Covid-19

Concept Document

B P Koirala Institute of Health Sciences

• The concept document is the outcome of rigorous discussion of the Rapid Response Team with other
different departments as well as the inputs from the members of the BPKIHS community. The
information, knowledge on such a novel topic is rapidly changing and thus the document will be
regularly updated. Thus, we request all our esteemed faculties and staff to guide the necessary
changes and suggest/advise/inform/update the RRT of any new ideas/protocols. (Email:
covidrrt@bpkihs.edu)
• These are suggestions/concepts given by the RRT and not necessarily the endorsement of the
Hospital Administration.
CONTENTS

1. Covid-19 Helpline and Department Numbers

2. Screening Algorithm

3. Case Definitions

4. Lab Diagnosis

5. Pediatrics Algorithm and Peculiarities in Children

6. Overview of Personnel Deputation

7. HealthCare Personnel deputation for designated areas

8. Screening Desk: Overview of Responsibilities

9. Fever Clinic: Overview of Responsibilities

10. Isolation Ward: Overview of Responsibilities

11. Guide to Personal Protection to be Provided as per exposure at work

12. Guidance on Putting on (Donning) and Removing (Doffing) PPE

13. Disinfection Procedures of contaminated floors, walls and objects

14. Dealing with Infectious Fabrics

15. Disposal Procedures for COVID-19 Related Medical Waste

16. Procedures for Taking Remedial Actions against Occupational Exposure to COVID-19

17. Procedures for Handling Bodies of Deceased Suspected or Confirmed Patients

18. References
 1. Covid-19 Helpline and Departmental Numbers

The numbers included are of those Department running OPD. These numbers have been made public so that
people can take consultation/make enquiries and follow up for usual issues on the phone.

Department Phone Number

Corona Virus Disease Helpline (Covid-19) 9802795252
9802795349
Dental 9805316730
Pediatrics and Adolescent Medicine 9802796316
9802795317
9802795305
9802795343
Dermatology 9805316791
General Practice and Emergency Medicine 9805316706
Psychiatry 9805316785
Orthopedics 9805316705
Surgery 9805316709
ENT 9805316703
Internal Medicine 9805316725
Cardiology 9805316816
Ophthalmology 9805316829
Obstetrics and Gynecology 9805316834
Pulmonary, Critical Care and Sleep Medicine 9805316825
Gastroenterology and Hepatology 9805316733
 2. Screening Algorithm
Working SOP/ Protocol for Adult patients (Age > 14 years) in BPKIHS for COVID-19

History of any one of the followings;

1) Fever
2) Respiratory symptoms (Cough, running
nose, shortness of breath, throat pain)

Screening Desk

1) History of travel<14 days from affected

YES countries NO
2) Contact history with confirmed COVID-19
patients
3) Family member returned from abroad in the
past 2 weeks

Asymptomatic Symptomatic Symptomatic + ADMISSION CRITERIA Fever Clinic

cc 1) Low blood pressure (MAP<65 mm Hg)
2) Dyspnea/ cyanosis
3) Falling oxygen saturation (Spo2< 90%)
4) Age > 60 yrs
5) Medical / Surgical / Psychiatric / Obstetrical /
Dental Emergency
6) Co morbidities
DM; CKD; CVD; HIV; Ch Lung Dzz;
Immunosuppressants; CLD

Home Self-Isolation / Admission in ISOLATION WARD Usual Mgmt

Quarantine Isolation & +
facility (Tandi) Swab Collection Self-Isolaton

NOTE:
Help desk outside GOPD (8 am to 5 pm); Help desk outside isolation ward (5pm to 8 am)
Fever clinic (9 AM to 2 PM)
Protocol/ SOP might change later as per availability of resources in BPKIHS
 3. Case Definitions

Suspected Case

Any patient with acute respiratory illness with ANY OF THE FOLLOWING:

1. A history of travel abroad in the 14 days prior to symptom onset or has a family member who has
returned from abroad in the last 14 days,

2. Close contact with a confirmed/ suspected case of 2019-nCoV in the 14 days prior to symptom
onset,

Healthcare worker taking care of confirmed/ suspected patients of 2019-nCoV

Close contact
Close contact is defined as:

● Healthcare associated exposure, visiting patients or staying in the same close environment as a
Covid-19 patient.
● Working together in close proximity or living in the same household with a Covid-19 patient.
● Travelling together with a Covid-19 patient in any kind of conveyance

The epidemiological link may have occurred within a 14‐day period before or after the onset of illness in
the case under consideration.

Probable case

A suspected case for whom testing for Covid-19 is inconclusive (the result of the test reported by the
laboratory).

Confirmed case

A person with laboratory confirmation of 2019-nCoV infection, irrespective of clinical signs and
symptoms

Clinical Features
The clinical and radiological manifestations of Covid-19 include:
● Fever (83%)
● Cough (82%)
● Shortness of breath (31%)
● Sore throat (5%)
● Rhinorrhoea (4%)
● Diarrhea (2%)
● ARDS (10-17% of admitted patients)
 4. Laboratory Diagnosis

4a. Whom to test:

a) For all Suspected cases with history of travel abroad and who exhibit symptoms, Nasopharyngeal
and Oro-pharyngeal swab is to be collected. (only for symptomatic patients admitted in Isolation
for now)

4b. Sample collection

General Guidelines

● Trained health care professionals to wear appropriate personal protective. Maintain proper
infection control when collecting specimens.

● Restricted entry to visitors or attenders during sample collection.

● Specimens should be collected as soon as possible once a suspected case is identified regardless of
time of symptom onset.

● It is recommended that testing of multiple clinical specimens from different sites, including two
specimen types—lower respiratory and upper respiratory must be done.

● Once collected, the Hospital Administration need to be informed for transport of sample to
Kathmandu for testing.

● Label each specimen container with the patient’s Hospital ID number, name, specimen type and the
date the sample was collected.
● Complete the requisition form for each specimen submitted (to be filled by Doctor on Duty).

● Proper disposal of all waste generated

4c. Nasopharyngeal swab AND oropharyngeal swab (NP/OP swab)

Nasopharyngeal swab: Tilt patient’s head back 70 degrees. Insert flexible swab through the
nares parallel to the palate (not upwards) until resistance is encountered or the distance is
equivalent to that from the ear to the nostril of the patient. Gently, rub and roll the swab. Leave the
swab in place for several seconds to absorb secretions before removing.

Oropharyngeal swab (e.g., throat swab): Tilt patient’s head back 70 degrees. Rub swab over both tonsillar
pillars and posterior oropharynx and avoid touching the tongue, teeth, and gums.

Use only synthetic fiber swabs with plastic shafts.

Place both NP and OP specimens in one VTM or UTM.
 5. Pediatrics Algorithm

1. Travel History from affected countries within 14 days outside Nepal, OR,
Close contact with a suspected or confirmed case of COVID 19, OR,
neonate born to a mother with confirmed CoVID-19
+
2. Any one of the following
a. Fever
b. Cough / running nose
c. Fast breathing

No Yes

Self / Home Isolation Admission criteria in Pediatric isolation ward, if any One of the
outside BPKIHS & following:
Telephonic follow up • Child with severe pneumonia
• General Danger signs (inability to breastfeed or drink,
Vomits out everything the child drinks, lethargy or
unconsciousness, or convulsions)
• Low Blood Pressure (Feeble, thready pulse with low pulse
volume, prolonged capillary refill time for more than 3 sec
or blood pressure < 5th centile for age, gender and height)
No • Sign and symptoms of respiratory distress including any
one of Fast breathing, nasal flaring, grunting and Chest
retractions
Self / Home Isolation • Cyanosis, falling oxygen saturation (SPo2 <90%)
outside BPKIHS & • Neonate born to a mother with confirmed CoVID 19 (The
Telephonic follow up admission criteria will subject to clinical condition of the
neonate)
• Presence of Co-morbidities (Diabetes mellitus, Congenital
Heart diseases, Chronic Kidney disease, HIV/AIDS, Chronic
Respiratory disease, Blood dyscrasias, Malnutrition, child
on steroids or immunosuppresants)
Note: Admitting the child will depend on the paediatrician’s
clinical judgement and discretion.

