2.third Wave Covid Tot-5-Micro-Infection Prevention & Control

THIRD WAVE COVID TOT-5-MICRO
Infection Prevention and Control, Biomedical Waste

Management, Sample Collection
www.gujhealth.gujarat.gov.in Health & Family Welfare Dept, Govt of Gujarat 1

WHO is at Risk?
www.gujhealth.gujarat.gov.in Health & Family Welfare Dept, Govt of 2

Advantages of IPC

IPC Goals in Outbreak Preparedness
• To reduce transmission of healthcare associated infections

• To enhance the safety of staff, patients and visitors
• To enhance the ability of the organization/health facility to respond to an
outbreak
• To lower or reduce the risk of the hospital (health care facility) itself
amplifying the outbreak

Modes of transmission of Covid-19
• Primarily transmitted through respiratory droplets(e.g. coughing/sneezing)
and contact routes
• Transmission may also occur through fomites
• Airborne transmission may be possible in specific circumstances in which

procedures or support treatments that generate aerosols are performed e.g.
endotracheal incubation, open suctioning, manual ventilation before intubation,
non-invasive positive pressure ventilation, tracheostomy, and cardiopulmonary
resuscitation.

Strategies for preventing/limiting spread of
COVID-19
• Applying standard precautions for all patients at all times

• Ensuring triage, early recognition and source control

• Implementing empiric additional precautions for suspected cases of COVID-19 infection

• Implementing administrative controls

• Implementing environmental and engineering controls

Elements of Standard Precautions
• Hand hygiene
• Respiratory hygiene (cough etiquette)
• PPE according to the risk
• Safe injection practices, sharps management and injury prevention
• Safe handling, cleaning and disinfection of patient care equipment
• Environmental cleaning
• Safe handling and cleaning of soiled linen
• Waste management

Control at the source
• The first priority is control at the source of infection – the patient
• A patient should cover mouth and nose, if possible with a mask or scarf, when in close
contact with other people
• During a pandemic, give a surgical or procedure mask to all patients presenting to

health facilities with fever/acute respiratory symptoms (cough or shortness of breath)
• Masks do not need to be used by patients when they are alone!

Distancing and separation
• In the home, distance/separate the sick person from those who are well as much as
possible
• In health facilities, separate patients with respiratory symptoms from others
• Ensure separate waiting areas for patients with respiratory symptoms
• Maximise distance between beds

Preventing infection at home
(What the ill person should do)
• Cover mouth and nose, if possible with a tightly-fitting mask or scarf, when in close
contact with other people

• distance/separate themselves from those who are well as much as possible

• Avoid close contact with uninfected people for at least 7 days after the beginning of
symptoms

• Ensure proper hand hygiene

Hand Hygiene
• Best way to prevent the spread of germs in the health care setting and community
• Our hands are our main tool for work as health care workers- and they are the key link
in the chain of transmission
• Use appropriate product and technique
• Soap and water
• Wash hands for 40–60 seconds!
• Alcohol-based hand rub when tap and running water is not available
• Rub hands for 20–30 seconds!
When hands are visibly dirty or contaminated with proteinaceous material, always use
soap, running water and single use towel


Hand Hygiene: WHO Five moments

Steps of Hand wash
SUMANKE

Respiratory hygiene (cough etiquette)
• All persons with signs and symptoms of a respiratory infection
(regardless of presumed cause) must follow respiratory hygiene/cough
etiquette
• Cover nose and mouth with tissue when coughing or sneezing
• Dispose of tissues in the nearest waste receptacle after use immediately
• Perform hand hygiene after contact with respiratory secretions and contaminated
objects/materials
• In absence of tissue/handkerchief patient to be instructed to cover their nose and
mouth with arm with elbows flexed during coughing/sneezing
• Do not spit here and there


PPE for use in health care for COVID-19

Principles of PPE Use
• Always perform hand hygiene before and after wearing PPE

• PPE should be available where and when indicated
• according to risk
• in the correct size
• Always put PPE on before contact with the patient
• Remove PPE immediately after completing the task and/or leaving the patient care area
• Never touch your face while wearing PPE
• Clean and disinfect reusable PPE between each use

