Coronavirus (COVID-19) Infection prevention and control ...



-30366-252158500 Coronavirus (COVID-19) Infection prevention and control guideline26 October 2020Version 5Revision historyIn the changing coronavirus (COVID-19) environment, content is often being updated. To ensure you are aware of the most recent changes, all content updates and the date the document was last updated will be highlighted in purple text and marked as updated.VersionDateRevised byChanges522 October 2020Infection Prevention and Control CellMajor structural revisionConventional use of PPEStaff attestationsAerosol TransmissionEye protection updatedPPE spotters introducedZoning concept for healthcarePAPRsUpdated showering guidanceNon-urgent patient transport upatedRespiratory protection program and hierachy of controlsCleaning section updatedMedical records/Patient charts updated4.1Infection Prevention and Control CellThe use of particulate filter respirators with valves42 September 2020Infection Prevention and Control CellInclusion of definition of close contact.Showering a suspected or confirmed COVID-19 patientUpdate to ‘Use of mobile phones in the healthcare setting’ to include other electronic devices and further information/link to cleaning of electronic equipmentInserted ‘Options for staff who work in healthcare/high risk settings and are unable to wear a surgical mask’Inserted requirements for face shieldsInserted Fit testing statementsAdded information about the use of face masks in children under 18 years of age in health care services to align with the DHHS advice 38 August 2020Infection Prevention and Control CellInserted link to ‘Disinfectants for use against COVID-19 in the ARTG for legal supply in Australia’Inserted statement that Disinfectant fogging/misting is not recommended for general use against COVID-19Updated physical distance section to align with updated physical distance advice, including references.Updated and added information on the use of face coverings/masks to align with latest DHHS guidanceUpdated extended use of PPE221 June 2020Infection Prevention and Control CellUpdate to information about:Victoria’s restrictions and physical distancing requirementsClinical transport services (non-critical) requirementsFit testingHandling medical recordsReference to Maintenance Standard for critical areas for Victorian Healthcare Facilities120 May 2020Infection Prevention and Control CellConsolidation of infection prevention and control advice into one document. Documents retired or changed:Removed – Infection Prevention and Control section from Case and contact management guidelines for health services and general practitionersRetired – Healthcare worker personal protective equipment (PPE) guidance for performing clinical proceduresRetired – Fact sheet for higher-risk healthcare workersRetired – Rational use of personal protective equipment and laboratory testingContents TOC \o "1-3" \h \z \u Contents PAGEREF _Toc54783874 \h 51.Acronyms and abbreviations PAGEREF _Toc54783875 \h 82.Background PAGEREF _Toc54783876 \h 92.1 Coronavirus (COVID-19) PAGEREF _Toc54783877 \h 9The infectious agent PAGEREF _Toc54783878 \h 92.2 National guidelines PAGEREF _Toc54783879 \h 92.3 Scope of this guideline PAGEREF _Toc54783880 \h 93.Mode of transmission PAGEREF _Toc54783881 \h 104.Definitions PAGEREF _Toc54783882 \h 104.1 Close contacts PAGEREF _Toc54783883 \h 104.2 Suspected cases PAGEREF _Toc54783884 \h 114.3 Confirmed case PAGEREF _Toc54783885 \h 114.4 Probable case PAGEREF _Toc54783886 \h 115.Infection control precautions in healthcare settings PAGEREF _Toc54783887 \h 125.1 Standard precautions PAGEREF _Toc54783888 \h 125.1.1 Hand hygiene PAGEREF _Toc54783889 \h 125.1.2 Use of face coverings/masks PAGEREF _Toc54783890 \h 135.1.3 PPE PAGEREF _Toc54783891 \h 145.1.4 Respiratory hygiene and cough etiquette PAGEREF _Toc54783892 \h 145.2 Transmission-based precautions PAGEREF _Toc54783893 \h 145.3 Physical distancing PAGEREF _Toc54783894 \h 155.4 Patient placement, movement and personal care PAGEREF _Toc54783895 \h 155.4.1 Patient placement in hospitals PAGEREF _Toc54783896 \h 155.4.2 Patient placement in residential care facilities PAGEREF _Toc54783897 \h 165.4.3 Patient movement PAGEREF _Toc54783898 \h 165.4.4 Personal care for patients PAGEREF _Toc54783899 \h 175.5 HCW cohorting PAGEREF _Toc54783900 \h 175.5.1 Patients/Residents/Clients Cohorting PAGEREF _Toc54783901 \h 176. Personal Protective Equipment (PPE) PAGEREF _Toc54783902 \h 186.1 PPE – single use or re-use PAGEREF _Toc54783903 \h 186.2 PPE – extended use PAGEREF _Toc54783904 \h 186.3 P2/N95 respirators PAGEREF _Toc54783905 \h 186.4 Protective eyewear PAGEREF _Toc54783906 \h 196.5 Gowns PAGEREF _Toc54783907 \h 206.6 Gloves PAGEREF _Toc54783908 \h 206.7 Conventional use of PPE PAGEREF _Toc54783909 \h 216.7.1 Tier 0 – Standard precautions (For patients assessed as low to no risk for coronavirus (COVID-19), that is, they do not meet the clinical criteria for coronavirus COVID-19) PAGEREF _Toc54783910 \h 216.7.2 Tier 1 – Area of higher clinical risk (In areas where the person is NOT suspected or confirmed to have coronavirus (COVID-19)) PAGEREF _Toc54783911 \h 216.7.3 Tier 2 – Droplet and contact precautions PAGEREF _Toc54783912 \h 216.7.4 Tier 3 – Airborne and contact precautions PAGEREF _Toc54783913 \h 256.8 PPE requirements for procedures PAGEREF _Toc54783914 \h 276.9 Looking after yourself when wearing PPE PAGEREF _Toc54783915 \h 286.10 Dos and don’ts of PPE use PAGEREF _Toc54783916 \h 287. HCW education and training PAGEREF _Toc54783917 \h 308.Signage PAGEREF _Toc54783918 \h 309. Respiratory Protection Program (RRP) PAGEREF _Toc54783919 \h 319.1 Overview of the respiratory protection program PAGEREF _Toc54783920 \h 319.2 Fit testing PAGEREF _Toc54783921 \h 329.3 Fit checking PAGEREF _Toc54783922 \h 329.4 PPE spotters PAGEREF _Toc54783923 \h 339.5 The use of particulate filter respirators with valves PAGEREF _Toc54783924 \h 339.5.1 Powered air-purifying respirators (PAPRs) PAGEREF _Toc54783925 \h 339.6 Options for staff who are unable to wear a surgical mask due to a medical exemption PAGEREF _Toc54783926 \h 3410.Environment and equipment management PAGEREF _Toc54783927 \h 3510.1 Environmental cleaning and disinfection PAGEREF _Toc54783928 \h 3510.1.1 Required agents for cleaning and disinfection PAGEREF _Toc54783929 \h 3510.1.2 Fogging (wet or dry) PAGEREF _Toc54783930 \h 3510.1.3 Alternative cleaning methods not outlined in this guidance PAGEREF _Toc54783931 \h 3610.2 Wearing PPE whilst undertaking cleaning and disinfection PAGEREF _Toc54783932 \h 3610.3 Cleaning and disinfection of suspected of confirmed COVID-19 inpatient room, outpatient or community setting (for example, a general practice) PAGEREF _Toc54783933 \h 3710.3.1 On discharge/transfer PAGEREF _Toc54783934 \h 3710.4 Management of equipment PAGEREF _Toc54783935 \h 3710.4 Waste management PAGEREF _Toc54783936 \h 3710.5 Linen PAGEREF _Toc54783937 \h 3810.6 Food services PAGEREF _Toc54783938 \h 3810.6.1 Crockery and cutlery PAGEREF _Toc54783939 \h 3810.7 Medical records / Patient charts PAGEREF _Toc54783940 \h 3811. General guidance for management of healthcare workers (HCWs) PAGEREF _Toc54783941 \h 3811.1 Screening PAGEREF _Toc54783942 \h 3811.2 Staff attestations PAGEREF _Toc54783943 \h 3911.3 HCW testing PAGEREF _Toc54783944 \h 3911.4 HCW clearance PAGEREF _Toc54783945 \h 3911.5 Higher risk HCWs PAGEREF _Toc54783946 \h 3911.5.1 Work options for healthcare workers in the higher-risk population PAGEREF _Toc54783947 \h 3911.5.2 Pregnant HCWs PAGEREF _Toc54783948 \h 4011.6 Uniforms and personal apparel