The document provides guidelines for infection control and prevention at Shubham Hospital in Varanasi, India during the COVID-19 pandemic. It outlines standard precautions including hand hygiene, respiratory hygiene, proper use of personal protective equipment (PPE), environmental cleaning and disinfection. Specific recommendations are given for hand hygiene techniques, types of PPE like gloves, masks, gowns and their proper use. Proper procedures for donning and doffing PPE are also described. The document stresses the importance of cleaning and disinfection of high-touch surfaces as well as cleaning procedures, disinfectants and techniques for cleaning floors and using the triple bucket system.

1. Infection Control &Prevention
for nCOVID19
at Shubham Hospital-Varanasi
Prepared by Yogesh rai

2. Infection Prevention & Control

3. Hospital InfectionControl committee, Shubhamhospital-Varanasi, U.P

4. Apply standard precautions for all
patients
Hospital InfectionControl committee, Shubhamhospital-Varanasi, U.P

5. Elements of Standard Precautions
 Hand hygiene
 Respiratory hygiene
 PPE as perrisk
 PPE donning and doffing
 Environment cleaning &disinfection
 Safe handling and cleaning of soiled linen/patient
cloth
 Waste management
Hospital InfectionControl committee, Shubhamhospital-Varanasi, U.P

6. Hand Hygiene

7. WHY is hand hygiene required`?
Hospital InfectionControl committee, Shubhamhospital-Varanasi, U.P
,

8. Why do we need steps of hand
hygiene?
Hospital InfectionControl committee, Shubhamhospital-Varanasi, U.P

9. WHEN do we need to practice hand hygiene?
WHO guidelines on hand hygiene in health care, 2009
Hospital InfectionControl committee, Shubhamhospital-Varanasi, U.P

10. WHICH: Hand wash or hand rub?
Hospital InfectionControl committee, Shubhamhospital-Varanasi, U.P
 Time required (for hand wash 40-60 secs vs. for
hand rub ~20 secs)
 After hand wash- Need towels to wipe
 Location of washbasin- not at point of care
 WHO recommends-for all clinical situations,
preferred use of hand rub if available, except
when hands are soiled (Do Hand wash).

11. Hand wash recommendations:
Hospital InfectionControl committee, Shubhamhospital-Varanasi, U.P
 Hand wash is a must
 After Using PPE
 After taking off thegloves
 When hands are visibly contaminated withblood/body
fluids
 Patients with Clostridium difficileor enteroviral diarrhea
 After using thetoilet
 Before and aftereating

12. Steps of hand rub/Hand wash
Hospital Infection Control Committee, KGMU, Lucknow, U.P
 Remove Jewellery before hand rub/hand wash
 Duration for hand rub: 15-20 seconds
 Duration for hand wash: 40-60 s
 Volume of hand sanitizer: ~ 3 ml
 Volume of soap (medicated): enough to produce
leather
 VERY IMPORTANT: Rub hands together until
dry (for Hand rub)
 Rub all surfaces thoroughly doing 7 steps.

13. Hospital InfectionControl committee, Shubhamhospital-Varanasi, U.P
Steps of Hand rub/ Hand wash

14. When is hand hygiene a must?
 Before
 touching any devices/equipment attached topatient
 Indwelling catheter
 Any otherdrain
 Ventilation equipment
 Drawing a specimen/placing IV line
 After
 All aboveactivities
 After touching door/ almirah handles
 Handling patient chart/monitor
 Touching own nose/mouth/hair
Hospital InfectionControl committee, Shubhamhospital-Varanasi, U.P

15. Respiratory hygiene
Wash hands with soap and water
Avoid patient careareas if you havea respiratoryinfection. Stay home if possible.
Weara maskduring hospital visits.
Hospital InfectionControl committee, Shubhamhospital-Varanasi, U.P

16. Personal Protective Equipment
(PPE)

17. Hospital InfectionControl committee, Shubhamhospital-Varanasi, U.P

18. Gloves: Types and usage
Hospital InfectionControl committee, Shubhamhospital-Varanasi, U.P
 Glovesdoreducedegreeof contaminationof hands (16
CFUs/min to 3 CFU/minof patientcare activities)
 Gloves may be Non-sterile/ sterile, non-powdergloves
(Latex orNitrile).
 Glovesshould alwaysbe inspected beforeuse tocheck
they are intact.
 Caution: Glovesdo NOT mean completeprotection.
Small unnoticed tears may be present/ hand
contaminationcan occurduring gloveremoval.
 Hand hygiene MUST be practiced aftergloveremoval