Preventing infection in healthcare facilities (Key principles)
• Distancing / separation / restriction of movement and of visitors

• PPE: gloves, gowns, masks, eye-protection
• Hand hygiene
• Cleaning, disinfection and sterilization
• Waste management
• Staff health management: Exposure prophylaxis, health monitoring
• Discharge of patients
• Care of the deceased

Preventing infection in healthcare facilities
• During a pandemic, all patients coming to health facilities with fever +

acute respiratory symptoms (cough or shortness of breath) must wear a
tightly-fitting mask or scarf whilst in waiting areas
• Anyone in close contact with patients (1metre or less) must also wear a
tightly-fitting mask or scarf .

Preventing infection in healthcare facilities (Indoor ward )
• The inpatient ward for patients with suspected covid-19 must be

separate from other inpatient wards
• Ensure capacity for rapid expansion of an overflow area if there
is large increase in number of patients
• If not possible, head-to-toe positioning to maximize separation
between patients' heads

Preventing infection in healthcare facilities
(Indoor ward)
• Restrict access, limit visitors

• Minimize the number of entries and exits to the respiratory inpatient ward.
• 8-hour shift limit for health-care workers on duty in the respiratory
inpatient ward.
• Doors closed, If possible, open windows to encourage air flow from room.
• Wear PPE in Donning room
• Used PPE discard in Doffing room
• Keep ward free of excessive equipment or furniture

Hospital admission and Patient Placement
• Place patients with COVID-19 infection in

single well ventilated room when possible
Timely and • If single isolation rooms not possible
effective Admit patients
triage and to dedicated • Keep patients in well ventilated wards
infection area
control
• Cohort patients with the same diagnosis
in one area/ward
• Do not place suspect/ confirmed COVID-
Specific case 19 patients in same area/ward as those
Safe transport and clinical
and discharge management who are confirmed
home protocols
• Assign trained and experienced healthcare
workers.

Environmental Cleaning and Disinfection

Environmental Decontamination
• COVID-19 virus can potentially survive in the environment for several

hours/days
• Premises and areas potentially contaminated with the virus to be cleaned
before their re-use
• Products containing antimicrobial agents known to be effective against
coronaviruses may be used
• Established cleaning strategies to be used
• Remove the majority of bioburden
• Disinfect equipment and environmental surfaces

Environmental Decontamination
• Housekeeping surfaces can be divided into two groups

• Those with minimal hand contact (e.g. floors and ceilings)
• “High touch surfaces” – those with frequent hand-contact
• High touch housekeeping surfaces in patient-care areas should be cleaned and
disinfected more frequently
• Doorknobs
• Bedrails
• Light switches
• Wall areas around the toilet in the patient’s room
• Edges of privacy curtains

Cleaning and Disinfection of Medical Equipment
• Wear gloves when handling and transporting used patient care

equipment
• Before removing equipment from patients room, medical equipment
must be disinfected
• Non-critical medical equipment:
• Usually only require cleansing followed by low- to intermediate-level
disinfection, depending on the nature and degree of contamination
• E.g., stethoscopes, blood pressure cuffs, equipment knobs and controls
Cleaning and Disinfection of Medical
Equipment
Area/Items Inputs Process Method/ procedure
Alcohol-based o Should be cleaned with detergent and water
Stethoscope rub/Spirit swab Cleaning
o Should be wiped with alcohol based rub/spirit swab before each patient contact
Washing
BP cuffs & covers Detergent Hot water o Cuffs should be wiped with alcohol- based disinfectant and regular laundering is
recommended for the cover
Detergent and water o Should be stored dry in individual holder

Alcohol rub o Clean with detergent and tepid water and wipe with alcohol rub in
Thermometer Cleaning between patient use
Individual thermometer holder
o Store in individual holder inverted
o Preferably one thermometer for each patient
Detergent and water Duster
Injection and Disinfectant o To be cleaned daily with detergent and water
dressing trolley Cleaning o After each use should be wiped with disinfectant
(70% alcohol)