Yes

Admit in Pediatric
*Swab Collection as per availability of Resources Isolation ward &
*Algorithm to change as per evidence/resources Swab collection BPKIHS
5a. Peculiarities in Children

The clinical features of children are almost similar to that of adults except a few peculiarities. Children may
present with any of the following features:

1. Mild illness (upper respiratory tract infection): fever, fatigue, cough (with or without sputum
production), anorexia, malaise, muscle pain, sore throat, dyspnea, nasal congestion, or headache.
Rarely, patients may also present with diarrhea, nausea, and vomiting.

2. Pneumonia: Child with pneumonia who has cough or difficulty breathing plus fast breathing.
Fast breathing (in breaths/min) is defined as:
< 2 months: ≥ 60 breaths/ minute
2–11 months: ≥ 50 breaths/ minute
1–5 years: ≥ 40 breaths/ minute AND
no signs of severe pneumonia.

3. Severe pneumonia:
Adolescents: fever or suspected respiratory infection, plus one of the following:
1. Respiratory rate > 30 breaths/min
2. Severe respiratory distress; or SpO2 ≤ 93% on room air.
Child with cough or difficulty in breathing, plus at least one of the following:
a. central cyanosis or SpO2 < 90%
b. severe respiratory distress (e.g. grunting, very severe chest indrawing)
c. signs of pneumonia with a general danger sign: inability to breastfeed or drink, lethargy or
unconsciousness, or convulsions.

Other signs of pneumonia may be present: chest indrawing, fast breathing (in breaths/min): < 2
months: ≥ 60; 2–11 months: ≥ 50; 1–5 years: ≥ 40. While the diagnosis is made on clinical grounds;
chest imaging may identify or exclude some pulmonary complications.
6. Overview of Personnel Deputation

a. Each and every Department in the institute including Hospital Administration, Medical and General
Store, Procurement, Computer section, Canteens and Essential supplies outlets and others in the
Institute will make 3 groups of personnel. Among these, at any one time, one group of personnel
will be posted for Corona related direct work whereas the other two teams will be on backup. For
the same, it is suggested that the groups be changed at an interval of 7 days. However, it is left upon
the discretion of the individual department to decide on the duration. The decision needs to be
conveyed to the Hospital Administration.

b. For families with more than one person working in the institute, it is suggested that only one
member be directly employed in Corona related activities.

c. It is strongly suggested that every personnel involved in the Corona virus response be given
incentive and the same needs to be decided by the Executives and conveyed at the earliest as
recommended in the government directive.

d. It is suggested that the GUEST HOUSE be used to house the personnel involved in direct Corona
related Corona activities. The same to be prioritized according to the level of exposure. The
complete quarantine of these members is to be enforced strictly by the security team.

e. For Symptomatic Healthcare personnel and family members, it is suggested that the empty rooms in
Nirvana be utilized.
7. Health Care Personnel deputation for designated areas

1. Covid-19 Screening Desk

Doctors: 1 (To be posted as per roster taken out by Hospital Director’s Office)
Nurses: 1 (As designated by Matron)
Health Aid: 1 (As designated by Hospital Director’s Office)
Security Personnel: 1 (As designated by Hospital Director’s Office)

2. Fever Clinic

Doctors: 4 (To be posted as per roster taken out by Hospital Director’s Office)
Nurses: 1 (As designated by Matron)
Health Aid: 1 (As designated by Hospital Director’s Office)
Security Personnel: 1 (As designated by Hospital Director’s Office)