PAGEREF _Toc54783949 \h 4011.7 Use of mobile phones and other electronic devices in healthcare settings PAGEREF _Toc54783950 \h 4012 General guidance for visitors to healthcare facilities PAGEREF _Toc54783951 \h 4212.1 Signage PAGEREF _Toc54783952 \h 4212.2 Screening PAGEREF _Toc54783953 \h 4212.3 Visiting confirmed COVID-19 cases PAGEREF _Toc54783954 \h 4213. Non-healthcare settings PAGEREF _Toc54783955 \h 4313.1 Preventing COVID-19 in the workplace PAGEREF _Toc54783956 \h 4313.2 Personal hygiene PAGEREF _Toc54783957 \h 4313.3 COVIDSafe cleaning plan for businesses PAGEREF _Toc54783958 \h 4313.4 What happens when there is a suspected or confirmed COVID-19 case PAGEREF _Toc54783959 \h 4413.4.1 Risk assessment PAGEREF _Toc54783960 \h 4413.4.2 Identify high touch surfaces PAGEREF _Toc54783961 \h 4413.4.3 Develop a coronavirus (COVID-19) deep cleaning schedule PAGEREF _Toc54783962 \h 4513.4.4 Monitoring compliance PAGEREF _Toc54783963 \h 4513.4.5 Waste PAGEREF _Toc54783964 \h 4513.4.6 Cleaning and disinfection of carpets and soft furnishings PAGEREF _Toc54783965 \h 4613.4.7 Management of linen, reusable cleaning equipment, crockery and cutlery PAGEREF _Toc54783966 \h 4613.5 Private accommodation facilities PAGEREF _Toc54783967 \h 4613.5.1 Cleaning a private residence when a coronavirus (COVID-19) case remains on the premises PAGEREF _Toc54783968 \h 4613.5.2 Cleaning when the confirmed coronavirus (COVID-19) case is no longer infectious PAGEREF _Toc54783969 \h 4713.5.3 Cleaning a multi-dwelling property or boarding house when a coronavirus (COVID-19) case remains on the premises PAGEREF _Toc54783970 \h 4713.6 Outdoor areas PAGEREF _Toc54783971 \h 4813.6.1 Public areas (playgrounds, public barbecue areas, parks) PAGEREF _Toc54783972 \h 4813.6.2 Pool areas, hot tubs or spas (private and public facilities) PAGEREF _Toc54783973 \h 4814. Care of the deceased if coronavirus (COVID-19) is suspected or confirmed PAGEREF _Toc54783974 \h 4814.1 Deaths in healthcare settings PAGEREF _Toc54783975 \h 4814.2 Deaths in the community PAGEREF _Toc54783976 \h 4914.3 Advice for funeral workers PAGEREF _Toc54783977 \h 4914. Management of an unconscious community collapse PAGEREF _Toc54783978 \h 4915. Where can I find more information? PAGEREF _Toc54783979 \h 5115.1 Cleaning and disinfection PAGEREF _Toc54783980 \h 5115.2 Educational resources PAGEREF _Toc54783981 \h 5115.2.1 COVID-19 PAGEREF _Toc54783982 \h 5115.2.2 Infection prevention and control PAGEREF _Toc54783983 \h 5115.3 Latest COVID-19 information PAGEREF _Toc54783984 \h 5115.4 Personal protective equipment PAGEREF _Toc54783985 \h 5216. References PAGEREF _Toc54783986 \h 52Acronyms and abbreviationsABHRalcohol-based hand rubAGPaerosol generating procedureAGBaerosol generating behaviourACIPCAustralasian College for Infection Prevention and ControlACSQHCAustralian Commission for Safety and Quality in Health CareCDCCenters for Disease Control and PreventionCDNACommunicable Diseases Network AustraliaCOVID-19coronavirus disease 2019EPAEnvironment Protection Authority VictoriaHCWhealthcare workerICEGinfection control expert groupPPEpersonal protective equipmentSARS-CoV2Severe Acute Respiratory Syndrome coronavirus 2TGATherapeutic Goods Administrationthe departmentDepartment of Health and Human ServicesWHOWorld Health OrganizationBackground2.1 Coronavirus (COVID-19)The infectious agentCoronaviruses are a large and diverse family of viruses that are known to cause illness of variable severity in humans, including the common cold, severe acute respiratory syndrome (SARS-CoV), and Middle East Respiratory Syndrome (MERS-CoV). Severe Acute Respiratory Syndrome coronavirus 2 virus (SARS-CoV-2) has been confirmed as the causative agent of the disease now called coronavirus disease 2019 (COVID-19). Early recognition and prompt implementation of appropriate infection prevention and control precautions is critical for preventing transmission of coronavirus (COVID-19). 2.2 National guidelinesThese infection prevention and control recommendations are based on the Communicable Diseases Network Australian (CDNA) Series of National Guidelines – Coronavirus 2019 (COVID-19) guideline <;, (start updated information) the Infection Control Expert Group (ICEG) guidelines <;, (end updated information) and the World Health Organization (WHO) guideline, Infection prevention and control during health care when COVID-19 is suspected: Interim guidance 29 June 2020 < consistent advice regarding the management of confirmed coronavirus (COVID-19) and suspected cases has evolved as further information regarding the specific risks of transmission associated with this infection have become known. As it has become available, this advice has been incorporated into this guideline.2.3 Scope of this guidelineThis guideline aims to detail the appropriate infection prevention and control measures required to prevent the transmission of coronavirus (COVID-19). The principles outlined in this document apply broadly to all settings including:Acute/Subacute careResidential care, also see COVID-19 Plan for the Victorian Aged Care Sector < health carePatient transport(start updated information) Accommodation response (hotel quarantine) program (end updated information)Non-healthcare settings, for example, office buildings, retail businesses, social venues, construction and industrial workplacesThe term patient in this document also applies to residents and clients.The advice in this document is specifically relevant for health care workers (HCWs) working in close contact with patients or the patient’s environment. For example, doctors, nurses, midwives, allied health, paramedics, students on clinical placements, personal care attendants, cleaners, food service staff and those working in other care environments such as Residential care, Hospital in the Home (HITH) and Residential in Reach (RIR).Mode of transmission(start updated information) Coronavirus (COVID-19) is predominantly spread through close contact from person to person, including between people who are physically near each other (within about 1.5 metres). Evidence to date suggests that, similar to other respiratory viruses, SARS-CoV-2 (the virus that causes COVID-19) is mainly transmitted by respiratory droplets which are spread from an infected person to others, during talking, shouting, singing, coughing or sneezing. These large droplets can also land on our hands, objects or surfaces so that the virus is transmitted through direct or indirect contact with a contaminated person, and surfaces or objects in the environment. Experts agree there is a gradient from large droplets to aerosols, however, those who have been in close or direct contact with a confirmed coronavirus (COVID-19) case are at higher risk.SARS-CoV-2 virus can also be transmitted via aerosols (or airborne transmission) in specific circumstances. The extent of transmission via aerosols (airborne transmission) is still being researched, however is well recognised during aerosol generating procedures in a health care setting, and probably important in the context of other behaviours, such as singing or shouting. That risk may be higher in certain conditions such as poorly ventilated, crowded indoor environments. Given the potential for aerosol (airborne) spread, a precautionary approach has been taken toward controlling this risk in Victoria by updates to the conventional use of Personal Protective Equipment (see section 6, PPE) in the care of patients with coronavirus (COVID-19) infection.The most effective measures to minimise the risk of transmission of SARS-CoV-2 are good hand and respiratory