Cleaning soiled bedding, towels and clothes
from patients with COVID-19
Clean laundry and surfaces in all environments where COVID-19 cases

receive care at least once a day and when a patient is discharged
• Hospital disinfectants:
• 70% ethyl alcohol for small areas – reusable dedicated equipment
(e.g., thermometers)
• Sodium hypochlorite at 0.5% (equivalent 5000 ppm) for surface disinfection
• Staff dealing with soiled bedding, towels and clothes from COVID-19 patients
should
• Wear appropriate PPE – heavy duty gloves, mask, eye protection (goggles/face shield),
long-sleeved gown, apron (if gown is not fluid resistant), and boots or closed shoes
• Never carry soiled linen against body; place soiled linen in a leak-proof bag or bucket
• Perform hand hygiene after blood/body fluid exposure and after PPE removal

Cleaning soiled bedding, towels and clothes from
patients with COVID-19
Soiled linen should be placed in clearly labelled, leak-proof bags or containers,

carefully removing any solid excrement and putting in covered bucket to dispose of in
the toilet
• Washing machine
• Wash at 60-90°C with laundry detergent followed by soaking in 0.1% chlorine for
approximately 30 minutes and dried
• Non machine washing
• Soaked in hot water with soap/detergent in a large drum
• Use a stick to stir and avoid splashing
• Empty the drum and soak linen in 0.1% chlorine for approx. 30 minutes
• Rinse with clean water and let linens dry fully in the sunlight

Cleaning and Disinfection of Occupied Patient
Rooms
• Designate specific well-trained staff for cleaning environmental surfaces

• Cleaning personnel should wear PPE and must be trained on proper use
of PPE and hand hygiene
• Define the scope of cleaning to be done each day
• Use a checklist to promote accountability for cleaning responsibilities
• Keep cleaning supplies outside the patient room
Cleaning of Housekeeping Surfaces and Eating
Utensils
• Housekeeping surfaces
• Require regular cleaning and removal of soil and dust
• Personal protective equipment (PPE) used during cleaning and housekeeping
procedures
• Need to be cleaned only with soap and water or a detergent/disinfectant,
depending on the nature of the surface and the degree of contamination
• Dishes and eating utensils used by a patient with known or suspected
infection
• No special precautions other than standard precautions
• Wear gloves when handling patient trays, dishes and utensils

Cleaning and Disinfection after Patient
Discharge/Transfer
• Clean and disinfect all surfaces that were in contact with patient or may
have become contaminated during patient care
• Do not spray or fog occupied or unoccupied rooms with disinfectant –
potentially dangerous practice that has no proven benefits

Steps of BMW Management
. •Segregation (at the point of generation)
. •Pretreatment (laboratory liquid waste)
. •Transportation to Central storage area
. •Transportation of waste to CBMWTF*
. •Treatment and Final disposal at CBMWTF
*CBMWTF= Common biomedical waste treatment facility

Disposal of BMW
Category Type of bag/container Type of waste Treatment disposal options
Yellow Non chlorinated colour coded bags in • Human anatomical waste Incineration/deep burial
coloured bins • Animal anatomical waste
• Soiled waste
• Expired or discarded medicines
Separate collection system leading to • Chemical waste
ETP • Micro, biotech & clinical lab waste
• Chemical liquid waste
Red Non chlorinated plastic bags in Contaminated waste (recyclable) tubing, bottles, Auto/micro/hydro and then sent to
coloured bins/ containers urine bags, syringes (without needles) and gloves recycling
White Translucent, puncture, leak & tamper Waste sharps including metals Auto/dry heat sterilization followed by
proof shredding /mutilation/encapsulation
Blue Water proof card board Glassware waste Disinfection or auto/micro /hydro then sent
boxes/containers to recycling
*Disposal by deep burial is permitted only in rural or remote areas where there is no access to common bio-
medical waste treatment facility. This will be carried out with prior approval from the prescribed authority
Specific guidelines for BMW of COVID-19
• Separate colour coded bins with foot operated lids in wards.
• Double layered bags(using 2 bags) should be used for collection of
COVID-19 waste.
• In addition to mandatory labelling, COVID -19 BMW bin should be
labelled as COVID-19 waste and keep separately in temporary storage
room.
• Maintain separate records of waste generated from COVID-19

• Non contaminated General waste should be disposed as a solid waste .