3. Isolation Ward

Doctors: 2 (To be posted as per roster taken out by Hospital Director’s Office over 24 hours)
Nurses: 3 (As designated by Matron over 24 hours)
Health Aid: 3 (As designated by Hospital Director’s Office over 24 hours)
Security Personnel: 2 (As designated by Hospital Director’s Office over 24 hours)

As the scope of Covid-19 evolves, more and more manpower will need to be involved in the screening
and management of these cases.
8. Screening Desk: Overview of Responsibilities

Responsibilities:
a. Give Covid suspected individual a SURGICAL MASK if not wearing a mask.
b. Maintain a log of all suspected cases coming in to the area.
c. Designate health aid to get OPD tickets / ID number for all suspected cases
d. Carry out Screening as per protocol laid out. Please FOCUS on TRAVEL History for now.
e. In case Home Isolation is suggested, please ensure that the Home Isolation Release Contract
form is filled. Please keep the Original Copy for Hospital Record and give the Carbon copy to the
concerned individual.
f. Teach the suspected individual/anyone with URTI features Home Isolation measures as outlined
below.
g. For Home Isolation, the provision of dedicated ambulances has been made for transfer. Please
ensure that suspected cases refrain from using public vehicles.
h. If the Admission criteria is fulfilled, please send to Isolation Ward. Separate dedicated
ambulance is on stand by for the same.
i. In cases of Clinical Confusion, please consult Rapid Response Committee members.
j. In situations of logistical confusion, please refer to Hospital Administration.
k. Please be on duty throughout the designated time.
l. ADEQUATE PROTECTION IS THE RIGHT OF THE PERSONNEL POSTED. Please refer to the Hospital
Administration if you think the Protection provided is NOT ADEQUATE.
m. Please Use Hand Wash and Sanitizers frequently. Hand wash is found to be superior in
disinfection than Sanitizers. Ensure Hand wash for 40-60 seconds and sanitizer use for at least
20 seconds.
n. Use dedicated equipment (e.g. stethoscopes, blood pressure cuffs and thermometers)
o. If equipment needs to be shared among patients, clean and disinfect between each patient use.
p. Please avoid accessory wear and if possible, mobile phone, during duty hours.

Personal Protection to be provided;

1. N95 (to be reused by the same individual. Discard N95 if soiled or contaminated with blood,
respiratory or nasal secretions, or other bodily fluids from patients)
2. Goggles (will be Sterilized and Reused)
3. Surgical Gown (As adequate distance will be maintained between patients and HCP)
4. Disposable Gloves
Average Daily Consumption of N95: 4
8a. Home Isolation / Self-Isolation Measures
• Stay home: (घरमा बस्ने)
o Do not use public transportation, taxis or rideshares.
o Do not go to work, school or other public places.
o Contact the BPKIHS Helpline for any issues

• Limit the number of visitors in your home: (घरमा अरु ब्याक्तिहरुको आवि जावि बंद गने)
o Only have visitors who you must see and keep visits short.

• At HOME Avoid contact with others: (घरमा पनन अरु ब्यक्ति हरु संग 2 meter को दरु ी राख्ने र घरमा ब्रिध र
दीघघकालीन रोगी हरु छन भने सतदो नक्जक नपने)
o Stay in a separate room away from other people in your home as much as possible and use a
separate bathroom if you have one.
o Make sure that any shared rooms have good airflow (e.g., open windows).
o Keep away from seniors and people with chronic medical conditions (e.g., diabetes, lung
problems, weakened immune system)
o Use separate toilet and bathroom if possible

• Keep distance:
o If you are in a room with other people, keep a distance of at least two meters from others and
wear a mask that covers your nose and mouth.
o If you cannot wear a mask, people should wear a mask when they are in the same room as you.

