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1. Infection prevention control strategy for
COVID-19 at saraswati medical college
& hospital for infectious disease.
SARASWATI MEDICAL COLLEGE AND HOSPITAL
LUCKNOW – KANPUR HIGHWAY NEAR BHALLA
FARM UTTARPRADESH
Dr. Manish Tiwari
Department of
microbiology smc
lucknow (unnao)

4. Standard precautions for all
patients

5. Component of Standard
Precautions
1. Hand hygiene
2. Respiratory hygiene
3. PPE donning and doffing
4. Environmentcleaning
5. Safe handling and cleaning of soiled
linen
6. Waste management

7. WHY is hand hygiene required`?

8. Why do we need steps of hand
hygiene?

9. WHO guidelines on hand hygiene in health care, 2009
WHEN: dowe need to practice hand
hygiene?

10. WHICH: Hand wash or hand rub?
 Time required (for hand wash 40-60 secs vs. for
hand rub ~20 secs)
 After hand wash- Need towels towipe
 Location of washbasin- not at point ofcare
 WHO recommends-for all clinical situations,
preferred use of hand rub if available, except
when hands are soiled (Do Handwash).

11. Hand wash recommendations:
 Hand wash is amust
 After Using PPE
 After taking off the gloves
 When hands are visiblycontaminated with blood/body
fluids
 Patients with Clostridium difficile or enteroviraldiarrhea
 After using thetoilet
 Before and after eating

12. Steps of hand rub/Hand wash
Remove Jewellery before hand rub
Duration: 15-20 seconds (hand rub)/ 40-60 s
(Hand wash)
Volume of agent: ~ 3 ml (Hand rub)/Liquid
medicated Soap, enough to produceleather
VERY IMPORTANT: Rub hands togetheruntil
dry (for Hand rub)
Rub all surfaces thoroughly doing 7steps.

13. Steps of hand rub/ hand wash

14. When is hand rub/hand wash a must?
 Before
 touching any devices/equipmentattached to patient
 Indwelling catheter
 Any other drain
 Ventilation equipment
 Drawing a specimen/placing IVline
 After
 All aboveactivities
 After touching door/ almirahhandles
 Handling patientchart/monitor
 Touching own nose/mouth/hair

15. Respiratory hygiene
Wash hands with soap and water
Avoid patient careareas if you havea respiratory infection. Stay home if possible.
Wear a mask during hospitalvisits.

21. Wear PPE before suspect/positive patient care
Putting on (Donning) PPE

22. Putting off (doffing) PPE

23. Gloves: types and usage
 Glovesdo reducedegree of contamination of hands (16
CFUs/min to 3 CFU/min of patient careactivities)
 Gloves may be Non-sterile/ sterile, non-powdergloves
(Latex orNitrile).
 Glovesshould always be inspected before use tocheck
they areintact.
 Caution: Gloves do NOT mean complete protection.
Small unnoticed tears may be present/ hand
contamination can occurduring glove removal. Hand
hygiene MUST be practiced afterglove removal

24. Usage of Mask
 Masks- Use-N 95
 When examining the known positivepatient
 When taking samples from suspectcases
 when doing bacterial culturesof respiratorysamples( from COVID-
19 suspected cases) in biosafetycabinets.
 When doing RNA extraction in biosafetycabinets
(If N 95 is notavailable usetriple layered surgical mask. Use
triple layered for all otherspecimens)
Do not touch front portion of mask with hands while or after
working
 Mask alone is insufficient toprovide theadequate level of protection
and other equally relevant measures should be adopted – Hand
hygiene

25. GOWN
 Single-use long-sleeved fluid-resistantor
 Reusable non-fluid-resistantgowns
 Plastic aprons (for use over non-fluid-resistant gowns
if splashing is anticipated and if fluid-resistant gowns
are notavailable)

26. EYEWEAR
 Safety goggles are intended to shield the wearer's eyes
from impact hazards such as flyingfragments, objects,
large chips, andparticles.
 Goggles fit the face immediately surrounding theeyes
and form a protectiveseal around theeyes.
 This preventsobjects from entering underoraround
thegoggles.

27. Head covers and shoe covers
 Shoeand head covers providea barrieragainst possible
exposure within acontaminated environment.
 They must be fluidresistant.

30. Environment & equipment surfaces
to be cleaned and disinfected daily
 Bed rails,
 Bed matress
 I.V pole
 Medicine trolly
 Monitors
 Ventilator tubings/ surfaces
 Keyboard
 Telephone receivers
 Door handles/knobs
 Stethoscope diaphragm/ othercomponents
 Floor &walls
 Windowsills
 Sisterdesk
 Tablesurfaces
 Almirah handles and surfaces
 Toilet seats and its surfaces (including floor and wallsof toilets)
 Toilet taps/ health faucets

31. Cleaning of small equipments
 Use 70% isopropyl alcohol:
 Stethoscope
 BP cuffs
 Rubber stoppers of multi-dose vials
 Small instrumentsurfaces
 All other surfaces in OPD- clean with detergent and
water followed by disinfection with cotton cloth
dipped in 0.5% hypochlorite.

32. High-touch surfaces
• Surfaces that have frequent contact withhands
• Examples:
Almirah handles
Telephones, call bells, computerkeyboards
Light switches, edges of privacycurtains
• Require more frequent cleaning and
disinfection than minimal contactsurfaces
• Cleaning and disinfection is to bedonedaily
and more frequently if the risk of
environmental contamination is higher.