hygiene, physical distancing, staying home and getting tested if you are unwell, and wearing a face mask. This advice about coronavirus (COVID-19) transmission is based on the Centers for Disease Control and Prevention (CDC) advice <; which indicates that it is much more common for SARS-CoV-2 virus to spread through close contact with a person who has COVID-19 than through airborne transmission, and aligns with advice from ICEG (end updated information)Definitions4.1 Close contactsIn keeping with the modes of transmission of coronavirus (COVID-19) infection, people who are designated as close contacts of an infected person are at highest risk of acquiring infection.A person is considered a close contact if they have had face-to-face contact for greater than 15 minutes or shared a closed space for more than two hours with a confirmed case (cumulative over the course of a week), in the period extending from 48 hours before the onset of symptoms in the confirmed case. A person may also be designated as a close contact if they have been exposed to an outbreak setting or exposure site where there is a higher risk of spread in that setting.Healthcare workers (HCWs) and other people who have taken recommended infection control precautions, including the use of appropriate PPE, while caring for or in the presence of a confirmed coronavirus (COVID-19) case/s are not considered to be close contacts.HCWs and patients may be considered close contacts in the setting of an outbreak in some environments such as residential aged care facilities (RACF), even if they have not had close contact with the index case.(start updated information) In the case of an interaction between a confirmed coronavirus (COVID-19) case and another person (or people), additional factors that should be considered in assessing whether a person is a close contact include; whether the contact was in a confined space or outdoors, the wearing of PPE, the presence of signs and symptoms in the case, exposure to aerosol generating behaviours (AGBs) or procedures (AGPs), the duration of contact/nature of contact and the distance between the case and contact(s). (end updated information)Further information about close contacts, secondary close contacts, and casual contacts may be found in the department’s Case and contact management guidelines for health services and general practitioners < Suspected cases(start updated information) Suspected cases include people awaiting the results of a coronavirus (COVID-19) test, where they meet clinical criteria that could be consistent with coronavirus (COVID-19).Clinical criteria include:Fever (≥37.5°C) OR chills in the absence of an alternative diagnosis that explains the clinical presentationORAcute respiratory infection (e.g. cough, sore throat, shortness of breath, runny nose, loss of smell or loss of taste)People at higher risk (who have epidemiological risk factors, such as being a close contact, a health care or aged care worker, an aged care resident or a returned traveller) should be tested even if they have other clinical symptoms including; headache, myalgia, stuffy nose, nausea, vomiting, and diarrhoea. In this document the term high-risk suspected case refers to a person with a compatible clinical illness and who meets one or more of the epidemiological criteria (as listed above). (start updated information) 4.3 Confirmed case(start updated information) A person who tests positive to a validated SARS-CoV-2 nucleic acidORhas the virus isolated in cell culture, with PCR confirmation using a validated methodORundergoes a seroconversion to or has a significant rise in SARS-CoV-2 neutralising or IgG antibody level (that is, four-fold or greater rise in titre). (end updated information)4.4 Probable case(start updated information) A person who has detection of SARS-CoV-2 neutralising or IgG antibody AND has had a compatible clinical illness AND meets one or more of the epidemiological criteria is considered a probable case.Further information can be found in Case and contact management guidelines (end updated information)Infection control precautions in healthcare settings5.1 Standard precautionsImplementation of standard precautions is the primary strategy for the prevention of infectious disease transmission in a healthcare facility. Standard precautions protect HCWs from contact and droplet transmission regardless of a patient’s infection status by assuming that every person is potentially infected or colonised with a pathogen that could be transmitted in the healthcare setting. Standard precautions include hand hygiene, appropriate and correct use of PPE, respiratory hygiene and cough etiquette, reprocessing of reusable medical devices, cleaning of shared equipment, aseptic technique, sharps/waste handling and disposal, appropriate handling of linen and routine environmental cleaning.Standard precautions are used when treating patients who are not suspected to have coronavirus (COVID-19) however are necessary to help prevent exposure/infection by asymptomatic or pre-symptomatic carriers of coronavirus (COVID-19). These principles apply to all settings where care is provided or there is a risk of blood or body fluid exposure including acute and subacute care facilities, residential care facilities, home care settings, community settings and other settings such as mortuaries.This document does not emphasise all aspects of standard precautions that are required for all patient care; the full description is provided in the Australian Guidelines for the Prevention and Control of Infection in Healthcare <;. Elements of standard precautions that particularly apply to preventing transmission of respiratory infections, including coronavirus (COVID-19), are summarised below.5.1.1 Hand hygieneHand hygiene is the single most important strategy in preventing transmission of infections. HCWs should perform hand hygiene in accordance with the WHO My 5 Moments for Hand Hygiene <; using alcohol-based hand rub (ABHR) as per manufacturer’s recommendations unless hands are visibly soiled in which case hands should be washed with liquid soap and water for 20 seconds. Patients and visitors should also be educated about the benefits of hand hygiene and encouraged and offered the opportunity to clean their hands when appropriate.5.1.1.1 Alcohol based hand rubs (ABHR)In the healthcare setting, hand rubs must be alcohol based and either registered with the Therapeutic Goods Administration (TGA) or be a specified hand sanitiser formulation excluded from TGA regulation for the duration of the coronavirus (COVID-19) pandemic. These formulations must contain only specified ingredients and meet strict labelling requirements. Manufacturers must test the alcohol concentrations of each batch, manufacture under sanitary conditions and maintain production record-keeping. Provided that the exact formulation and other requirements are followed, these formulations are permitted for use in both healthcare facilities and for consumer use. Further information can be found on the TGA website < Hand drying methods(start updated information) Common hand drying methods include paper towels, cloth towels (reusing or sharing towels should be avoided because of the risk of cross-infection) and air dryers (warm air dryers and jet air dryers).There is currently insufficient evidence to determine if using a clean towel or an air dryer is more effective at reducing germs on your hands. Both are effective ways to dry your hands. Germs spread more easily when hands are wet, so the important thing is to dry hands completely, whatever method used.Air