• Cover your coughs and sneezes: (खोतदा या ह्यातछु गदघ कुहहनाले छोपेर गने)
o Cover your mouth and nose with a tissue when you cough or sneeze.
o Cough or sneeze into your upper sleeve or elbow, not your hand.
o Throw used tissues in a lined wastebasket and wash your hands. Lining the wastebasket with a
plastic bag makes waste disposal easier and safer.
o Wash your hands after emptying the wastebasket.

• Wash your hands: (बारम्बार हाि धुनें)

o Wash your hands often with soap and water for at least 20 seconds every time
o Keep a separate towel for personal use
o Use an alcohol-based hand sanitizer if soap and water are not available.

• Wear a mask over your nose and mouth: (एतलै आफ्नो कोठा मााँ हुदा बाहे क सधै मास्क लाउने)
o Wear a mask if you must leave your house to see a health care provider.
 o Wear a mask when you are within two metres of other people.

Household cleaning and disinfection (घरको सर-सफाई गने)

• Clean all “high-touch” areas such as counters, toilets, sink tap handles, tabletops, doorknobs, TV
remotes, phones, and bedside tables daily using regular household cleaners.

• Clean more often if surfaces become visibly soiled.

• Clean any surfaces than may have blood, body fluids and/or secretions on them.

• Wear disposable gloves when cleaning surfaces.

• Use a diluted bleach solution (2 teaspoons of bleach to 4 cups of water) or household disinfectant.

Laundry (लुगा धुदा रगि वा खोकी का नछट्टा वा रयाल परे को भएमा अलगै धुन)े

• Clothing and bedclothes can be cleaned using regular laundry soap and water and do not require
separation from other household laundry.

• If clothing or bedding have blood, body fluids and/or secretions, wear disposable gloves while handling
soiled items, remove gloves and wash hands immediately afterwards.

Waste management (फ्यालने फोहोर अलगै Dustbin मा Plastic बेरेर फालने)

• All waste generated can be bagged in a regular plastic bag and disposed of in regular household waste.
Personal waste (such as used tissues) and disposable cleaning cloths can be stored securely within
disposable rubbish bags. These bags should be placed into another bag, tied securely and kept separate
from other waste. This should be put aside for at least 72 hours before being put in your usual external
household waste bin.

When to END Self-Isolation or Home-Isolation?

Self-isolation: If you have been symptomatic, then you may end your self-isolation after 7 days. The 7-day
period starts from the day when you first became ill.

Household isolation: If living with others, then all household members who remain well may end
household-isolation after 14 days. The 14-day period starts from the day illness began in the first person to
become ill. Fourteen days is the incubation period for coronavirus; people who remain well after 14 days are
unlikely to be infectious.

Refer to YOU TUBE Video: Bharat bpkihs virus spread

9. Fever Clinic: Overview of Responsibilities

Responsibilities:
a. Only individual without travel history will be coming to the fever clinic. However, in view of the
probable contact of these individuals with those returning from abroad, please take all
necessary precautions.
b. Usual clinical approach has to be applied to these individuals with routine testing.
c. If the follow up can be done on telephone, please provide them with helpline numbers of the
respective departments.
d. For cases with symptoms of URTI and/or LRTI, please counsel for all steps of self-isolation as
outlined for Covid suspect cases.
e. In situations of logistical confusion, please refer to Hospital Administration
f. Please be on duty throughout the designated time
g. ADEQUATE PROTECTION IS THE RIGHT OF THE PERSONNEL POSTED. Please refer to the Hospital
Administration if you think the Protection provided is NOT ADEQUATE.
h. Use dedicated equipment (e.g. stethoscopes, blood pressure cuffs and thermometers)
i. If equipment needs to be shared among patients, clean and disinfect between each patient use.
j. Please Use Hand Wash and Sanitizers frequently. Hand wash is found to be superior in
disinfection than Sanitizers. Ensure Hand wash for 40-60 seconds and sanitizer use for at least
20 seconds.
k. Please avoid accessory wear and if possible, mobile phone, during duty hours.