19. Usage of Mask
 Masks- Use-N 95
 Whenexamining theknownpositivepatient
 Whentaking samples from suspectcases
 Whendoing bacterialculturesof respiratorysamples (
fromCOVID-19 suspected cases) in biosafetycabinets.
 WhendoingRNA extractionin biosafetycabinets
(If N 95 is notavailable usetriplelayeredsurgical mask. Use
triplelayeredforall otherspecimens)
Do not touch front portion of mask with hands while or after
working
 Mask aloneis insufficienttoprovidetheadequatelevel of protection
and other equally relevant measures should be adopted – Hand
hygiene
Hospital InfectionControl committee, Shubhamhospital-Varanasi, U.P

20. GOWN
 Single-uselong-sleevedfluid-resistantor
 Reusable non-fluid-resistantgowns
 Plasticaprons (to beused on non-fluid-
resistantgowns)
 Qualityof gownsdependson-
 Weight in grams per square metre (GSM value)- 40/70/95GSM
 Fabric strength test- tensility & strengthtest
 Seam & joint test- to see if leakage can occur
 Moisture vapour transmissiontest
 Synthetic blood penetration test
Hospital InfectionControl committee, Shubhamhospital-Varanasi, U.P
Cover all gown

21. EYEWEAR
 Gogglesfit the face immediatelysurrounding theeyes
and form a protectiveseal around theeyes.
 This preventsaerosols fromentering underoraround
the goggles.
Hospital InfectionControl committee, Shubhamhospital-Varanasi, U.P

22. Head covers and shoe covers
 Shoeand head covers providea barrieragainstpossible
exposurewithin a contaminated environment.
 They must be fluid resistant & preferablyof the same
material asgown.
Hospital InfectionControl committee, Shubhamhospital-Varanasi, U.P
High shoe covers

23. Hospital InfectionControl committee, Shubhamhospital-Varanasi, U.P

24.  WearScrubsuitor ICU dress beforedonning
 Do a handhygiene
 Select PPE of correctsize
 Alwaysput on PPE beforecontactwith the COVID 19
patient.
 WearPPE only in designated DONNINGarea.
Hospital InfectionControl committee, Shubhamhospital-Varanasi, U.P
Prerequisites before donning PPE

25. Points to remember for PPE
 Alwaysremove PPE aftercompleting the task
 Disinfectthe PPE components beforediscarding
 Neverreuse until instructed (Clean& disinfect before
reuse)
 Change PPE if it has anydefectorgetscontaminated
during procedure.
 Remove carefullyto avoid contamination/infection.
 Do NOTtouch PPE components from frontafter
using.
 Nevertouchyourfaceoranybodypartwhileusing
PPE.
Hospital InfectionControl committee, Shubhamhospital-Varanasi, U.P

26. Wear PPE before suspect/positive patientcare
Putting on (Donning) PPE
Donning PPE
1. Perform hand
hygiene
2. Put onscrub
suit/ICU dress
3. Put onprotective
pants
4. Both Shoecovers
5. Gown
6. Inner pair of gloves
7. Mask
8. Head cover
9. Eyecover
10. Face shield
11. Outer pair ofgloves

27. Putting off (doffing) PPE
Doffing PPE
1. Take out outer pair ofgloves
2. Do hand hygiene over innerpair
gloves with hand rub
3. Remove shoe cover (Disinfect
with 70% alcohol)
4. Do hand hygiene on innerglove
with hand rub
5. Remove face shield/eye cover
(Disinfect with 70%alcohol)
6. Do hand hygiene again on inner
gloves
7. Remove head gear (Disinfect with
70% alcohol)
8. Do hand hygiene again oninner
pair gloves with hand rub
9. Remove gown (Disinfectwith
70% alcohol)
10. Do hand hygiene again oninner
gloves
11. Remove Mask (Disinfectwith
70% alcohol)
12. Remove disposablepants
(Disinfect with 70%alcohol)
13. Remove inner pair of gloves
(Disinfectwith 70% alcohol)
14. Do hand hygiene with hand rub

