Health Emergency Operations Center

 5. Before Return to home after Burial

 Key messages should be delivered to those attended in burial about IPC.

 The reusable equipment like metallic bed, water containers and other fomites must be
first cleaned with soap and water and then disinfected and dried (using 0.5% Chlorine)
 All disposable used PPE should bury or burnt at safe way.

 Any team member who used rubber boots should take off rubber boots and disinfect
them with 0.5% chlorine solution.
 All people attended to cemetery should conduct hand hygiene before returning home
(Soap and water or an alcohol-based hand rub should be used)

Public Health Emergency Operations Center

 Handling Dead Bodies of Unknown Cause

 Avoid transport of Dead body form one region to another region or form one country to another.

• If the transportation is obligatory, it requires strict IPC procedures and trained personnel
dedicated for this purpose.
 If a death is believed to be due to confirmed COVID-19 infection, there is unlikely to be any
need for a post-mortem examination.
 If it is felt that a death may be due to COVID-19 but has not been proved prior to death, the
decision as to whether the examination has to be limited to obtaining the necessary swabs or
should entail a fuller more invasive post-mortem examination depends on the needs of the
investigating police officer and other relevant parties.

Public Health Emergency Operations Center

 PPE used during Post Partum Examination

 Glove, if there is a risk of cuts, puncture wounds, or other injuries that break the
skin, wear heavy-duty gloves over the nitrile gloves.
 Wear a clean, long-sleeved fluid-resistant or impermeable gown to protect skin
and clothing.
 Eye goggle
 N-95 respirator
 Rubber boots

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The objectives are:
a) Determine the risk categorization of each HCW after exposure
to a COVID-19 patient
b) Inform the management of the exposed HCWs based on risk

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 Summary

 What new lesson do you learned?

 Can you apply this new lesson to your set up?

Public Health Emergency Operations Center

TOGETHER WE CAN CONTROL
THE PANDEMIC

Adherence to IPC principle saves

your life!

Public Health Emergency Operations Center