HOSPITAL INFECTION PREVENTION AND CONTROL GUIDELINES FOR

COVID-19
 INTRODUCTION
A pneumonia of unknown cause detected in Wuhan, China was first reported to the WHO
Country Office in China on 31 December 2019. It was caused by a novel Coronavirus (2019-
nCoV). The disease has since spread all over the world. On 11 February 2020, WHO
announced a name for the new coronavirus disease: COVID-19 and WHO declared COVID-
19 as a pandemic on 11th March 2020. There is a need to build a comprehensive strategy to
prevent infections, save lives and minimize impact.
Keeping in view the capability of the virus to spread in health care facility proper guidelines
for infection control measures need to be prepared.
STANDARD PRECAUTIONS
According to WHO there are two main routes of transmission of the COVID-19 virus: respiratory
and contact. Standard precautions along with transmission based precautions must be followed
at all times in hospital setting to prevent spread of infection. Standard precautions are basic
infection control precautions which must be applied to all patients at all times, regardless of
diagnosis or their infectious state.
Components of standard precautions include -
 HAND HYGIENE – Perform hand hygiene frequently with an alcohol-based hand rub if your hands
are not visibly dirty or with soap and water if hands are dirty.

 PERSONAL PROTECTIVE EQUIPMENT (PPE) - HCWs should wear PPE (Gloves, mask,
gown, eye protection, or face shield) when touching blood, body fluids, secretions, excretions,
and contaminated items.

 DISINFECTION - Cleaning and disinfection of environmental surfaces, beds, bed rails, and
bedside equipment should be done properly.

 SPILL MANAGEMENT – Any spillage of blood or body fluids should be cleaned promptly
to prevent contamination.

 BIOMEDICAL WASTE MANAGEMENT - Proper segregation, transport, storage and

disposal of hospital waste should be done to avoid the transfer of microorganisms to other
patients or the environment.

 PREVENTION OF NEEDLE STICK INJURIES – Extreme precaution should be taken to

prevent injuries with sharp objects, such as needles and scalpels.

 RESPIRATORY HYGIENE / COUGH ETIQUETTE -

- Patients should cover their nose and mouth with bent elbow or tissue when coughing or
sneezing.
- Head should be turned away from others while coughing.
- Tissues should be disposed into appropriate waste bins after use immediately.
- Touching of mouth and nose should be avoided
 - Hand hygiene should be done after contact with respiratory secretions.
- Surgical mask should be placed on the coughing patient in common areas.
- Spatially separating patients (> 3 feet) with respiratory infections from other patients when
feasible.

TRANSMISSION BASED PRECAUTIONS –

Additional transmission based precautions apart from Standard precaution should be
followed for prevention and control of infection due to 2019-n CoV. As the infection is
transmitted through droplets and contact, droplet and contact precautions should also be
followed. These measures protect health care workers and other patients from cross
infections.

DROPLET PRECAUTIONS –

Basic components of Standard precautions should be followed.

Patient placement

- Patient should be placed in single room.

- When single rooms are not available patients should be placed in same room.
- Patients should be physically separated at least 3 feet apart.
- Patients should wear a triple layer surgical mask at all times.
- Curtains should be drawn between two patients to minimize chances of direct contact.
- Doors should be kept closed.
- All suspect cases detected in the isolation ward (till a diagnosis is made), will be
hospitalized and kept in isolation till such time they are tested negative.
- Persons testing positive for COVID-19 will remain to be hospitalized till such time 2 of
their samples are tested negative as per MoHFW’s discharge policy.

Respiratory hygiene / Cough etiquette

- Patients should cover their nose and mouth with with flexed elbow or tissue when coughing
or sneezing.
- Head should be turned away from others while coughing.
- Tissues should be disposed into appropriate waste bins after use.
- Hand hygiene should be done after contact with respiratory secretions.
- Touching of mouth and nose should be avoided
- Surgical mask should be placed on the coughing patient in common areas.
- Spatially separating patients (> 3 feet) with respiratory infections from other patients when
feasible.