28. Environment Cleaning

29. Hospital Infection Control committee, KGMU,
Lucknow, U.P

30. Environment & Equipment surfaces
to be cleaned and disinfected daily
Hospital InfectionControl committee, Shubhamhospital-Varanasi, U.P
 Bed rails,
 Bed matress
 I.V pole
 Medicinetrolly
 Monitors
 Ventilator tubings/surfaces
 Keyboard
 Telephonereceivers
 Door handles/knobs
 Stethoscopediaphragm/ othercomponents
 Floor &walls
 Windowsills
 Sisterdesk
 Tablesurfaces
 Almirah handlesand surfaces
 Toiletseatsand its surfaces (including floor and wallsof toilets)
 Toilet taps/ healthfaucets

31. Cleaning of small equipments
Hospital InfectionControl committee, Shubhamhospital-Varanasi, U.P
 Use 70% isopropylalcohol:
 Stethoscope
 BP cuffs
 Rubber stoppers of multi-dosevials
 Small instrument surfaces
 All other surfaces in fever OPD- clean with detergent
and water followed by disinfection with cotton cloth
dipped in 0.5% Sodium Hypochlorite.

32. High-touch surfaces
Hospital InfectionControl committee, Shubhamhospital-Varanasi, U.P
• Surfaces that have frequent contact with hands
• Examples:
Almirah handles
Telephones, call bells, computer keyboards
Light switches, edges of privacycurtains
• Require more frequent cleaning and
disinfection than minimal contact surfaces
• Cleaning and disinfection is to be done daily
and more frequently if the risk of
environmental contamination is higher.

33. Low-touch surfaces
Hospital InfectionControl committee, Shubhamhospital-Varanasi, U.P
• Surfaces that have minimal contactwith hands
• Examples:
 Walls and ceilings
 Mirrors and window sills
• Require cleaning on a regular (but not necessarily
daily) basis
• When soiling orspillsoccur,
• Many low-touchsurfaces may becleaned on a periodic
basis rather than a daily basis if they are also cleaned
when visibly soiled

34. ENVIRONMENT SURFACE CLEANING At Trauma
emergency (includes Beds/ bed mattress /patient
trolly/i.v poles/ medicine trolly/ventilator surfaces/
humidifiers/ monitors/ tubing surfaces
 Surface cleaning has to bedonethreetimes in aday.
 Wear PPE before doing disinfection and cleaningprocedure.
 First clean thoroughly with detergent and water with a clean
cotton gauge piece. Let it dry (if the cloth becomesdirty enough,
change thecloth)
 After drying disinfect with 0.5%hypochlorite orbleaching powder
solution (Several wipesmay be required to disinfect a surface)
 Metal surfaces: Disinfectwith 0.5%hypochlorite or bleaching
powder followed by disinfection with 70% alcohol after 5-10
minutes.
 Floorand wall cleaning and disinfectionare tobedonewith 7.35%
H2O2 and 0.23% peraceticacid.
 Wash your hands with soap and water after doffing PPE.
Hospital InfectionControl committee, Shubhamhospital-Varanasi, U.P

35. OT at Trauma emergency
 Sterilise & disinfect the OTafterevery infected surgery/
COVID suspect/ positivepatientsurgery.
 Do fogging with H2O2 based disinfectant (e.g 7.35% w/v
H2O2 and 0.23% w/v peracetic acid or H2o2 with 0.01%
w/v Silvernitrate IP, 10% w/v Hydrogen Peroxide)
 All surface needs to bedisinfectedproperlywith 0.5%
hypochlorite.
 Wallsand floorare to bedisinfected with 0.5%
hypochlorite/ bleaching powdersolution.
Hospital InfectionControl committee, Shubhamhospital-Varanasi, U.P

36. Hospital Infection Control committee, Shubhamhospital-Varanasi, U.P

37. Hospital InfectionControl committee, Shubhamhospital-Varanasi, U.P

38. Hospital InfectionControl committee, Shubhamhospital-Varanasi, U.P

39. Hospital InfectionControl committee, Shubhamhospital-Varanasi, U.P

40. CAUTION
KINDLY DISINFECT YOUR
SHOE SOLE ON THE DOOR
MAT CONTAINING 1%
HYPOCHLORITE BEFORE
GOING OUTSIDE
BY ORDER
Hospital Infection Control committee, Shubhamhospital-Varanasi,U.P