dryers should not be placed in clinical or patient areas as they are not only noisy but research has shown that in a healthcare environment, drying hands with paper towels may provide a superior infection control result than warm air or jet air dryers. However they may be considered in non-clinical areas, such as public toilets.Frequently touched areas of the hand dryers (i.e. buttons to activate the drying mechanism of the hand dryer) and the entire body of the dryer should be cleaned regularly. Nearby surfaces (such as the sink and taps) should also be cleaned regularly to remove any germs that may have been spread when drying hands. (end updated information)5.1.2 Use of face coverings/masks(start updated information) All Victorians must wear a fitted face mask that covers the nose and mouth when they leave home, no matter where they live. Masks should be multilayered (three layers is recommended). Face shields, bandanas, scarves, loose snoods or loose neck gaiters on their own are not considered a sufficient face covering <;. Cloth face coverings and masks should only be worn by HCWs when arriving or leaving the healthcare facility. The latest Victorian guidance on the use of PPE for HCWs is available on the department’s website < staff in high-risk areas, including non-public facing staff, must wear a level 1 or type 1 surgical mask (at a minimum) while at work. Cloth masks cannot be used at work.Some current guidelines are outlined below:Infants and children under the age of 12 are not required to wear a face covering. Due to risk of strangulation/choking it is not safe to use a face covering on a child under two years of age.Perform hand hygiene before putting on and after removing the face coveringFace coverings must cover the nose and mouth to be effectiveDo not touch the front of the face covering while wearing itDo not dangle mask under chin, under nose, placed on top of the head, or off ear.Single use masks must not be re-worn once taken off for any reasonFace coverings should not be worn around the neck for eating, drinking, smoking etcReplace if the face covering becomes damaged, damp, wet, soiled or likely contaminated.Face coverings are potentially contaminated and should not be reapplied after removal.If disposable e.g. surgical mask discard in a general waste bin after each useIf reusable e.g. cloth mask wash with hot water and detergent and dry before reuse.More information is available from:Department of health and Human Services < Victoria < Work Australia (start updated information)5.1.3 PPE HCWs must wear PPE when it is anticipated that there may be contact with a patient’s blood or body fluids, mucous membranes, non-intact skin or other potentially infectious material or equipment. PPE should be removed in a manner that prevents contamination of the HCW’s clothing, hands and the environment. In the context of COVID-19, required PPE includes; a mask or respirator, eye protection, a gown and gloves. Surgical masks must be worn in all clinical settings unless a P2/N95 respirator is required as defined by ‘A guide to the conventional use of PPE’ is available on the department’s webste <;.(start updated information) Eye protection (including safety glasses, goggles or face shields) should be worn for all patient-facing interactions regardless of whether there is the risk of splash or splattering of blood or body fluids, secretions or excretions. More information on PPE requirements is available <; (end updated information)5.1.4 Respiratory hygiene and cough etiquetteCover your nose and mouth with a disposable, single-use tissue when you cough or sneeze and discard it immediately into a bin. If you do not have a tissue, cough or sneeze into your inner elbow. Keep contaminated hands away from the mucous membranes of the mouth, eyes and nose. Hand hygiene must be performed after coughing, sneezing, using tissues, or after contact with respiratory secretions or objects contaminated by these secretions. Patients with respiratory symptoms should be provided with a surgical mask to wear, if tolerated, and placed separately to other patients while awaiting care. Any HCW who is unwell with symptoms of acute respiratory infection should not attend work and should be tested for coronavirus (COVID-19), as per testing criteria. Testing criteria can be found at Health services and general practice - coronavirus disease (COVID-19)/Current Victorian coronavirus disease COVID-19 case definition and testing criteria < Transmission-based precautionsTransmission-based precautions are applied in addition to standard precautions where the route of transmission may not be interrupted completely by standard precautions.They apply to HCWs, residential care workers, community workers, and families/visitors of those suspected or confirmed to be infected with coronavirus (COVID-19).The key concepts include:timely identification and isolation/quarantining of suspected or confirmed coronavirus (COVID-19) patients/residents/clientsprotection of HCWs, visitors and the wider community by employing transmission-based precautionsIn line with advice from the WHO and ICEG recommendations, airborne and contact precautions or droplet and contact precautions are the recommended transmission-based precautions for HCWs providing routine care of suspected and confirmed cases of coronavirus (COVID-19) infection, including during initial triaging. (see the Guide to the conventional use of PPE for health workers <;).(start updated information) Clearance from isolation or quarantine (home or in hospital) is based on a patient being symptom free for 72 hours and being at least 10 days after illness onset (or positive test date) and testing at day 11 for those in quarantine and completion of 14 days in quarantine. Details of releasing cases from isolation can be found in the department’s Case and contact management guidelines for health services and general practitioners <;. (end updated information)5.3 Physical distancingPhysical distancing is to be practiced within all clinical and non-clinical settings in a health service. It applies to interactions between staff, patients, visitors and contractors.The principles of physical distancing may be applied more broadly in any workplace setting. This includes:For enclosed roomsLimit the number of people present to maintain appropriate spaceAim for four square metres per person in an enclosed spaceUse signage to indicate the safe capacity of lifts or roomsWhile within the space, maintain 1.5 metres distance from other peopleIf 1.5 metres cannot be maintained, minimise time in close proximity or wear a maskPosition waiting room chairs 1.5 metres apart where possible or block out interval chairsRemove excess tables to limit staff congregation in staff communal areasDirect interactions between staff conducted at a distancefor example (but not limited to): ward rounds, shift handovers and meal breaksMeal breaks—consider staggering break times to limit levels of staff congregationStaff and patients to remain at least 1.5 metres apart with the exception of clinical examinations, procedures and nursing careIn residential care settings, communal activities may still proceed as long as physical distancing is practiced. This may mean smaller groups offered more frequently.More detailed and specific information on physical distancing < information on Victoria’s current restrictions < Patient placement, movement and personal care5.4.1 Patient placement in hospitalsFor coronavirus (COVID-19) patients, the following patient placement options should be used in the following order, according to facility resources:Single room with ensuite facilities, negative pressure air handling, with or without a dedicated anteroomSingle room with ensuite facilities without negative pressure air handlingSingle room without ensuite facilities and without negative pressure air handlingCohorted roomIf ensuite facilities are not available, a dedicated toilet / commode should be used where possible, ensuring the lid is closed when flushed to reduce any risk of aerosolisation. This equipment should be wiped with a disinfectant wipe or equivalent after each use. It should be clearly signed that the toilet or equipment is dedicated for the use of one patient.