PPE
 MASKS –
 Individuals with respiratory symptoms should:
 Wear a medical mask while waiting in triage or other areas and during transportation within the
facility;
  Wear a medical mask when staying in areas dedicated to suspected or confirmed cases;
 Not wear a medical mask when isolated in single rooms, but they should cover their mouth and
nose when coughing or sneezing with disposable paper tissues. Tissues must be disposed of
appropriately, and hand hygiene should be performed immediately afterwards.
 Health care workers should:
 Wear a medical mask when entering a room where patients with suspected or confirmed
COVID-19 are admitted;
 Use a particulate respirator at least as protective as a US National Institute for Occupational
Safety and Health-certified N95, European Union standard FFP2, or equivalent, when
performing aerosol-generating procedures such as
 Tracheal intubation
 Non-invasive ventilation
 Tracheotomy
 Cardiopulmonary resuscitation
 Manual ventilation before intubation
 Bronchoscopy.
 HCWs should wear protective eyewear if there is risk of splashes to the mucosa.
 PPE should be changed and hand hygiene performed between contact with patients in the
same room.
 Mask management –
If medical masks are worn, appropriate use and disposal are essential to ensure they are
effective and to avoid any increase in transmission. The following information on the
correct use of medical masks is derived from practices in health care settings -
 Place the mask carefully, ensuring it covers the mouth and nose, and tie it securely
to minimize any gaps between the face and the mask.
 Avoid touching the mask while wearing it.
 Remove the mask using the appropriate technique: do not touch the front of the
mask but untie it from behind.
 After removal or whenever a used mask is inadvertently touched, clean hands using
an alcohol-based hand rub or soap and water if hands are visibly dirty.
 Replace masks as soon as they become damp with a new clean, dry mask. Do not
re-use single-use masks.
 Discard single-use masks after each use and dispose of them immediately upon
removal.
 RATIONALE USE OF PERSONAL PROTECTIVE EQUIPMENT -
Setting Setting Target Activity PPE or procedure
personnel or
patients
Health care facilities

Inpatient facilities

Patient Health care workers Providing direct care to - Medical mask

room COVID19 patients) - Gown
- Gloves
- Eye protection (goggles or
face shield)
Aerosol-generating - Respirator N95 or FFP2
procedures performed on standard, or equivalent.
COVID-19 patients - Gown
- Gloves
- Eye protection
- Apron
Cleaners Entering the room of - Medical mask
COVID-19 patients - Gown
- Heavy duty gloves
- Eye protection (if risk of
splash from organic
material or chemicals)
- Boots or closed work
shoes
Visitors Entering the room of a - Medical mask
COVID19 patient - Gown
- Gloves
Other areas All staff, including Any activity that does not No PPE required
of patient health care workers. involve contact with
transit COVID-19 patients
Triage Health care workers Preliminary screening not - Maintain spatial distance
involving direct contact. of at least 1 metre.
(This category includes the - No PPE required
use of no-touch
thermometers, thermal
imaging cameras, and
limited observation and
questioning, all while
maintaining a spatial
distance of at least 1 m.)
Setting Setting Target Activity PPE or procedure
personnel or
patients
Patients with Any - Maintain spatial distance
respiratory of at least 1 metre.
symptoms
- Provide medical mask if
tolerated by patient.

Patients without Any No PPE required

respiratory
symptoms

Laboratory Lab technician Manipulation of respiratory - Medical mask

samples - Gown
- Gloves
- Eye protection (if risk of
splash)
Administra All staff, including Administrative tasks that do No PPE required
tive areas health care workers. not involve contact with
COVID-19 patients
Outpatient facilities

Consultatio Health care workers Physical examination of - Medical mask

n room patient with respiratory - Gown
symptoms - Gloves
- Eye protection
Healthcare personnel Physical examination of PPE according to standard
patients without respiratory precautions and risk
symptoms. assessment
Patients with Any Provide medical mask.
respiratory
symptoms.
Patients without Any No PPE required
respiratory
symptoms.
Cleaners After and between - Medical mask
consultations with - Gown
patients with respiratory - Heavy duty gloves
symptoms. - Eye protection (if risk of
splash from organic
material or chemicals).
- Boots or closed work
shoes
Setting Setting Target Activity PPE or procedure
personnel or
patients
Waiting Patients with Any - Provide medical mask.
room respiratory - Immediately move the
symptoms. patient to an isolation
room or separate area
away from mothers; if
this is not feasible,
- Ensure spatial distance
of at least 1 m from
other patients.
Patients without Any No PPE required
respiratory
symptoms.
Administra All staff, including Administrative tasks No PPE required
tive areas health care workers.
Triage Health care workers Preliminary screening not - Maintain spatial distance
involving direct contact. of at least 1 metre.
- No PPE required
Patients with Any - Maintain spatial distance
respiratory of at least 1 metre.
symptoms - Provide medical mask if
tolerated by patient.
Patients without Any No PPE required
respiratory
symptoms