41.  PPE for Cleaners/ sweepers
includes the following:
Impermeableplasticapron
Gum boots
Disposablemask and caps
Gloves
Eye protectionwherever
required
Hospital InfectionControl committee, Shubhamhospital-Varanasi, U.P

42. Cleaning of floors
Hospital InfectionControl committee, Shubhamhospital-Varanasi, U.P
• 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 box safely
• Use separate mop for different areas (lab area,
corridors, offices)
• DO NOT USE BROOM/VACUUM CLEANERS
• Use dust control mop prior to wetmop
• Do not lift dust mop off the floor use swivel
motion, never shake the mop, minimize
turbulence.

43.  Progress from the least soiled areas (low-touch) to
the most soiled areas (high-touch) and from high
surfaces to low surfaces
 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 the solution
 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
Hospital InfectionControl committee, Shubhamhospital-Varanasi, U.P

44. Mopping Floors using WetMop
and Bucket
Hospital Infection Control committee, Shubham hospital-Varanasi, U.P
• Prepare fresh cleaning solution
• Place ‘wet floor’ caution sign outside of room
or area being mopped
• Divide the area intosections
•Immerse mop in cleaning solution andwring
out
• Push mop around paying particular attention
to removing soil from corners; avoid splashing
walls orfurniture

45. Mopping Floors using Wet Mop and
Bucket
Hospital Infection Control committee, Shubham hospital-Varanasi, U.P
• Use “figure of eight” strokes in open andwide
spaces- overlapping each stroke; turn mop
head over every five or sixstrokes
• For small spaces, start in the farthest corner of
the room, drag the mop toward you, thenpush
it away
• Work in straight, slightly overlapping lines and
keep the mop head in full contact withthe
floor
• Repeat until entire floor isdone
• Change the mop head as perprotocol

46. Figure of eight stroke technique for mopping
Reference: National Guidelines for Clean Hospitals; Ministry Of Health And Family Welfare Government
Of India 2015
Hospital Infection Control committee, Shubham hospital-Varanasi, U.P

47. Triple bucket system
• Floorcleaning
• Procedure for washing, rinsing, and sanitizing where a
different bucket and sponge or mop is used foreach task
• Forwashing:
 First bucket with water and detergent is used only for this
purpose and will not be used forrinsing or sanitizing
• ForRinsing:
 Second bucket with water only, will be used solely forthis
purpose.
• A third bucket:
 Containing water and a disinfectant solution shall be usedfor
disinfection only
Hospital Infection Control committee, Shubham hospital-Varanasi, U.P

48. Water + detergent Only water Water + disinfectant
Mopping Floors using Wet Mopand
Bucket
Hospital Infection Control committee, Shubham hospital-Varanasi, U.P

49. Triple bucket system
Hospital Infection Control committee, Shubham hospital-Varanasi, U.P

50. Disinfecting Ambulance
Hospital Infection Control committee, Shubham hospital-Varanasi, U.P
 Driverof ambulance mustwearpersonal protective
equipment(PPE)
 patientand attendantshould be providedwith triple-
layer mask andgloves
 Disinfectall surfaceswithin ambulancewith detergent
and water followed by 1% hypochlorite solution. (and
all metal surfaces to be also disinfected with 70%
alcohol after usinghypochlorite)
 Disinfect the floorof ambulancewith 1 % hypochlorite
solution

51. After cleaning
• If disposablepadsare used- discard them in yellowbag
• Aftercleaning, wash the cloth with detergentand sun
dry
• Launder mop headsdaily
• Allwashed mop heads must bedried thoroughly
beforere-use.
• Cleansanitationcartand carts used to transport
biomedical wastedaily.
• Allattachments of machines should beremoved,
emptied,cleaned and dried beforestoring.
Hospital Infection Control committee, Shubham hospital-Varanasi, U.P