(start updated information) In the case of coronavirus (COVID-19) patients who are hospitalised on a ward, zoning may be applied to separate areas according to whether patients are; recovered from or test negative for coronavirus (COVID-19), suspected to have coronavirus (COVID-19), or confirmed to have coronavirus (COVID-19). (end updated information)5.4.2 Patient placement in residential care facilitiesWherever possible, a single room with ensuite facilities should be utilised for any suspected or confirmed coronavirus COVID-19 cases.PPE should be available outside the roomSpecial arrangements may be made for residents with cognitive impairmentResidents who are suspected to have coronavirus (COVID-19) should:not be cohorted while awaiting results except in some outbreak situationsnot be cohorted if coinfected with a multi-resistant organisms (e.g. methicillin resistant staphylococcus aureus [MRSA]) or other communicable diseases such as influenzabe nursed in a single room using transmission-based precautions until results are knownResidents who have had close contact (back to 48 hours prior to of onset of symptoms) with someone who has confirmed coronavirus (COVID-19):should be quarantined in a single room for 14 daysmonitored for symptomsIf coronavirus (COVID-19) is confirmed in only one resident, other residents will be classified as close contacts and need to remain in quarantine for 14 days.Residents who have left the facility to attend a medical appointment or have had a hospital inpatient admission and have had no contact with a suspected or confirmed coronavirus (COVID-19) case do not need to be isolated or quarantined upon return unless they have symptoms as described by the case definition. See testing assessment criteria <;. (start updated information) Exceptions to this recommendation exist if a resident is returning to a facility where there is an active outbreak. Recommendations for the transfer of aged care residents can be found at Aged Care Sector - Coronavirus <; and Advice for residential aged care in relation to admission and transfer into RACFs - 9 October 2020 <;.(end updated information)In the case of an outbreak of coronavirus (COVID-19) in residential aged care facilities (RACF), zoning may be applied to separate areas or rooms according to whether patients are; recovered from or test negative for coronavirus (COVID-19), suspected to have coronavirus (COVID-19), or confirmed to have coronavirus (COVID-19).5.4.3 Patient movementMovement of patients within a facility should be limited to essential purposes.If a patient who is suspected or confirmed to have coronavirus (COVID-19) needs to be transferred to another department within the facility, they should wear a surgical mask wherever possible,and if tolerated.If being transferred to another department within the facility, the receiving department should be notified in advance.HCWs transferring the patient will be required to wear clean PPE for droplet/contact precautions. If transferring via a lift, ensure the route is clear and the lift is used for the sole purpose of transferring the patient. Cleaning and disinfection must be completed to reduce environmental contamination.If an aerosolising generating procedure is expected to be performed on route (for example, intubated patient moved from operating theatre to ICU) staff should wear airborne and contact precautions (for example, a P2/N95 respirator).The medical record should not be placed on the patient’s bed.5.4.4 Personal care for patients(start updated information) Bathrooms are wet and enclosed and may be poorly ventilated, and being in this environment over a prolonged period of time could place staff at risk. Furthermore, if PPE becomes damp or soiled it will be ineffective. (end updated information)Showering a suspected or confirmed COVID-19 positive patient or resident may result in the aerosolisation of shower mist. This mist could act as a potential source of infection. This has been proven in relation to other pathogens such as legionella, but has not yet been demonstrated in the transmission of coronavirus (COVID-19).(start updated information) In the case of patients or residents who require minimal assistance with personal hygiene, the risk of transmission of coronavirus (COVID-19) to staff, may be reduced by minimising the time spent in the bathroom with a patient or resident. The risk of infection transmission may also be mitigated by using a gentle stream of water from a handheld shower head, which would reduce any risk of droplet aerosolisation.In the case of patients or residents who require direct support with their personal hygiene, alternative hygiene care (e.g. bed bath) may be provided outside of the bathroom environment if the risk of showering is deemed unacceptably high until they are cleared of their coronavirus (COVID-19) status. More information and resources <https>//dhhs..au/clinical-guidance-and-resources-covid-19> (end updated information)5.5 HCW cohortingHCWs caring for COVID-19 positive patients/residents should be cohorted where possible to avoid potential exposure of additional HCWs and patients/residents. In the context of a known outbreak of COVID-19, follow the department’s advice for cohorting staff and residents/patients.5.5.1 Patients/Residents/Clients Cohorting(start updated information) Cohorting refers to the grouping of individuals with the same condition and or same laboratory confirmed organisms in the same location (that is, room, section or building). It is appropriate to keep individuals who are confirmed or suspected to have coronavirus (COVID-19) or who meet the definition of close contact in the same area (section or floor), that is separate from those who have no coronavirus (COVID-19) risk factors or confirmed coronavirus (COVID-19) individuals who have met clearance criteria.Cohorting is necessary where the health care setting/or RACF has been declared an outbreak where the facility has limited single isolation rooms with ensuite. The goal of cohorting is to minimise interaction between infectious individuals and non-infected individuals as much as possible. Cohorting may be accompanied with zoning. Zoning refers to designating areas such as a room, or an area(wing/floor/separate building), for the management of individuals who are close contacts or with suspected or confirmed COVID-19. (end updated information)6. Personal Protective Equipment (PPE)6.1 PPE – single use or re-useWhere a PPE is labelled as single use it must not be reused.