Transport team

Healthcare Transporting
personnel suspected COVID-19
patients to the referral
healthcare facility.
Driver Involved only in driving - Maintain spatial distance
the patient with of at least 1 metre.
suspected COVID-19 - No PPE required
disease and the driver’s
compartment is
separated from the
COVID-19patient.
Assisting with loading - Medical mask
or unloading patient - Gowns
- Gloves
 with suspected - Eye protection
COVID-19 disease.
No direct contact with Medical mask
patient with suspected
COVID-19, but no
separation between
drivers’ and patients’
compartments.
Patient with Transport to the Medical mask if tolerated
suspected COVID- referral healthcare
19 disease. facility.
Cleaners Cleaning after and - Medical mask
between transport of - Gown
patients with suspected - Heavy duty gloves
COVID-19 disease to the - Eye protection (if risk
referral healthcare of splash from organic
facility. material or chemicals).
- Boots or closed work
shoes
Sequence of donning and doffing PPE
 Patient transport

- Patient should wear mask during transport.

- Respiratory etiquette/ Cough hygiene should be followed.
Patient-care equipment and instruments/devices

- Dedicated or disposable patient care equipment should be used as far as possible.

- When reusable equipment’s are used they should be cleaned and disinfected before use on
another patient according to manufacturer’s instruction.
CONTACT PRECAUTIONS –
Basic components of Standard precautions should be followed.
Patient placement

- Patient should be placed in single room.

- When single rooms are not available patients should be placed in same room.
- Patients should be physically separated at least 3 feet apart.
- Curtains should be drawn between two patients to minimize chances of direct contact.
- Patient notes or bedside charts should be kept outside the room.
- Doors should be kept closed.
- All suspect cases detected in the isolation ward (till a diagnosis is made), will be
hospitalized and kept in isolation till such time they are tested negative.
- Persons testing positive for COVID-19 will remain to be hospitalized till such time 2 of
their samples are tested negative as per MoHFW’s discharge policy.
PPE
- Wear gloves and gowns when coming in contact with patient or patient’s surroundings.
- PPE should be changed and hand hygiene performed between contacts with patients in the
same room.
- Hand hygiene should be performed before donning and after removal of PPE.
Patient transport

- Infected area of the patient’s body should be covered properly before transportation.
- Contaminated PPE should be removed and disposed and hand hygiene performed prior to
transporting patients on Contact Precautions
- Clean PPE should be donned to handle the patient at the transport destination.
Patient-care equipment and instruments/devices

- Dedicated or disposable patient care equipment should be used as far as possible.

- When reusable equipment’s are used they should be cleaned and disinfected before use on
another patient.
ENVIRONMENTAL CLEANING IN HEALTH CARE FACILITIES –

Environmental cleaning is part of standard precautions.

Cleaning agents and disinfectants

1. 1% Sodium Hypochlorite can be used as a disinfectant for cleaning and disinfection

2. The solution should be prepared fresh.
3. Leaving the solution for a contact time of at least 10 minutes is recommended.
4. Alcohol (e.g. isopropyl 70% or ethyl alcohol 70%) can be used to wipe down surfaces
where the use of bleach is not suitable, e.g. metals.