• Disinfect inner and outer surface of container/bin/ trolleys used for
storage of COVID-19 waste with 1% sodium hypochlorite solution daily.
• Update the details of COVID -19 BMW generation. Register in CPCB
mobile application namely COVID19BMW
• Depute dedicated sanitation workers.

• Donning & Doffing zone must be separate.
• PPE material –plastic-discard in red bags.
• PPE material –non plastic-discard in yellow bags.
• Wear PPE then tie the bags .
• Spray over the bags with freshly prepared 1%sodium hypochlorite

solution.

Summary
• IPC is key for quality patient care and containment

• Based on key principles- Hand Hygiene, Respiratory etiquette, contact and
droplet precautions
• Hospital Infection Prevention & control- Standard & Additional precautions
• Protect Yourself and the community
• Triage for OPD and inpatients
• PPE
• Judicious and appropriate use
• Pay attention to donning and doffing
• Home care precautions

THIRD WAVE COVID TOT-4-MICRO
Sample Collection and Transport for COVID 19 diagnosis
www.gujhealth.gujarat.gov.in Health & Family Welfare Dept, Govt of Gujarat 38

Objective
• At the end of this module, learner will know about

• Which sample to collect for COVID 19 diagnosis
• How to collect the sample
• From whom to collect
• How to label, transport and store the sample

What is role in sample collection & transport
Select Collect Transport
Clinician to decide Appropriate clinical By following all biosafety

necessity for collection of sample need to be collected precautions and using
clinical specimens only by laboratory Personal Protective
after following the case personnel/healthcare Equipment(PPEs), clinical
definition and criteria as worker trained in samples need to be sent to
given by Government of specimen collection. the designated laboratory
India. by following standard
triple packaging.

Specimen – collection and storage
Specimen type material Container Temper Temperature Comments

ature (Transport to (if any)
laboratory
Nasopharyngeal and Dacron or 4 °C ≤5 days: 4 °C The nasopharyngeal and
oropharyngeal swab polyester flocked >5 days: -70 °C oropharyngeal swabs should be
swabs* placed in the same tube to increase
the viral load
Bronchoalveolar lavage sterile container 4 °C ≤48 hours: 4°C There may be some dilution of
>48 hours: –70 °C pathogen, but still a worthwhile
specimen
Tracheal aspirate, sterile container 4 °C ≤48 hours: 4°C

nasopharyngeal aspirate or >48 hours: –70 °C
nasal wash

Specimen – collection and storage
Specimen type material Container Tempe Temperature Comments

rature (Transport to (if any)
laboratory)
Sputum Sterile 4 °C ≤48 hours: 4°C Ensure the material is from
container >48 hours: –70 °C the lower respiratory tract
Tissue from biopsy or sterile container 4 °C ≤24 hours: 4°C Autopsy sample collection
autopsy including from with saline >24 hours: –70 °C preferably to be avoided
lung

Sample collection Kit contents:
• One Tube of Virus Transport Media (VTM)

• One Nasopharyngeal swab (smaller swab, flexible shaft)
• One Oro pharyngeal swab.
• 3 Ziploc specimen bag containing absorbent pad
• Laboratories Test Requisition form / Specimen Referral Form (SRF)
• Ice pack (keep in deep freeze until ready to package & transport
specimens)

Sample collection Kit contents:

Important point
• Label tube of VTM legibly with the patient’s name & SRF ID.

Collecting Nasopharyngeal specimen:
• Tilt patient’s head back 70 degrees.
• Gently and slowly insert a swab with a flexible shaft (wire or plastic) through the nostril
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, indicating contact with the
nasopharynx.
• Swab should reach depth equal to distance from nostrils to outer opening of the ear.
Gently rub and roll the swab. Leave swab in place for several seconds to absorb
secretions.
• Slowly remove swab while rotating it and place it in VTM tube

Collecting Nasopharyngeal specimen:

Collecting Throat specimen
(Oropharyngeal swab )
• Use a throat swab to collect specimen by swabbing the patient’s posterior

pharynx and tonsillar area (avoid the tongue).
• Insert the swab into the vial of VTM. If the swab shaft extends past the top of
the tube, clip it so that the top of the swab shaft it is just below the top of the
tube allowing the end with the swab tip to remain in the liquid. The swab tip
must be immersed in the liquid.
• Note: Throat swab tips must be synthetic (ex: polyester, rayon, or dacron).
Cotton or calcium alginate tipped, or wooden shaft swabs are unacceptable .

