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COVID-19 PREVENTION: ENHANCED CLEANING AND DISINFECTION PROTOCOL TEMPLATEThis is a generic example designed to be customised according to your own risk assessmentIn accordance with guidelines from the WHO, PHE and the HSE, the FORMTEXT Practice name is implementing enhanced cleaning and disinfection procedures to protect staff and patients and to limit the transmission of COVID-19 in the community.Transmission of COVID-19 is thought to occur mainly through respiratory droplets generated by coughing and sneezing, through close contact (less than 2m) with others, or by contact with contaminated surfaces. The predominant modes of transmission are thought to be droplet and contact, and any AGPs (aerosol-generating procedures) present an additional risk.Survival in the environmentIn light of limited data for SARS-CoV-2, evidence was assessed from studies conducted with previous human coronaviruses including MERS-CoV and SARS-CoV. Human coronaviruses can survive on inanimate objects and can remain viable for up to 5 days (depending on type of surface) at temperatures of 22 to 25°C and relative humidity of 40 to 50% (which is typical of air-conditioned indoor environments).To reduce potential for virus contamination all high touch surfaces both in the treatment areas and the common areas should be identified and cleaned/disinfected according to the specified schedule. Products for environmental disinfectionFollow the manufacturer’s instructions to ensure that disinfectants are prepared and handled safety, personnel should wear the appropriate personal protective equipment (PPE) and be trained to use it safely. Eye protection and medical masks may also be needed to protect against chemicals in use or if there is a risk of splashing. Ethanol 70-90%Chlorine-based products (e.g. hypochlorite) at 0.1% (1000 ppm available choride) for general environmental disinfection, or 0.5% (5000 ppm) for blood and body fluids large spillsHydrogen peroxide >0.5%Other disinfectants can be considered, provided the manufacturers recommend them for the targeted microorganisms, especially enveloped viruses such as SARS-CoV-2. Disinfectant wipes, such as Clinell and numerous others, are acceptable providing the contact time is achieved. Disinfectants should meet EN1446 or EN16777 standardContact time of a minimum of 1 minute is recommended for these disinfectants or as recommended by the manufacturer.Hypochlorite is rapidly inactivated in the presence of organic material; therefore, regardless of the concentration used, surfaces should always be cleaned with soap and water or a detergent to remove organic matter first, followed by disinfection. Disinfectant solutions should always be prepared in well ventilated areas. Avoid combining disinfectants, both during preparation and usage, as such mixtures cause respiratory irritation and can release potentially fatal gases, in particular when combined with hypochlorite solutions.Hand hygieneHand hygiene and frequent hand washing up to the wrist by all workplace staff is paramount. Use disposable paper towels after hand washing and change any reusable towels between clients. Wash reusable towels in a dedicated washing machine at 90°C. Good hand washing technique is an essential part of infection control as many infections are spread by hand contact. See HYPERLINK "" PHE Best Practice: How to hand washHand washing should be performed before and after contact with a client and includes the use of liquid antimicrobial soap and water for at least 20 seconds to inactivate the virus; alternatively, alcohol-based hand rubs (>60% alcohol) can be substituted for unsoiled hands but must be left to dry on the hands and not wiped with a tissue. Everyone, patients, staff and other visitors, should hand wash or sanitise:Before entering the premises and leaving the premisesBefore and after eating or after using the toiletimmediately after using any handkerchief or tissue or smoking/vapingIn addition, the WHO (World Health Organisation) recommends healthcare workers clean their hands:Before touching a patient,Before clean/aseptic procedures,After body fluid exposure/risk,After touching a patientAfter touching patient surroundings Alcohol-based (>60% ethanol) hand sanitizer dispensers should be made available in each room.Enhanced cleaning and disinfection proceduresGeneral guidance:Wear disposable gloves when cleaning and disinfecting, and discard after use. Wash hands with soap and water immediately after gloves are removed.Wear eye protection when there is potential for splash or splatter to the face.Aprons are recommended to protect personal clothing.Remove all inessential clutter: magazines or brochures, toys, stationery, desk ornaments etc. from waiting room and reception area and also from kitchen, offices, treatment rooms and store rooms.Remove curtains/blinds/other soft furnishings if not essentialStaff clothes/uniforms/towels to be washed >60C after each shiftCleaning and disinfection of surfaces:Increase the frequency of cleaning and disinfecting as defined in the cleaning and disinfection schedule (Table 1), focusing on touch surfaces such as in waiting rooms, restrooms, tables, buttons, light switches, handrails, tables |desks | counters, taps, sinks, door handles, shared devices and keyboardsVentilate as well as possible, including treatment rooms between each patient (with door closed), and remove fans.Clean low touch surfaces, high touch surfaces then floors (in that order)Disposable cloths, mops etc. are preferableConsider using National Colour Coding Scheme for cleaning materials and equipmentCLEANING AND DISINFECTION SCHEDULE Table 1: This is a generic example, please amend according to your own risk assessmentElementFrequencyProductsSuspected or confirmed COVID-19+ exposureProductsALL ROOMSDeep clean every room - all touch surfaces throughout clinic including equipment, plus ceilings, walls, windows, doors, cupboard doors, vacuum carpets, mop floors, wash or remove curtains or blindsPrior to reopeningDetergent where appropriate then disinfectant, or a combined detergent/disinfection product. Disposable cloths and mops – handles wiped before being put awayPrior to reopeningDetergent followed by disinfection, or a combined productThorough ventilationCOMMON AREASEntrance and waiting roomAll touch points: knocker/bell, door handles/knobs, hand rails, chair seat, back and armsFloorsBetween each patientDaily at start of dayDetergent then disinfectant, or a combined productVacuum or mop ImmediatelyVentilate.Detergent then disinfection, or a combined product disposable mopReception & office areas Anything touched by a patient or visitor such as card payment terminal, perspex screen, counter top, doors, handlesBetween each patientDetergent then disinfectant, or a combined productImmediatelyVentilate areaDetergent then disinfectant, or a combined productChairs, counters/desk tops, door, cabinet and drawer handles, switches, window and door handles, light switchesBetween staff changes & start of dayDetergent then disinfectant, or a combined productImmediatelyDetergent then disinfection, or a combined productEquipment: Computer and tablet keyboards, mouses and mouse mats, touch screens, phones, calculators, pens, perspex screensBetween staff changes & start of dayDisinfectant wipes Immediately DisinfectFloorsDaily at start of dayVacuum or mopImmediately after disinfectingVacuum or mopKITCHENS AND REST ROOMSTables, worktops, chairs and chair arms, worktop appliances (kettle/coffee machine/microwave), fridge handles, sink and draining board, taps, cupboard and door handles, light switches, locker doors and handles. Avoid sharing containers/jars/utensilsFloor and all surfaces and touch points at end of day, dispose of J-cloths etc. Tea towels in washing machine, empty binsStaff member to clean own touch points, crockery and cutlery before leaving room. Full clean daily at start of dayFull clean daily at start of dayWipe with detergent then disinfect, or a combined product.ImmediatelyVentilate,Detergent then disinfect, or a combined productLAVATORIES/BATHROOMSDoor knobs, light switches, toilet seat, bowl and lid, flush handles or knobs, toilet brush handle, basins and tap handles, paper towel dispenser, soap dispenser pumpsAfter each use Start of dayDisinfectantDetergent then disinfect, or combined productImmediatelyDetergent then disinfectant or mixed productFloorEnd of dayVacuum or detergent followed by disinfectantSTOREROOMSDoor handles, light switches, cupboard doors, tables and surfaces,DailyDetergent, disinfectantImmediatelyDetergent then disinfectantTREATMENT ROOMSDesk surfacePatient chair – seat, back and armsTreatment couch – top, back, sides, armsChange bed roll and pillow casesTrays/trolleys – top, sides and legsAll patient touch pointsVentilate if possibleBetween each patientFull clean at start of dayDetergent then disinfectant, or combined productImmediatelyDetergent then disinfectantThorough ventilationIf possible isolate room for 72 hrs before cleaning or usingAny devices used during treatmentAny reusable PPEAny additional AGP protocolsBetween each patient if multiple use. Masks can be sessional.DisinfectImmediatelyDetergent then disinfectant or combined productDesk, work surfaces and table tops & legs, window sills, drawer handles, pens and desk furniturePatient chair seat, back and armsTrays and trolleys top, sides and legsAny items standing out on surfaces, containers, dispensers, equipmentDoor, cupboard, drawer and window handles, light switches, Basins/sinks, taps, mirrorsEquipment and devices – touch screens, keyboards, iPads, handpieces, eyewear, face shields, phones, mouse, mouse matStart of shiftClean and disinfectImmediatelyDetergent then disinfectant, or a mixed productFloorsDaily at start of dayHoover or mopAfter disinfectionWindows Doors, door frames, walls, blinds Curtains, upholstery, soft furnishingsWeekly if risk assessment indicates thisWindow cleanerDetergent, disinfectantDamp dust and hooverBefore re-useDetergent + disinfectant or combined productQuarantine, or steam clean if isolation isn’t possibleFurther resourcesPHE Best Practice: How to hand washPHE Best Practice: How to hand rubWHO How to handwash videoHow to use hand sanitiser videoPHE Covid-19 Infection prevention and control guidance Appendix 2PHE Covid-19 Infection prevention and control guidance complete[Thanks to Maddie Groves RGN for proof-reading and helpful amendments] ................
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