Personal Protective Equipment (PPE) to wear while carrying out cleaning and disinfection
works

1. Wear heavy duty/disposable gloves, disposable long-sleeved gowns, eye goggles or a

face shield, and a medical mask (please see the PPE document for details)
2. Avoid touching the nose and mouth (goggles may help as they will prevent hands from
touching eyes)
3. Disposable gloves should be removed and discarded if they become soiled or damaged,
and a new pair worn
4. All other disposable PPE should be removed and discarded after cleaning activities are
completed. Eye goggles, if used, should be disinfected after each use, according to the
manufacturer’s instructions.
5. Hands should be washed with soap and water/alcohol-based hand rub immediately after
each piece of PPE is removed, following completion of cleaning.
Cleaning guidelines

1. Where possible, seal off areas where the confirmed case has visited, before carrying out
cleaning and disinfection of the contaminated environmental surfaces. This is to prevent
unsuspecting persons from being exposed to those surfaces.
2. When cleaning areas where a confirmed case has been, cleaning staff should be attired in
suitable PPE. Disposable gloves should be removed and discarded if they become soiled
or damaged, and a new pair worn. All other disposable PPE should be removed and
discarded, after cleaning activities are completed. Goggles, if used, should be disinfected
after each use, according to manufacturer’s instructions. Hands should be washed with
soap and water immediately after the PPE is removed.
3. Mop floor with routinely available disinfectant.
4. Wipe all frequently touched areas (e.g. lift buttons, hand rails, doorknobs, arm rests,
tables, air/ light controls, keyboards, switches, etc.) and toilet surfaces with chemical
disinfectants and allow to air dry. 1% sodium hypochlorite solution can be used. Alcohol
can be used for surfaces, where the use of bleach is not suitable.
5. Clean toilets, including the toilet bowl and accessible surfaces in the toilet with
disinfectant or 1% sodium hypochlorite solution.
6. Wipe down all accessible surfaces of walls as well as blinds with disinfectant or bleach
solution.
 7. Remove curtains/ fabrics/ quilts for washing, preferably using the hot water cycle. For
hot-water laundry cycles, wash with detergent or disinfectant in water at 70ºC for at least
25 minutes.
8. Discard cleaning items made of cloth and absorbent materials, e.g. mop head and wiping
cloths, into biohazard bags after cleaning and disinfecting each area. Wear a new pair of
gloves and fasten the double-bagged biohazard bag with a cable tie.
9. Disinfect buckets by soaking in disinfectant or bleach solution, or rinse in hot water
before filling.
10. Disinfectant or 1% sodium hypochlorite solution should be applied to surfaces using a
damp cloth. They should not be applied to surfaces using a spray pack, as coverage is
uncertain and spraying may promote the production of aerosols. The creation of
aerosols caused by splashing liquid during cleaning should be avoided. A steady
sweeping motion should be used when cleaning either floors or horizontal surfaces, to
prevent the creation of aerosols or splashing. Cleaning methods that might aerosolize
infectious material, such as the use of compressed air, must not be used.
11. Biohazard bags should be properly disposed-off, upon completion of the disinfection
work.

Frequency of cleaning of surfaces:

1. High touch surfaces: Disinfection of high touch surfaces like (doorknobs, telephone,
call bells, bedrails, stair rails, light switches, wall areas around the toilet) should be
done every 3-4 hours.
2. Low-touch surfaces: For Low-touch surfaces (walls, mirrors, etc.) mopping should
be done at least once daily.

Precautions to take after completing the clean-up and disinfection

1. Staff should wash their hands with soap and water immediately after removing the PPE,
and when cleaning and disinfection work is completed.
2. Discard all used PPE in a double-bagged biohazard bag, which should then be securely
sealed and labelled.
3. The staff should be aware of the symptoms, and should report to their occupational health
service if they develop symptoms.