OP sample collection

Important steps:
• Securely tighten the cap on the tube of VTM and recheck to make certain
it is labeled with patient name & SRF ID.
• Complete a Laboratories test requisition form /Clinical data.
• For test requested, write “COVID-19" under Comments.
• Ensure that all information is legible, complete and accurate. Place the
completed form into the outside pocket of the specimen bag. Do not
enclose it inside the bag with the specimen tube.

Procedure to package and transport sample/specimen [1/3]
1
2
START…
Use Personal Protective Equipment Seal the neck of the sample vials
(PPE) while handling specimen using parafilm
4 3
Continued on
next page…
Arrange primary container (vial) in Cover the sample vials using

secondary container absorbent material
Note: Sample vials can also be placed inside a zip-lock pouch, covered in absorbent material and secured by heat- sealing
or rubber bands. Then, the zip-lock pouch should be placedPage
www.gujhealth.gujarat.gov.in 10inside another plastic pouch and&secured
Health Family Welfare Dept, Govt of 51
5 6
Continued from
previous page…
Place the centrifuge tube Place the zip-lock pouch inside a

inside a zip-lock sturdy plastic container and seal the
pouch neck of the container
8 7
Continued on
next page…
Use a hard card-board box as an outer Use a thermocol box as an outer container and
container and placing the secondary container place the secondary container within it, surrounded
and the gel packs Page 11 by hard- frozen gel packs
9 11
10
Continued from
previous page…
Place the completed Specimen Referral Form Secure the zip-lock pouch with the Attach the labels:
(available on www.niv.co.in) and request letter Specimen Referral Form on the • Senders’ address, contact number;
inside a leak-proof, zip-lock pouch outer container Consignee’s address /contact number;
• Biological substance- Category B;
• ‘UN 3373’; Orientation label, Handle
Documents to accompany: with care
• Packaging list/proforma Invoice
• Air way bill (for air transport) (to be prepared by sender or shipper)
• Value equivalence document (for road/rail/sea transport) END
Note: 1. A vaccine-carrier/ice-box can also be used as an outer container

2. The minimum dimensions of the outer container should
www.gujhealth.gujarat.gov.in
Page
12 be 10 x 10 x 10 cmHealth
(length&xFamily
width Welfare
x height)]
Dept, Govt of 53
Sample Packaging

Transport
• Place the sample in vaccine carrier with ice packs and transport to
laboratory at 2-8* C
• If there is delay in transport then keep sample in refrigerator for 48 hrs and
after that in -70OC
• Transport the sample to designated testing laboratory

References
• WHO training modules for humanitarian agency (Infection prevention and

Control ) – module 4
• Guidelines for Handling, Treatment and Disposal of Waste Generated
during treatment/Diagnosis/ Quarantine of COVID-19 Patients, CPCB, 17th
July 2020, page 1-11.
• Malini R. Capoor and Annapurna Parida, Current perspectives of
biomedical waste management in context of COVID-19”, IJMM
• Apurba Sankar Sastry , Sandhya Bhat K. Essentials of Medical
Microbiology, 3rd edition.
• C P Baveja, V Baveja; Complete Microbiology for MBBS: 7th Edition.