(start updated information) PPE should be available in sufficient numbers and different sizes and easily accessible by HCWs. Monitoring stock levels is key to tracking PPE usage to avoid running out and misuse of this essential resource for HCWs.If supply levels of PPE, particularly eye protection, become critical, and there are no alternatives, it may be necessary for healthcare facilities to put in strategies to allow for the decontamination and reuse. More information <; More information on PPE supply and access to PPE <; (end updated information)If a health facility does employ these strategies it is considered to be “off-label” and the health facility is responsible for any risk or associated liability. In reprocessing these items, factors to consider, aside from the removal of the infectious risk, is the damage to the integrity and function of the item which can affect its efficacy.PPE items which may be re-used are:items that may be laundered such as re-usable gownsgoggles or face shields that are described by the manufacturer as reusable and can be cleaned and disinfected between uses.Each organisation should develop a local procedure for cleaning and disinfecting these items, including which products are to be used and where cleaning and disinfection will occur.Follow the manufacturer’s instructions for the number of times an item can be reused knowing it will be dependent on what activities the item was used for and if damaged.6.2 PPE – extended useExtended use is the practice of wearing PPE for repeated close contact encounters with several different COVID-19 patients without removing between encounters.(start updated information) Extended use of PPE is dependent on the context (pandemic) and the cohort (outbreak setting).Cohort 1--- No COVID-19 casesCohort 2--- Suspected cases or close contactsCohort 3--- Probable or Confirmed cases (end updated information)Face masks and respirators – provide respiratory tract protection (for example, surgical face masks, P2/N95 respirators) must be removed and disposed of when taking breaks. However, unless damp, wet or visibly soiled, these may be worn until it becomes hard to breathe, the mask or respirator no longer conforms to the face or loses its shape, or for the duration of a clinic or shift of no more than four hours.Eye protection may similarly be worn for the duration of a shift unless contaminated.(start updated information) Extended use of gowns may occur in screening clinics where there are multiple people waiting for a COVID-19 swab collection and when providing care in a cohorted COVID-19 room or ward area as long as patients do not have known co-infections/colonisations, for example, a multi-drug resistant organism. (end updated information)6.3 P2/N95 respiratorsP2/N95 respirators (particulate filter respirators) must be worn in the following circumstances:undertaking an AGP on a person with suspected, probable or confirmed coronavirus (COVID-19) case(start updated information) the care of high-risk suspected or confirmed coronavirus (COVID-19) patients regardless of the amount of time in contactthe care of suspected and confirmed cases of coronavirus (COVID-19) in residential aged care facilitiesproviding care to a person with suspected coronavirus (COVID-19) and there is a risk of aerosol generating behaviours (including screaming, shouting, crying out and vomiting). (end updated information)P2/N95 respirators should be:discarded and replaced if contaminated with blood or bodily fluidsreplaced if it becomes hard to breathe through or if the mask no longer conforms to the face or loses its shaperemoved outside of patient care areas (for example, between wards, break room, reception area) and are to be removed before proceeding to care for patients that are not isolated for coronavirus (COVID-19).(start updated information) Further information is available in Guidance on the use of personal protective equipement (PPE) in hospitals during the COVID-19 outbreak < also the Federal guideline coronavirus (COVID-19) recommended minimum requirements for the use of masks or respirators by health and residential care workers in areas wth significant community transmission: (end updated information)6.4 Protective eyewear(start updated information) Ocular (eye) transmission of COVID-19 is a potential route of occupational acquisition for healthcare and other frontline workers. Protective eyewear provides mucosal protection and have been associated with a lower risk of infection. Eye protection is required for all patient-facing healthcare workers. Options include face shields, goggles and safety glasses. When wearing an P2/N95 respirator, it is important to select the proper eye protection to ensure that the respirator does not interfere with the correct positioning of the eye protection, and that the eye protection does not affect the fit or seal of the respirator. Fit check is required each time a respirator is worn. (start end information)Face shields should be well designed and should extend below the chin anteriorly, to the ears laterally, and there should be no exposed gap between the forehead and the shield’s headpiece. All should provide a clear plastic barrier that covers the face. (start updated information) Face shields which have a gap between the forehead and the headpiece are unsuitable for use in the operating theatre, birthing suite, or when certain aerosol-generating procedures are performed on coronavirus (COVID-19) cases (unless additional eye protection is worn under the face shield). These shields are however an appropriate form of eye protection in non-high-risk areas. Closely fitted wrap-around goggles or safety glasses that meet Australian standards are suitable eye protection, while usual prescription glasses, contact lenses or safety glasses that are not wrap-around do not provide adequate protection and are therefore not suitable. (end updated information)Single use or reusable goggles or face shields must be worn for the duration of the clinic or shift under the following conditions:Single use goggles and face shields must be removed, and disposed of when they become contaminated or after assisting with an AGP. They must be removed and disposed of before going on breaks and a new one applied on return to the clinical area.Reusable goggles and face shields must be removed, cleaned and disinfected according to the manufacturer’s guidelines and the health facilities procedure on cleaning and disinfection of reusable items. They must also be cleaned when they become contaminated or after assisting with an AGP. They must be removed, cleaned, disinfected and stored safely before going on breaks or at the end of the shift.Protective eyewear must be discarded if damaged, if visibility is obscured and cleaning does not restore visibility and if it can no longer be fastened securely to the head.(start updated information) More information regarding eye protection is available in Use of eye protection for healthcare workers factsheet <;. More information regarding cleaning and disinfection of reusable goggles and face shields is available from the Australian Government Department of Health website <;. (end updated information)6.5 GownsGowns (for example, disposable fluid-repellent gowns) provide clothing protection. If the gown is disposable and soiled, take it off and dispose of it. If the gown is reusable (non-disposable), take it off and get it reprocessed.Extended use of gowns may occur in screening clinics where there are multiple people waiting for a coronavirus (COVID-19) swab.Extended use of gowns may also occur when providing care in a cohorted coronavirus (COVID-19) room or ward area as long as patients do not have known co-infections/colonisations, for example, a multi-drug resistant organism.The same gown must not be worn between a patient with confirmed coronavirus (COVID-19) and a patient who is not yet confirmed to have coronavirus (COVID-19). This includes patients who are deemed to be a close contact or who are suspected but not yet confirmed.6.6 GlovesGloves (for example, single-use disposable gloves) provide hand protection. Gloves are never a substitute for hand hygiene. (start updated information) If they become contaminated, for example, during patient care, they should be removed, hand hygiene performed and a new pair donned. Gloves should not be washed or have ABHR applied as such practices may affect glove integrity. Gloves must always be changed between patients and hand hygiene performed.Double gloving is not recommended as an additional protective measure against coronavirus (COVID-19) acquisition. Longer cuffed gloves may be worn to prevent potential exposure to blood and body fluid contamination, for example, when performing high risk procedures or for environmental cleaning and disinfection.Gloves used in the healthcare setting must be medical grade. Refer to the standards AS/NZS 4011 and ISO 11193 (Single-use medical examination gloves) for further information.Non-sterile single-use medical gloves are available in a variety of materials, the most common being natural rubber latex (NRL) and synthetic materials (for example, nitrile). NRL remains the material of choice due to its efficacy in protecting against blood borne viruses and properties that enable the wearer to maintain dexterity. A local policy is required on using alternative glove types when patients or staff have latex allergies. (end updated information)6.7 Conventional use of PPEPPE requirements are outlined in Guidelines on the conventional use of PPE for health workers available on the Department’s website < of PPE required are described as Tier 0 to Tier 3 according to the level of patient risk for coronavirus (COVID-19) and type of clinical procedure being undertaken.Tier 0 Standard Precautions – Currently not applicable in Victorian healthcare facilitiesTier 1 Area of higher clinical risk – In areas where the person is NOT suspected or confirmed to have COVID-19.Tier 2 Droplet and contact precautions –providing care to a person who is suspected to have coronavirus (COVID-19) (excluding when undertaking AGPs or when there is an AGB).Tier 3 Airborne and contact precautions – Care of confirmed, high-risk suspected or probable cases of coronavirus (COVID-19), and when undertaking an AGP or where there is a risk of AGBs in cases with suspected, probable or confirmed coronavirus (COVID-19). This includes all patients with high-risk suspected, probable or confirmed coronavirus (COVID-19) regardless of the amount of time in contact.6.7.1 Tier 0 – Standard precautions (For patients assessed as low to no risk for coronavirus (COVID-19), that is, they do not meet the clinical criteria for coronavirus COVID-19)NOT CURRENTLY APPLICABLE as all staff are required to wear some level of PPE regardless of level of patient risk for coronavirus (COVID-19).6.7.2 Tier 1 – Area of higher clinical risk (In areas where the person is NOT suspected or confirmed to have coronavirus (COVID-19))All staff must wear (at a minimum) a level 1 or type 1 surgical mask while at work. This includes non-public facing staff. Staff who are directly involved in treating patients must also wear eye protection.Standard precautions apply, for any encounter where the risk for coronavirus (COVID-19) is determined to be low or no-risk. That is, additional PPE may be required as per an assessment of risk of exposure to blood of body fluids or when contact with non-intact skin or mucous membranes is anticipated.Ensure hand hygiene is performed in accordance with the WHO My 5 Moments of Hand Hygiene.6.7.3 Tier 2 – Droplet and contact precautionsDroplet and contact precautions means:single-use face mask (surgical mask level 2 or 3)eye protection (for example, safety glasses/goggles or face shield. Note: prescription glasses are not sufficient protection) long-sleeved gown (level 2,3 or 4)gloves (non-sterile)Masks, gloves and gowns are not to be worn outside of patient rooms (for example, between wards, break room, reception area) and are to be removed before proceeding to care for patients that are not isolated for coronavirus (COVID-19).Specific examples of use of Tier 2 PPE can be found in the Guide to the conventional use of PPE for health workers available on the department’s website < pertaining to specific areas of the hospital are mentioned below.6.7.3.1 Operating theatresWhere AGPs are to be performed in a positive pressure operating theatre, the PPE guidance set out for AGPs should be followed.A positive pressure operating room with adequate air changes will quickly eliminate the virus from the environment. The risk of infection to the HCW from an airborne source is low if the HCW is wearing the appropriate PPE. Air passing to adjacent areas becomes diluted and is not considered a risk.In addition, the following should be considered:If emergency surgery is indicated for a patient with suspected or confirmed coronavirus (COVID-19), where safe to do so, schedule the patient as the last surgical case to provide maximum time for adequate air changes and clean and disinfect the environmentMinimise the number of staff entering and leaving the theatreMinimise the amount of equipment in the roomEnsure air outlets are not blockedPlace an airborne precaution sign on every door of the theatreIf possible, intubate patient closest to the exhaust fan located in the operating roomKeep the operating room door closed after the patient is intubatedExtubate the patient in the operating roomAllow the patient to recover in the operating room rather than in the regular open recovery facilitiesLeave the room for at least 30 minutes (or as determined by the number of air exchanges per hour – see Tier 3 – Airborne and contact precautions below for further information) after the patient has left the areaBreathing circuit filters with 0.1–0.2 μm pore size can be used as an adjunct infection-control measureDispose of a single use anaesthetic circuit or reprocess a reusable anaesthetic circuit according to organisational protocolsMinimum maintenance schedules for air handling is described in the ‘Maintenance Standard for critical areas for Victorian Healthcare Facilities’ <;. The standards cover air change rates, air flow visualisation, HEPA filter validation, door seal checks and more. Scheduled maintenance should be reported to the Infection Control team 3 monthly ensuring patient safety.As an adjunct to this, air movement may be mapped on an ad hoc basis (for example, using a smoke stick) from sterile field to ventilation exhaust.6.7.3.2 Birthing suitesPPE requirements for birthing suites is outlined in the Personal protective equipment (PPE for Maternity and Neonatal services document). <; 6.7.3.3 Ambulance/paramedicsWhen providing direct patient care to a suspected or confirmed coronavirus (COVID-19) patient the following PPE should be used:Place a mask on the patient if assessed as at risk (and can be tolerated)Adhere to Tier 2 droplet/contact precautions for low-risk suspected coronavirus (COVID-19) casessingle-use surgical maskeye protection (for example, safety glasses/goggles or face shield. Note that prescription glasses are not sufficient protection)long-sleeved gown or coverallsgloves (non-sterile)Adhere to Tier 3 airborne/contact precautions for; high risk suspected coronavirus (COVID-19) cases, confirmed cases and if an AGP (for example, intubation) is to be undertaken or if there is a risk of AGBs P2/N95 respirator (for team (driver and buddy) instead of surgical maskeye protection (as above)long-sleeved gown or coverallsgloves (non-sterile)6.7.3.4 Clinical transport services (Non-Emegency Patient Transport [NEPT])Clinical transport staff are to screen all passengers for risk of coronavirus (COVID-19).Transfer of patients in non-critical transport services is dependent on individual organisation policy and procedure. Consideration should be given to the following:clinical appropriateness (for example, acuity of the patient)access to required PPE as per organisation policyability to safely don and doff PPE (has appropriate training been provided)ability to adequately clean the interior of the vehicle and timely access to appropriate facilities, consumables and equipment to undertake decontamination.Clinical transport staff need to apply physical distancing (1.5 metres) and place the client in the rear of the vehicle.