Personal Protection to be provided;

1. N95 (to be reused by the same individual. Discard N95 if soiled or contaminated with blood,
respiratory or nasal secretions, or other bodily fluids from patients)
2. Goggles (will be Sterilized and Reused)
3. Surgical Gown
4. Disposable Gloves

Average Daily Consumption of N95: 5

10. Isolation Ward: Overview of Responsibilities

Responsibilities:
a. Routine Clinical Care of the patient.
b. Personal protection steps and steps for donning and doffing of these kits are to be compulsorily
followed. Visual guides on these will be available at the site.
c. In situations of logistical confusion, please refer to Hospital Administration
d. Please be on duty throughout the designated time
e. ADEQUATE PROTECTION IS THE RIGHT OF THE PERSONNEL POSTED. Please refer to the Hospital
Administration if you think the Protection provided is NOT ADEQUATE.
f. Use dedicated equipment (e.g. stethoscopes, blood pressure cuffs and thermometers)
g. If equipment needs to be shared among patients, clean and disinfect between each patient use.
h. Strictly restrict visitor access to patients (Security personnel to ensure this provision)
i. Please Use Hand Wash and Sanitizers frequently. Hand wash is found to be superior in disinfection
than Sanitizers. Ensure Hand wash for 40-60 seconds and sanitizer use for at least 20 seconds.
j. Please avoid accessory wear and if possible, mobile phone, during duty hours.

Personal Protection to be provided;

1. N95 (to be reused by the same individual. Discard N95 if soiled or contaminated with blood,
respiratory or nasal secretions, or other bodily fluids from patients)
2. Goggles + Face Shield (will be Sterilized and Reused)
3. Surgical Gown / PPE gowns as available (As adequate distance will be maintained between patients
and HCP)
4. Disposable Gloves

Average Daily Consumption of N95: 10 (+8 if one Critical Case is on Ventilator)

Average Daily Consumption of PPE: 10 (+8 if one Critical Case is on Ventilator)
11. Guide to Personal Protection to be Provided as per exposure

Protection Level Personal Protection Scope of Application

Disposable Surgical Mask OPDs

Level I Usual work uniform Ward
Soap Water / Sanitizers Routine Care
Hospital Premises
Administration

Disposable Surgical Cap Screening Desk

N95 Fever Clinic
Surgical Gown / Medical Isolation Ward
Protective Gown* Swab Collection
Goggles Laundry
Level II
Disposable Gloves Direct Cleaning of Bio-medical
Soap Water / Sanitizers waste of
suspected patients
Transport Workers involved in
direct
Corona related work

Disposable Surgical Cap Critical Care

N95 Swab Collection
Medical Protective Gown* / Intubation and other aerosol
Level III
Surgical Gown generating
Goggles and Face-shield procedures
Disposable Gloves
Soap Water / Sanitizers

*Medical Protective Gown to be prioritized according to the level of exposure and availability of resources in
BPKIHS
 12. Guidance on Putting on (Donning) and Removing (Doffing) PPE

12a. Putting On (Donning) PPE

Protocol for Donning PPE:

1. Put on special work clothes and work shoes
2. Wash hands
3. Put on disposable surgical cap
4. Put on medical protective mask (N95)
5. Put on inner disposable gloves
6. Put on goggles and protective clothing
7. Put on disposable isolation gown and face shield (if required in the area)
8. Put on outer disposable gloves
12b. Removing (Doffing) PPE

Protocol for Doffing PPE:

1. Wash hands and remove visible bodily fluids/blood contaminants on both hands
2. Replace outer gloves with new gloves
3. Remove disposable gowns / protective clothing along with outer gloves (for gloves and protective
clothing, turn inside out, while rolling them down) (remove the waterproof boot covers with
clothing)
4. Wash hands and remove goggles
5. Wash hands and remove mask
6. Wash hands and remove cap
7. Wash hands and remove inner disposable gloves
8. Wash hands
13. Disinfection Procedures of contaminated floors, walls and objects

