Infection control

1. Infection Prevention Control in
COVID-19: Protect the
Protectors
Dr Nikhilesh Menon R
MD DTM&H CIC
EIS (South) Scholar, ICMR-NIE

2. SARS-COV 2
THE ORIGIN

3. Emergence and spread of SARS CoV-
2
 Dec 30, 2019- A cluster of undiagnosed
pneumonia was identified in Wuhan, Hubei
Province, China
 Jan 8, 2020- novel coronavirus (SARS CoV-2)
discovered
 Rapidly spread to other countries like Thailand,
Singapore, USA
 Jan 30, 2020- India reported first case of SARS-
CoV-2
 Mar 11, 2020- WHO declared as pandemic
 Aug 4, 2020,
◦ Globally: Total cases- 18.2M, Total Deaths: 692000
(3.7%)

4. SARS Cov 2- Timeline, Ernakulam
District
 March 7, 2020- First SARS CoV-2 case was reported in
the district
 March 28, 2020- First SARS CoV-2 death in the district
 April 2020- First 25 cases from the district reported
 May 2020- First 100 cases reported
 June 2020- 200 cases reported

5. The Virus
 Enveloped, ssRNA virus belonging to
beta Corona virus family
 IP : Typically 5-6 days (2-14 days)
 Droplet transmission
 Contact transmission

6. Case Definitions
Probable Case of COVID-19*
A person with severe acute respiratory illness (SARI), ILI, +
history of fever and cough requiring admission to hospital, + no
other etiology that fully explains the clinical presentation AND
any one of the following
 A history of travel 14 days prior to symptom onset.
 health care worker in an health care setting providing COVID
care
 person with no travel history developing an unusual/
unexpected clinical course/ sudden deterioration
 A person with ARI and history of exposure
*initial case definitions (January 2020) focussed on Wuhan returnees and later
addendums added as the pandemic evolved.

7. Confirmed Case
A person with laboratory confirmation of COVID- 19
by Real time reverse transcriptase Polymerase
Chain Reaction (rRT-PCR), irrespective of clinical
signs and symptoms
Case definitions
Case definitions as per Govt. of Kerala
guidelines

8. High Risk contact:
 Direct close physical contact with lab confirmed case or
his/her secretions
• Touched body fluids of the patient
• Had direct physical contact including physical examination
without PPE
• Touched or cleaned the linens, clothes, or dishes of the
patient
• Lives in the same household
• Close proximity (within 3 ft) of the confirmed case without
precautions
• Close proximity (within 3 ft) for more than 6 hours ,any kind
of conveyance with a symptomatic person who later tested
positive for COVID-19
Contact definition

9. Low Risk Contact:
 Shared/travelled in the same space, not having a
high risk exposure to a confirmed or suspect case
of COVID-19
 Travelled in same environment
(bus/train/flight/any mode of transit) but not having
a high-risk exposure
Contact definition

10. 2 Jan O5 Jan 26 Jan 01 Feb 12 March 01 April 20 May 05 June 30 June 22 July
Initial Testing
categories, Wuhan
returnees
Follow up testing
positives,revision
Extended to non
Wuhan returnees,
countries other than
China
Addendum. Fever
removed from Cat A Elective surgeries,
migrants with
ILI,antenatal testing,
follow up positive
testing ~7 days
Antigen test
follow up
positives,
discharge
Revised
Comprehensive
guidelines
No testing for Cat A
Risk Based (Cat A,
B,C ) testing
guidelines.
Testing Prisoners,
Parole Included
Follow up testing
positives, 10 days (Cat
A),14 days (Cat B and
C)
Changes in Testing Guidelines,
Jan-June 2020

11. IPC- PROTECTING THE
PROTECTORS

14. IPC-COVID 19
 Standard precautions
 Contact precautions
 Droplet precautions

15. Standard precautions
 Hand hygiene
 Personal protective equipment
 Respiratory hygiene and cough
etiquette
 Environmental cleaning and
disinfection
 Handling of laundry
 Biomedical waste management
 Spill management
 Safety Climate

16. Hand hygiene
 Perform handwash / handrub every 2
hours
(staff and patients) – 2 hrly announcement
 Handrub – routine patient handling and
clinical rounds
 Handwash
- visibly soiled hands
- after exiting restroom
- before handling food and medication

19. SOCIAL DISTANCING
 Infection may be much more than the
cases(80% are asymptomatic)
 Save the old from young
 Keep young away from each other to stop
the spread

20. Social Distancing In a Travel
Setting

21.  Posters at the Entrance, Cover your
Cough posters
 Cover mouth and nose with a tissue when
coughing or sneezing;
 Dispose of the tissue after use in the
nearest waste container;
 Perform hand hygiene after contact with
respiratory secretions and contaminated
objects/materials.
 Masking and Separation of Persons with
Respiratory Symptoms
Respiratory hygiene/Cough
etiquette