2.third Wave Covid Tot-5-Micro-Infection Prevention & Control

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

2.third Wave Covid Tot-5-Micro-Infection Prevention & Control

Uploaded by

Copyright:

Available Formats

THIRD WAVE COVID TOT-5-MICRO

Infection Prevention and Control, Biomedical Waste

www.gujhealth.gujarat.gov.in Health & Family Welfare Dept, Govt of Gujarat 1

www.gujhealth.gujarat.gov.in Health & Family Welfare Dept, Govt of 2

www.gujhealth.gujarat.gov.in Health & Family Welfare Dept, Govt of 3

• To reduce transmission of healthcare associated infections

www.gujhealth.gujarat.gov.in Health & Family Welfare Dept, Govt of 4

• Transmission may also occur through fomites

• Airborne transmission may be possible in specific circumstances in which

www.gujhealth.gujarat.gov.in Health & Family Welfare Dept, Govt of 5

• Applying standard precautions for all patients at all times

www.gujhealth.gujarat.gov.in Health & Family Welfare Dept, Govt of 6

www.gujhealth.gujarat.gov.in Health & Family Welfare Dept, Govt of 7

• The first priority is control at the source of infection – the patient

• During a pandemic, give a surgical or procedure mask to all patients presenting to

• Masks do not need to be used by patients when they are alone!

• In health facilities, separate patients with respiratory symptoms from others

• Ensure separate waiting areas for patients with respiratory symptoms

• Maximise distance between beds

www.gujhealth.gujarat.gov.in Health & Family Welfare Dept, Govt of 9

www.gujhealth.gujarat.gov.in Health & Family Welfare Dept, Govt of 10

www.gujhealth.gujarat.gov.in Health & Family Welfare Dept, Govt of 11

www.gujhealth.gujarat.gov.in Health & Family Welfare Dept, Govt of 12

www.gujhealth.gujarat.gov.in Health & Family Welfare Dept, Govt of 13

www.gujhealth.gujarat.gov.in Health & Family Welfare Dept, Govt of 14

www.gujhealth.gujarat.gov.in Health & Family Welfare Dept, Govt of 15

• Always perform hand hygiene before and after wearing PPE

www.gujhealth.gujarat.gov.in Health & Family Welfare Dept, Govt of 16

• Distancing / separation / restriction of movement and of visitors

www.gujhealth.gujarat.gov.in Health & Family Welfare Dept, Govt of 17

• During a pandemic, all patients coming to health facilities with fever +

www.gujhealth.gujarat.gov.in Health & Family Welfare Dept, Govt of 18

• The inpatient ward for patients with suspected covid-19 must be

www.gujhealth.gujarat.gov.in Health & Family Welfare Dept, Govt of 19

• Restrict access, limit visitors

www.gujhealth.gujarat.gov.in Health & Family Welfare Dept, Govt of 20

• Place patients with COVID-19 infection in

www.gujhealth.gujarat.gov.in Health & Family Welfare Dept, Govt of 21

www.gujhealth.gujarat.gov.in Health & Family Welfare Dept, Govt of 22

• COVID-19 virus can potentially survive in the environment for several

www.gujhealth.gujarat.gov.in Health & Family Welfare Dept, Govt of 23

• Housekeeping surfaces can be divided into two groups

www.gujhealth.gujarat.gov.in Health & Family Welfare Dept, Govt of 24

• Wear gloves when handling and transporting used patient care

recommended for the cover

Detergent and water o Should be stored dry in individual holder

www.gujhealth.gujarat.gov.in Health & Family Welfare Dept, Govt of 26

Clean laundry and surfaces in all environments where COVID-19 cases

www.gujhealth.gujarat.gov.in Health & Family Welfare Dept, Govt of 27

Soiled linen should be placed in clearly labelled, leak-proof bags or containers,

www.gujhealth.gujarat.gov.in Health & Family Welfare Dept, Govt of 28

• Designate specific well-trained staff for cleaning environmental surfaces

www.gujhealth.gujarat.gov.in Health & Family Welfare Dept, Govt of 30

www.gujhealth.gujarat.gov.in Health & Family Welfare Dept, Govt of 31

. •Segregation (at the point of generation)

. •Pretreatment (laboratory liquid waste)

. •Transportation to Central storage area

. •Transportation of waste to CBMWTF*

. •Treatment and Final disposal at CBMWTF

*CBMWTF= Common biomedical waste treatment facility

www.gujhealth.gujarat.gov.in Health & Family Welfare Dept, Govt of 34

• Non contaminated General waste should be disposed as a solid waste .

• Depute dedicated sanitation workers.