33. Low-touch surfaces
• Surfaces that have minimal contactwith hands
• Examples:
 Walls and ceilings
 Mirrors and windowsills
• Require cleaning on a regular (but not necessarily
daily) basis
• When soiling or spillsoccur,
• Many low-touch surfaces may be cleaned on a
periodic basis rather than a daily basis if they are also
cleaned when visiblysoiled

38.  PPE for Cleaners/ sweepers
includes the following:
Impermeable plasticapron
Gum boots
Disposable mask andcaps
Gloves
Eye protection wherever
required

39. Cleaning of floors
• Remove gross soil (visible to naked eye) prior to
cleaning and disinfection
• If any needle or sharps are there in the floor segregate
in puncture proof boxsafely
• Use separate mop for different areas (lab area,
corridors, offices)
• DO NOT USE BROOM/VACUUM CLEANERS
• Use dust control mop prior to wet mop
• Do not lift dust mop off the floor use swivel motion,
never shake the mop, minimizeturbulence
• Triple bucket method to beused

40.  Progress from the least soiled areas (low-touch) to
the most soiled areas (high-touch) and from high
surfaces to lowsurfaces
 Wash the mop under running water before doing
wet mopping
 An area of 120 square feet to be mopped before re-
dipping the mop in thesolution
 Cleaning solution to be changed after cleaning an
area of 240 square feet
 Change more frequently in heavily contaminated
areas, when visibly soiled and immediately after
cleaning blood and body fluid spills

41. Mopping Floors using Wet Mop
and Bucket
• Prepare fresh cleaningsolution
• Place ‘wet floor’ caution sign outside of room
or area being mopped
• Divide the area intosections
•Immerse mop in cleaning solution and wring
out
• Push mop around paying particular attention
to removing soil from corners; avoid splashing
walls orfurniture

42. Mopping Floors using Wet Mop
and Bucket
• Use “figure of eight” strokes in open and wide
spaces- overlapping each stroke; turn mop
head overevery fiveorsix strokes
• For small spaces, start in the farthest corner of
the room, drag the mop toward you, then push
itaway
• Work in straight, slightly overlapping lines and
keep the mop head in full contact with the
floor
• Repeat until entire floor isdone
• Change the mop head as perprotocol

43. Figure of eight stroke technique for mopping
Reference: National Guidelines for Clean Hospitals; Ministry Of Health And Family Welfare
Government Of India 2015

44. Triple bucket system
• Floorcleaning
• Procedure for washing, rinsing, and sanitizing where a
different bucketand spongeor mop is used foreach task
• Forwashing:
 First bucketwith waterand detergent is used only forthis
purposeand will not be used forrinsing orsanitizing
• For Rinsing:
 Second bucketwith wateronly, will be used solely forthis
purpose.
• A third bucket:
 Containing waterand adisinfectantsolution shall be used for
disinfectiononly

45. Water + detergent Only water Water + disinfectant
Mopping Floors using Wet Mop and
Bucket

46. Triple bucket system

47. After cleaning
• If disposablepadsare used- discard them in yellow bag
• Aftercleaning, wash theclothwith detergentand sun
dry
• Launder mop headsdaily
• All washed mop heads must bedried thoroughly
before re-use.
• Clean sanitationcartand carts used to transport
biomedical wastedaily.
• All attachments of machines should beremoved,
emptied, cleaned and dried beforestoring.

49. Laundring patient clothes
 Place soiled cloths in designated container for laundering
 Do not shake theclothes
 Patient clothes laundry is to be done by dipping in 0.5%
hypochlorite solution for 30 minutes followed by washing
with detergent and hot water (70oC)
 Or the patient may dispose clothes in yellow bins for
incineration

51. Cleaning and disinfection of isolation
room when patient is discharged
 To bedone same as described above
 Fogging with 7.35 % H2O2 + 0.23% Peroxyacetic acid isto
be done.
 Ask the patient to take bath with soapand waterand wear
clean clothes.
 Launderordispose patientold clothes as described
previously.
 Patient belongings such as mobile/ laptop surfaces needs
to bedisinfected with accelerated H2O2 wipes for 1 minute
thoroughly. Followed by disinfection with spirit swab. Dry
and handle them topatient.

57. Labelling of Waste
 All waste has to be in double layered medical waste
bags.
 Label the waste as COVID-19waste
 Spray 0.5% hypochlorite to decontaminateouter
surface

59. Spill Management
 Coverthe spill with absorbentcottonoracloth.
 Disinfect the surfacewith 10% bleach for 10-15
minutes.
 Now useclothorcotton toabsorb the spill
 Collect thespill with scoopand discard it in the
yellow/ red bag.
 Finally mopwith detergentand water.

60. Hypochlorite solution and Bleach
preparation for floor &wall disinfection
 1% Bleaching powdersolution-
 Prepare 33 gms of bleaching powder (bleachingpowder
with 30% strength) in 1 litre ofwater.
 1% Hypochlorite solution- For instrumentand
bench and smallspill
 Prepare by mixing 200 ml (of 5% availablechlorine
hypochlorite ) in 800 ml of water.

61. Hypochlorite solution and Bleach preparation
for surface disinfection
 0.5% Bleaching powder solution- Forinstrument
and bench and smallspill
 Prepare 16 gms of bleaching powder (bleachingpowder
with 30% strength) in 1 litre ofwater.
 0.5% Hypochlorite solution- For instrumentand
bench and smallspill
 Prepare by mixing 100 ml (of 5% availablechlorine
hypochlorite ) in 900 ml of water.

62. Handling dead bodies
 Fill all openingsof dead bodywith cotton ballsor
gauge dipped in 1% hypochlorite.
 Wrap the bodywith double layercloth soaked in 1%
hypochlorite
 Wrap again in leak proof wrappingsheet.
 Disinfect the surface with 1%hypochlorite.
 Transfer the body through separate passage to
mortuary. Wear PPE whiletransporting.