22. Respiratory hygiene and cough
etiquette

24. PERSONAL PROTECTIVE
EQUIPMENT
 Use according to type of exposure
- Direct contact with patient – gown,
gloves, goggles/face shield, 3 layer mask
- Aerosol generating procedure
(intubation, suctioning, CPR, collection of
specimen) – gown,gloves, goggles/face
shield, N95 mask
- Buddy system/mirror

28.  Droplet transmission
- mask, social distance
 Contact transmission
- hand hygiene

29. Environmental cleaning and
disinfection
 All cleaning staff should wear adequate PPE
 Isolation ward - Gown, heavy duty gloves,
boots, shoe cover, goggles/face shield , N95
mask
 1% hypochlorite solution (30 gm in 1 litre
water)
 70% alcohol – metal surfaces, sensitive
equipment
 Cleaning followed by disinfection

30. Cleaning
 Clean area to dirty area
 Unidirectional mopping
 Avoid re- dipping of mop
 Change cleaning solution for each
room
 Do not shake mops

31. 3 Bucket system

32. Strategy modification
Strategy General hospital COVID hospital
Bleaching powder
conc.
0.5% 1%
Floor and toilet
cleaning
once a day Thrice a day
High touch areas Once a day 2 hourly
Elevator cleaning Once a day 2 hourly

33. High touch areas (facility
based)
 Telephone
 Bed rails
 Tables, chairs
 Door handles
 Lift
 Light switches
 Wall near the restroom
 Cabinets

35. Elevator – high touch area
 Entry limited to 4 people at a time
 Stand facing away from each other
 Handrub should be placed inside lift
 Checklist
 Role of dedicated staff

39. Handling of laundry
 Place soiled linen in labelled bags or
containers for transport to washing facility
 Minimal agitation
 Disposable sheets and pillow covers
 Disinfection of Cotton sheets
- Soak in 0.5% hypochlorite solution for 30
mins, clean with detergent and water, dry in
sunlight.

40. Disposable bed sheets

41. Biomedical waste
management
 All Covid 19 waste other than food waste
- YELLOW BAG
 Fill only 2/3rds of the bag
 Double bagging
 Label – “Covid 19 waste”, date, ward.
 Food waste treated with bleach and
collected in GREEN BAG

42. BMW contd...
 Waste collected twice daily
 Transported to storage area through
designated route in designated
bins/trolleys
 Record number/ weight of bags
 Clean and disinfect waste collection bins
and storage area daily with 1% bleach
 Daily transport to CBMWTF in
designated vehicles (IMAGE)

43. Activities of Hospital Infection
Control Committee
 Convening of HICC meeting once in a week
 Preparation of SOP on Infection prevention
and control (IPC)
 Regular HIC rounds by Microbiologist
(Infection Control Officer) and Head nurse
(Infection Control Nurse)
 Checklist for cleaning, disinfection and
waste management

46. ACTIVITIES contd…
 Session in regular training programmes.
 Hands on training on hand washing, PPE
donning and doffing.

47. Inpatient setting in a NON
COVID hospital
 Treat all patients as COVID suspects
 Patient education regarding use of mask from
the time of admission followed up in
wards
 One bystander per patient
 Waiting area outside the hospital (OBG and
paediatrics)
 Restrict visiting time

48. IP setting contd…
HCW
 Spend minimum time at the hospital
(duty time only)
 Avoid unneccessary mingling and
wandering among staff
 To avoid mass quarantine if a HCW turns
out positive

49. Out patient setting
 Appropriate PPE – N95 mask / triple
layer mask, faceshield, gloves
 Minimal examination of the patient –
mostly inspection
 Hand hygiene after each patient
 Ensure that the patient is also wearing
mask

50. OP setting contd…
 Token system to avoid crowd
formation
 Adequate security staff to ensure
social distancing
 NCD clinic and Immunisation clinic –
shifted to a different area away from
routine OP/IP

51. Field staff
 Training
 Appropriate PPE – triple layer mask, gloves,
faceshield
 Access to hand hygiene
 Immunisation clinic
- well ventilated area(open doors and
windows)
- Token system (inform parents in advance)
- Ensure social distancing, use of mask
- Hand hygiene after each chilld

52. COVID CARE CENTRES
(CCC)
 Asymptomatic quarantined individuals
 Instructions given at the time of admission
 HCW and support staff– triple layer mask,
gloves
 On call doctor / staff entering CCC to
examine symptomatic patient – N95 mask,
gloves
 Minor complaints can be sorted via phone
 Transport symptomatic individuals via
ambulance to nearest hospital with isolation
facility

53. Summary
 Standard precautions
 SOP
 Checklist
 Review
 Teamwork

54. Thank You