Novel Coronavirus – 2019 (nCoV 2019) Information
In December 2019, a number of patients were diagnosed with pneumonia in the city of Wuhan, China-later diagnosed with nCoV. Since then thousands of patient have been diagnosed with this virus not only in China but also in other countries. Infections reported outside China have mostly been diagnosed among travelers returning from Wuhan.
The spectrum of infection ranges from asymptomatic infection to fever, mild respiratory illness severe pneumonia or acute respiratory distress syndrome (ARDS). Major modes of transmission includes animal-to-animal, animal-to-human and human-to-human contact. The possibility of Coronavirus infection must be considered in patients with:
i) fever, cough, shortness of breath AND
ii) travel to China in the last 14 days OR contact with infected patient within the last 14 days.
Currently, there is no antiviral therapy or vaccination available for this infection and treatment is mainly supportive. Good infection prevention strategies are crucial in preventing infection propagation through communities.
► wash hands frequently (before eating or cooking, after using the restroom and when soiled)
► healthcare workers must strictly adhere to the following moments of hand hygiene: before and after touching a patient, before clean or aseptic procedures, after coming in contact with patient surroundings and body fluids)
► practice good cough etiquette (i.e cough on your sleeve or use a tissue paper or cloth to cover your mouth)
► dispose used tissue paper in bins
► refrain from spitting in your surroundings and use waste bins
► avoid close contact with people with respiratory illnesses
► avoid touching your eyes, nose or mouth with unwashed hands
If a suspected case is received at a hospital, the front-line staff should offer a surgical mask to the patient and provide education regarding cough etiquette. These patients should not be seated in the same area as other patients; a room should be vacated in close vicinity and the patient transferred to that room. A physician (preferably infectious diseases/ pulmonary /internal medicine) and the infection control department should be informed. Contact and droplet precaution signs should be posted outside rooms where such patients are assessed and/or treated. All healthcare workers evaluating the suspected patient must wear personal protective equipment (PPE) before evaluating the patient.
For all suspected patients, standard, contact and droplet precautions (use gloves, gowns, & surgical masks) must be used. Patients undergoing aerosol generating procedures (e.g. bronchoscopy, cardio-pulmonary resuscitation, intubation, nasopharyngeal specimen collection, noninvasive ventilation or airway suctioning), must be placed in standard, contact and airborne precautions (use gloves, gown and N-95 masks). Eye protection with goggles or face shield is essential while managing all such patients. Disposable devices should be used when available. If such devices are not available, dedicated equipment must be used for these patients; if this is not possible, disinfect all patient care equipment before using on another patient.
Limit visitors to admitted patients and maintain a list of all visitors and staff members involved in care of such patients. Assign the same staff to patients with suspected or confirmed infection. Patients should be kept in a separate room. Patients with known nCoV infection may be placed in the same room if separate rooms are not available. As mentioned above, patients undergoing aerosol generating procedures require negative pressure rooms; if these are not available, temporary negative pressure can be created installing exhaust fan to the outside,. Isolation must continue until symptoms resolve.
Limit patient movement. If transport is necessary, the patient must put on a surgical mask and the receiving area should be informed prior to the transfer. All waste must be treated an infected and potentially harmful. Laboratory samples should be placed in a biohazard bag and then in a puncture proof container before transportation.
Cleaning and disinfection guidelines:
Appropriate environmental cleaning should be carried out as suggested below:
1. Wear personal protective equipment (Gloves, gown & mask) before cleaning
Discard all disposal items in infectious waste
2. Disinfectant all hard surfaces with high concentration of surface disinfectant (e.g., sodium hypochlorite) and prepared solution as per manufacturing guidelines
3. Use duster impregnated with approved disinfectant/spray for cleaning e.g. clockwise, top to bottom, cleanest to dirtiest.
4. Emphasis on cleaning of high-touch surfaces (areas frequently touched by patients, visitors and staff)
5. Change the bed linen/paper sheet between the patients and place used linens (e.g., bed sheets) in a designated hamper.
6. Clean all patient’s monitoring devices with alcohol wipe (blood pressure cuff, thermometer, pulse oximetry sensors, stethoscope, ophthalmoscope, otoscope etc.) between patients.
7. Clean counters and electronic items (computer, keyboard, telephone etc.)
8. Disinfect patient mobility items (wheelchair, stretcher etc.) between patients.
9. Consider potential contamination of privacy curtains.
10. Do not bring cleaning/procedure carts into isolation room
11. Change mop after each room, and after cleaning blood and bodily fluid spills.