SPILL MANAGEMENT –
- Wear non-sterile gloves.
- For large spills, cover with absorbent paper/ rag piece
- If any broken glass and sharps, using a pair of forceps and gloves, carefully retrieve.
- Use a large amount of folded absorbent paper to collect small glass splinters.
- Place the broken items into the puncture proof sharps container.
- Cover the spill with sodium hypochlorite (1%) for 10–20 minutes contact time.
- Clean up spill and discard into infectious waste bin, and mop area with soap and hot
water.
- Clean the mop and mop area with 1% sodium hypochlorite.
- Wash mop with detergent and hot water and allow it to dry.
BIOMEDICAL WASTE MANAGEMENT -
Bio-medical waste management for BMW from patients in novel Corona Virus Ward/OPD
will be done as per BMWM (Principal) rules 2016 and BMWM (Amendment) rules 2018,
2019, National IPC guidelines 2020, CDC and WHO IPC update Jan 2020.
Only pretreatment and segregation will be done in the hospital and the final disposal will be
done by common biomedical waste treatment and disposal facility (CBMWTF).
Biomedical waste devices, articles generated during diagnosis, treatment, management,
immunization etc from patients with nCoV and HCW working in such ward/opd should be
managed in accordance with safe routine procedures and rules.
Yellow Category
(a)Human Anatomical Waste: Human tissues, biopsy: Yellow coloured non-chlorinated
plastic bags.
(b) Animal anatomical waste: Not applicable in nCorona virus ward/OPD (only in nCoV
research labs)
(c) Soiled Waste: Items contaminated with blood, body fluids like dressings, plaster casts,
cotton swabs and bags containing residual or discarded blood and blood components are
disposed off in yellow bag.
(d) Cytotoxic drug vials shall not be handed over to unauthorised person under any
circumstances. Expired cytotoxic drugs to be returned back to the manufacturer or supplier
for incineration at temperature >1200°C. Leftover cytotoxic drugs cytotoxic drugs and
items contaminated with cytotoxic drugs along with glass or plastic ampoules, vials etc to
common biomedical waste treatment facility for incineration at >1200 °C in yellow bag
or container with cytotoxic label.
(e) Chemical Waste: Chemicals used in production of biological and used or discarded
solid disinfectants, residual or discarded chemical solid waste and chemical sludge are
discarded in yellow coloured non-chlorinated plastic bags or containers and disposed of
by incineration by CBMWTF.
(f) Liquid waste generated due to use of chemicals in production of biologicals, used or
discarded disinfectants, patients samples infected secretions, aspirated body fluids liquid
from laboratory, ward, OT and disinfecting activities etc should be collected separately
and made safe by disinfection by chemical treatment using 1-2% sodium hypochlorite
solution for a contact period of 30 min and directed to effluent treatment system or then
discharged into drains/sewers.
(g) Discarded items: Linen, Mattresses, beddings contaminated with blood or body fluid
should be treated with Non-chlorinated (lime/alcoholic: 5 % Lysol for 30 minutes, 5%
Phenol for 30 min) or 1-2% sodium hypochlorite chemical disinfection followed by
shredding and customised to fit in nonchlorinated yellow bag for incineration.
(h) Microbiology, biotechnology waste - Microbiology, biotechnology waste i.e.
laboratory cultures, stocks or specimens of microrganisms, live or attenuated vaccines,
humans and animals cell culture used in research, residual toxins culture plates dishes have
to be pretreated on site by autoclaving in an autoclave safe plastic bag/container there after
sent for final disposal in its respective colour category to CBMWTF. The discarded blood
bags are to be counted, sealed, weighed and all the records to be made and then packed in
autoclave safe plastic bags or containers to be autoclaved on site and then sent in yellow
bag to CBMWTF for incineration.
Red category
Contaminated Waste (Recyclable)
Wastes generated from disposable items such as tubing, drains, oxygen mask, bottles,
intravenous tubes and sets (with needles cut), catheters, urine bags, and gloves are nicked,
wherever applicable and put in red bag.
Translucent (White) Category
Waste sharps including Metals:
Needles, scalpels, blades or any other contaminated sharp object that may cause puncture
and cuts are to be placed in sharp blasters. Collect and send for final disposal when 3/4
full. These are sent for final disposal to CBMWTF.
Blue category:
Glass and metallic implants
Broken or discarded and contaminated glass, have to be disinfected (1-2% sodium
hypochlorite for 30 minutes at least) to be packed in puncture proof and leak proof boxes
or containers with blue colored marking and then sent to common central waste site for
final disposal to CBMWTF. The uninfected glass like medicine bottles or ampoules are
noninfected and are put in puncture proof and leak proof boxes or containers with blue
coloured marking. The metallic implants are pretreated in the same manner and are to be
packed in separate puncture proof and leak proof boxes or containers with blue coloured
marking.
References- https://www.cdc.gov/coronavirus/2019-ncov/index.html
www.who.int›coronaviruse›20200126-ncov-ipc-during-health-care

www.ncdc.gov.in