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Coronavirus (COVID 19) infection prevention and control guidance part 2

Continue from Coronavirus (COVID 19) infection prevention and control guidance part 1

13. Linen
Bag linen inside patient isolation room in accordance with procedures for infectious linen. Unbagged linens should not be carried through the ward or other clinical areas.
14. Waste
Large volumes of waste may be generated by frequent use of PPE; advice from the local waste management team should be sought prospectively on how to manage this.
Dispose of all waste as clinical waste.
Waste from a possible or a confirmed case must be disposed of as Category B waste. The transport of Category B waste is described in Health Technical Memorandum 07-01: Safe management of healthcare waste. Advice on waste categorization was provided the Advisory Committee on Dangerous Pathogens on 31 January 2020.
If ambulant, the patient can use the ensuite WC. If bedpans are used, the excreta should solidified using super absorbent polymer gel granules and then disposed of as clinical waste. The use of these granules must be strictly controlled as described in this NHS National Patient Safety Alert. Communal facilities must not be used.
15. Specimens
All specimens and request forms should be marked with a bio hazard label.
The specimen should be double-bagged in the isolation room by a staff member wearing recommended PPE.
Specimens should be hand delivered to the laboratory by someone who understands the nature of the specimens. Pneumatic tube systems must not be used to transport specimens.
Transport of samples between laboratories should be in accordance with Category B transportation regulations. PHE follows the guidance on regulations for the transport of infectious substances 2019–2020.
16. Mobile healthcare equipment
The following advice applies to devices that cannot be left in the isolation room, such as portable X-ray machines:
• use of mobile healthcare equipment should be restricted to essential functions as far as possible to minimize the range of equipment taken into and later removed from the room
• the operator of the device, if not routinely looking after the patient, must be trained and supervised in infection prevention and control procedures, including the use of PPE
• the operator should wear PPE as described above when in the isolation room
• any equipment taken in to the room and which must be subsequently removed, must be disinfected prior to leaving the anteroom
• any additional items such as a digital detector or a cassette will also need to be disinfected, regardless of whether there has been direct contact with the patient or not. This is due to the risk of environmental contamination of the equipment within the isolation room
17. Critical care
• all respiratory equipment must be protected with a high efficiency filter (such as BS EN 13328-1). This filter must be disposed of after use
• disposable respiratory equipment should be used wherever possible. Re-usable equipment must, as a minimum, be decontaminated in accordance with the manufacturer’s instructions
• a closed suctioning system must be used
• ventilator circuits should not be broken unless necessary
• ventilators must be placed on standby when carrying out bagging
• PPE must be worn
• water humidification should be avoided, and a heat and moisture exchanger should be used
18. Transfers to other departments

Where possible, all procedures and investigations should be carried out in the single room with a minimal number of staff present. Only if clinical need dictates, and in consultation with the infection control team, should patients be transferred to other departments. The following procedures then apply:
• the trolley used to transport the patient from the isolation room, should be disinfected as far as possible (see environmental decontamination immediately before leaving the room by an individual wearing protective clothing and PPE as described previously
• the department must be informed in advance of the patient’s arrival
• any extraneous equipment to be removed safely from the investigation or treatment room
• the patient must be taken straight to and from the investigation or treatment room and must not wait in a communal area
• the patient should wear a ‘surgical ‘ mask if this can be tolerated - this will prevent large respiratory droplets being expelled into the environment by the wearer
• the treatment or procedure room, trolley or chair and all equipment should be decontaminated after use, as per the cleaning instructions above
• to enable appropriate decontamination after any procedure, patients should be scheduled at the end of a list, as far as possible. After the procedure, access to such spaces should be restricted and environmental decontamination implemented
• during patient transfers a process to ensure that no individuals not wearing PPE come within 2 metres of the patient should be followed. Anyone in the vicinity of the patient (for example carrying out procedures, transferring the patient or standing within 2m of the patient) must wear the PPE previously described
19. Transfers to other hospitals
• transfer of cases to another hospital should be avoided unless it is necessary for medical care
• if transfer is essential, the IPCT at the receiving hospital and the ambulance staff must be advised in advance of the special circumstances of the transfer, so that appropriate infection control measures can be taken
20. Handling dead bodies
• the act of moving a recently deceased patient onto a hospital trolley for transportation to the mortuary might be sufficient to expel small amounts of air from the lungs and thereby present a minor risk
• a body bag should be used for transferring the body and those handling the body at this point should use full PPE
• the outer surface of the body bag should be decontaminated (see environmental decontamination) immediately before the body bag leaves the anteroom area. This may require at least 2 individuals wearing such protective clothing, in order to manage this process
• the trolley carrying the body must be disinfected prior to leaving the anteroom
• prior to leaving the anteroom, the staff members must remove their protective clothing
• once in the hospital mortuary, full PPE should be used if the body bag is opened
• washing or preparing the body is acceptable if those carrying out the task wear PPE. Mortuary staff and funeral directors must be advised of the biohazard risk. Embalming is not recommended
• if a post mortem is required safe working techniques (for example manual rather than power tools) should be used and full PPE worn, in the event that power tools are used. High security post mortem suites are available if needed and can be discussed with the PHE incident team
• after use, empty body bags should be disposed of as category B waste
21. Putting on and removing personal protective equipment
21.1 Putting on PPE
Before donning, healthcare workers should put on scrubs, ensure hair is tied back securely and off the neck and collar, remove jewellery or pens, ensure they are hydrated, and perform hand hygiene.
Staff should wear the following PPE, put on in the following order:
• gown
• FFP3 respirator and fit check
• eye protection (goggles or face shield)
• disposable gloves
The order given above is practical but the order for putting on is less critical than the order of removal given below. During donning each item must be adjusted as required to ensure it fits correctly and interfaces well with other PPE items.
21.2 Removal of PPE
PPE should be removed in an order that minimizes the potential for cross-contamination. Before leaving the side room gloves, gown and eye protection should be removed (in that order, where worn) and disposed of as clinical waste. After leaving the area, the respirator can be removed and disposed of as clinical waste.
The order of removal of PPE is suggested as follows, consistent with WHO guidance:
• peel off gloves and dispose in clinical waste
• perform hand hygiene
• remove gown by using a peeling motion, fold gown in on itself and place in clinical waste bin
• remove goggles or visor only by the headband or sides and dispose in clinical waste
• remove respirator from behind and dispose in clinical waste
• perform hand hygiene

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