13a. Disinfection for Floor and Walls

• Visible dirt to be completely removed before disinfection

• Disinfect the floor and walls with 1000 mg/L chlorine-containing disinfectant through floor
mopping or wiping;
• Make sure that disinfection is conducted for at least 30 minutes;
• Carry out disinfection three times a day and repeat the procedure at any time when there is
contamination.

13b. Disinfection of Object Surfaces

• Visible dirt to be completely removed with detergent and water before disinfection
• Wipe the surfaces of objects with 1000 mg/L chlorine-containing disinfectant or wipes with
effective chlorine; wait for 30 minutes and then rinse with clean water.
• Perform disinfection procedure three times a day (repeat at any time when contamination is
suspected);
• Wipe cleaner regions first, then more contaminated regions: first wipe the object surfaces that
are not frequently touched, and then wipe the object surfaces that are frequently touched.

For spills of a small volume(< 10 ml) of blood/bodily fluids:

Carefully remove the spills with disposable absorbent materials such as gauze, wipes, etc., which
have been soaked in 5000 mg/L chlorine-containing disinfecting solution.

For spills of a large volume(> 10 ml) of blood and bodily fluids:

Completely cover the spill with bleach powder containing water-absorbing ingredients or completely
cover it with disposable water-absorbing materials and then pour a sufficient amount of 10,000
mg/L chlorine-containing disinfectant onto the water-absorbing material (or cover with a dry towel
which will be subjected to high-level disinfection). Leave for at least 30 minutes before carefully
removing the spill.
After removing the spills, disinfect the surfaces of the polluted environment or objects.
The containers that hold the contaminants can be soaked and disinfected with 5,000 mg/L active
chlorine-containing disinfectant for 30 minutes and then cleaned.
The collected pollutants should be disposed of as medical waste.
The used items should be put into double-layer medical waste bags and disposed of as medical
waste. Disinfection Procedures for Infectious Fabrics of Suspected or Confirmed Patients
Commonly used Disinfectants effective against SARS-CoV-2
1. Sodium hypochlorite (1%) or household bleach
2. Ethyl Alcohol (at least 70%)

Recommended Frequency of cleaning

*High Touch surfaces: every 3-4 hours (At least thrice a day)
±Low touch surfaces: once daily

Preparations of 1% sodium hypochlorite from bleaching powder

• 320 grams of bleaching powder in 10 liter of water
or
1 kg bleaching powder in 30 liter of water
• Prepare the solution everyday.
• Leave the solution for at least 10 minutes as contact time.

Particulars Recommended method

Floor Detergent and water &
1% Sodium hypochlorite
Walls± 1% Sodium hypochlorite
Table top, door knobs/handle, bed rails, light Detergent and water
switches, furniture, stair rails and other or
surfaces* 1% Sodium hypochlorite
(70% alcohol on metallic surfaces)
Do not use hypochlorite on metals
Toilet bowl and accessible surfaces 1% Sodium hypochlorite
Taps and other metallic items Detergent and water
14. Dealing with Infectious Fabrics

Includes;
• Clothes, bed sheets, bed covers and pillowcases used by patients;
• Ward area bed curtains;
• Floor towels used for environmental cleaning.

14a. Collection methods

• First, pack the fabrics into a disposable plastic bag and seal the bag;
• Then, pack this bag into another plastic bag, seal the bag with cable ties in a goose neck fashion;
• Attach a special infection label. Send the bag to the laundry room.

14b. Storage and washing

• Infectious fabrics should be separated from other infectious fabrics (non-COVID-19) and washed
in a dedicated washing machine;
• Wash and disinfect these fabrics with chlorine-containing disinfectant at 90 °c for at least 30
minutes.