52. Laundry / cleaning and
disinfection of isolation room
after patient discharge

53. Laundring patient clothes
Hospital Infection Control committee, Shubham hospital-Varanasi, U.P
 Place soiled cloths in designated container forlaundering
 Do not shake theclothes
 Patient clothes laundry is to be done by dipping in 0.5%
hypochlorite solution for 30 minutes followed bywashing
with detergent and hot water (70oC)
 Or the patient maydispose clothes inyellow bins for
incineration

54. Hospital Infection Control committee, Shubham hospital-Varanasi, U.P

55. Cleaning and disinfection ofisolation
room when patient is discharged
Hospital Infection Control committee, Shubham hospital-Varanasi, U.P
 Tobe done same as describedabove
 Fogging with 7.35 % H2O2 + 0.23% Peroxyacetic acid is to
be done.
 Ask the patient to take bath with soap and waterand wear
clean clothes.
 Launder ordispose patient old clothes as described
previously.
 Patient belongings such as mobile/ laptop surfaces needs
to be disinfected with accelerated H2O2 wipes for 1minute
thoroughly. Followed by disinfection with spirit swab. Dry
and handle them topatient.

56. Biomedical Waste Disposal

57. Gloves in Yellow
at isolation ward only
All patient food waste
at isolation ward
Hospital Infection Control committee, Shubham hospital-Varanasi, U.P

58. All Plastic waste (food plastic
/water bottles at
quarantine/isolation ward
Hospital Infection Control committee, Shubham hospital-Varanasi, U.P

59. Hospital Infection Control committee, Shubham hospital-Varanasi, U.P

60. Hospital Infection Control committee, Shubham hospital-Varanasi, U.P

61. Black Bin
 Only in quarantine area/ officearea/ trauma
emergency area.
 Treat the non infected routine waste as general solid
wasteand disposeto local municipal as perSWM rule,
2016.
Hospital Infection Control committee, Shubham hospital-Varanasi, U.P

62. Labelling of Waste
Hospital Infection Control committee, Shubham hospital-Varanasi, U.P
 Allwaste has to be in double layered medical waste
bags.
 Label the wasteas COVID-19waste
 Spray 0.5%hypochlorite to decontaminate outer
surface

63. Hospital Infection Control committee, Shubham hospital-Varanasi, U.P

64. Spill Management
Hospital Infection Control committee, Shubham hospital-Varanasi, U.P
 Coverthe spill withabsorbentcotton oracloth.
 Disinfect the surfacewith 10% bleach for 10-15
minutes.
 Now use cloth orcotton toabsorbthe spill
 Collectthe spillwith scoopand discard it in the
yellow/ red bag.
 Finallymopwith detergent and water.

65. Hypochlorite solution and Bleach
preparation for floor &wall disinfection
Hospital Infection Control committee, Shubham hospital-Varanasi, U.P
 1% Bleachingpowder solution-
 Prepare 33 gms of bleaching powder (bleaching powder
with 30% strength) in 1 litre of water.
 1% Hypochloritesolution- For instrumentand
bench and smallspill
 Prepare by mixing 200 ml (of 5% availablechlorine
hypochlorite ) in 800 ml of water.

66. Hypochlorite solution and Bleach preparation
for surface disinfection
Hospital Infection Control committee, Shubham hospital-Varanasi, U.P
 0.5% Bleaching powdersolution- For instrument
and bench and smallspill
 Prepare 16 gms of bleaching powder (bleaching powder
with 30% strength) in 1 litre of water.
 0.5% Hypochloritesolution- For instrumentand
bench and smallspill
 Prepare by mixing 100 ml (of 5% availablechlorine
hypochlorite ) in 900 ml of water.

67. Handling dead bodies
Hospital Infection Control committee, Shubham hospital-Varanasi, U.P
 Fillall openingsof dead bodywith cotton ballsor
gaugedipped in 1% hypochlorite.
 Removeall tubingsand discard in appropriatebin.
 Wrapthe bodywith doublelayercloth soaked in 1%
hypochlorite
 Wrapagain in leak proof wrapping sheet.
 Disinfect the surfacewith 1% hypochlorite.
 Transfer the body throughseparate passage to
mortuary. WearPPE whiletransporting.

68. Hospital Infection Control committee, Shubham hospital-Varanasi, U.P