14c. Disinfection of transport tools

• Dedicated transport tools should be used specifically for transporting infectious fabrics;
• The tools shall be disinfected immediately each time after being used for transporting infectious
fabrics;
• The transport tools should be wiped with chlorine-containing disinfectant (with 1000 mg/L
active chlorine). Leave disinfectant for 30 minutes before wiping the tools clean with clean
water.
15. Disposal Procedures for COVID-19 Related Medical Waste

• All waste generated from suspected or confirmed patients shall be disposed of as medical

waste;

• Put the medical waste into a double-layer medical waste bag, seal the bag with cable ties in a

gooseneck fashion and spray the bag with 1000 mg/L chlorine containing disinfectant;

• Put sharp objects into a special plastic box, seal the box and spray the box with 1000 mg/L

chlorine-containing disinfectant;

• Put the bagged waste into a medical waste transfer box, attach a special infection label, fully

enclose the box and transfer it;

• Transfer the waste to a temporary storage point for medical waste along a specified route at a

fixed time point and store the waste separately at a fixed location;

• The medical waste shall be disposed off in the incinerator.

16. Procedures for Taking Remedial Actions against Occupational Exposure to COVID-19

• Skin exposure (directly contaminated by a large amount of visible bodily fluids, blood, secretions or
fecal matter from the patient): Remove the contaminants with clean tissue or gauze, then apply 75%
alcohol to the skin and let the solution sit for 3 minutes followed by thoroughly flushing with
running water.

• Mucous membrane exposure: Flush with plenty of Normal Saline for disinfection.

• Sharp object injury (Piercing of the body by sharp objects that were directly exposed to the patient's
bodily fluids, blood, secretions or fecal matter): Flush the wound with running water and disinfect
with 75% alcohol.

• Direct exposure of respiratory tract (Falling off of a mask, exposing the mouth or nose to a
confirmed patient (1 meter away) who is not wearing a mask): Immediately leave the isolation area.
Gargle with plenty of Normal Saline. Dip a cotton swab into 75% Alcohol and wipe the nasal cavity
gently in circular motion.
17. Procedures for Handling Bodies of Deceased Suspected or Confirmed Patients

• Staff PPE: The staff must make sure they are fully protected by wearing work clothes, disposable
surgical caps, disposable gloves and thick rubber gloves with long sleeves, medical disposable
protective clothing, medical protective masks (N95), protective face shields, work shoes or rubber
boots, waterproof boot covers, waterproof aprons or waterproof isolation gowns, etc.

• Corpse care: Fill all openings or wounds the patient may have, such as mouth, nose, ears, anus and
tracheotomy openings, by using cotton balls or gauze dipped in 3000-5000 mg/L chlorine-containing
disinfectant.

• Wrapping: Wrap the corpse with a double-layer cloth sheet soaked with disinfectant, and pack it
into a double-layer, sealed, leak-proof palstic sheet soaked with chlorine containing disinfectant.

• The body shall be transferred by the staff in the isolation ward directly to a specified location for
cremation by a special vehicle as soon as possible.

• Final disinfection: Perform final disinfection of the ward and the elevator.
18. References

1. Handbook of Covid-19 Prevention and Treatment. The first affiliated hospital, Zhejiang
University School of Medicine
2. AIIMS Protocol on Covid-19
3. CDC. Recommended Guidance for Extended Use and Limited Reuse of N95 Filtering
Facepiece Respirators in Healthcare Settings
4. WHO-Clinical management of severe acute respiratory infection (SARI) when COVID-19
disease is suspected: Interim guidance-13 March 2020.
5. Paediatric intensive Care Society, Paediatric Critical Care Covid-19 Guidance
6. Qi Lu, Yuan Shi. Coronavirus disease (COVID‐19) and neonate: What neonatologist need to
know. J Med Virol. 2020;1–4.