(start updated information)Donning and doffing PPE processes for NEPTNEPT services are used when a person may require clinical monitoring or supervision during transport, but do not require a time critical ambulance response. In Victoria, there are seven registered service providers.NEPT transfers occur between a vast array of healthcare providers of different sizes, different building designs and different functions, including between:hospitals and/or aged care facilitieshospitals or homes (including aged care) to outpatient services or clinics or to specialist medical appointments, diagnostic services, dialysis, endoscopy and rehabilitation.Due to these factors it is challenging to develop a standardised approach for doffing PPE used at a receiving facility when transporting a person with confirmed or suspected coronavirus (COVID-19).Each health service should develop a plan to suit their particular service and this should be communicated to the NEPT provider. These plans should take into consideration how many entry points the service has and what risk of exposure there is to the general public if there are shared entry points or lifts and where the person will be required to wait if they cannot be seen immediately.The plan should include the following elements:ingress and egress paths to limit exposure or contamination during transferan agreed handover point, ensuring confidentiality is maintaineda waiting space if requireda location where it is safe to doff the PPE used for transporta location to don clean PPE and to clean the transport equipment and the vehicle (end updated information)6.7.3.5 Transferring patient home with family member (following testing in ED or discharged following admission for COVID-19 infection)Driver and patient to wear a surgical mask(start updated information) Open windows to increase vehicle ventilation to outside air andset air-conditioner to external airflow (end updated information)Remain in home isolation/quarantine until advised by the department.6.7.3.6 Residential care facilities (for HCWs, family and visitors)When providing care to residents who are low/no risk for COVID-19 a surgical mask and eye protection is required as per Tier 1. Gowns and gloves may be required as per standard precautions.(start updated information)When providing direct resident care to suspected or confirmed coronavirus (COVID-19) residents the following PPE applies:N95/P2 respirator and eye protection (for example, safety glasses/goggles or face shield. Note that prescription glasses are not sufficient protection)long-sleeved gowngloves (non-sterile) (end updated information)PPE guidance is available for residential aged care < Primary care/ Ambulatory care/ Outpatient settingsAll patients should be screened for coronavirus (COVID-19) risk factors prior to any appointments in these settings. If the patient is assessed as being low or having no risk for coronavirus (COVID-19), PPE as per Tier 1 is required; standard precautions apply for all examinations.If the patient is deemed to be at risk, suspected or confirmed to have coronavirus (COVID-19), wherever possible, appointments should be deferred until recovered or no longer at risk (for example, quarantine period is complete). If the appointment cannot be deferred, place a mask on the patient (if tolerated) and immediately place them into a single room. Use the following PPE:single-use surgical mask for low-risk suspected cases and N95/P2 respirator for high-risk suspected and confirmed caseseye protection (for example, safety glasses/goggles or face shield. Note that prescription glasses are not sufficient protection)long-sleeved gowngloves (non-sterile)6.7.3.8 Individual’s homes (HCWs providing clinical care, social services staff)All patients should be screened for coronavirus (COVID-19) risk factors prior to attending an individual’s home. If assessed as low or no risk for coronavirus (COVID-19) as per Tier 1 is required; standard precautions apply for all rmation on PPE requirements for community service providers is available < providing direct hands-on care of a confirmed or suspected coronavirus (COVID-19) person in home isolation/quarantine:(start updated information)single-use surgical mask for low-risk suspected cases and N95 respirator for high-risk suspected and confirmed cases (end updated information)eye protection (for example, safety glasses/goggles or face shield. Note that prescription glasses are not sufficient protection)long-sleeved gowngloves (non-sterile)hand hygiene products such as alcohol-based hand rub or hand wipes6.7.3.9 Taking nasopharyngeal swabsDeep nasal and oropharyngeal specimens are taken for diagnosis of coronavirus (COVID-19). Swabs may also be taken in ‘clearing’ cases following a coronavirus (COVID-19) diagnosis. Use the following PPE when taking samples from symptomatic patients:single-use surgical maskeye protection (for example, safety glasses/goggles or face shield. Note that prescription glasses are not sufficient protection.)long-sleeved gowngloves (non-sterile)6.7.3.10 Patient use of PPEIn clinical areas, communal waiting areas and during transportation, it is recommended that suspected or confirmed coronavirus (COVID-19) patients wear a surgical face mask if this can be tolerated. The aim of this is to minimise the dispersal of respiratory secretions, reduce both direct transmission risk and environmental contamination.A face mask should not be worn by patients if there is potential for their clinical care to be compromised (for example, when receiving oxygen therapy via a mask). A face mask can be worn until damp or uncomfortable.6.7.3.11 For children (0-2 years of age)Children two years old and under should never wear a face covering/ mask due to choking and strangulation risks.6.7.3.12 Children (3-17 years of age) in health servicesChildren three to seventeen years of age only need to wear a surgical face mask if they are suspected or confirmed coronavirus coronavirus (COVID-19) positive if this can be tolerated, when they are:in a primary care setting e.g. General Practitioner or paediatrician’s roomsin an outpatient departmentin an emergency department unless a single room can be organisedunable to be located in a single room in an inpatient areaoutside of their room, for example, during transfer to another department for a medical procedure6.7.4 Tier 3 – Airborne and contact precautionsAirborne/Contact precautions are required:when undertaking an AGP (see Table 1 below for list of AGPs) on a person with suspected, probable or confirmed coronavirus (COVID-19) (including a person in quarantine and an unconscious patient when a coronavirus (COVID-19) history is unknown)(start updated information) in the care of all high-risk suspected, probable and confirmed cases settings where there is risk of unplanned aerosol generating behaviours (including shouting, screaming, crying out and vomiting) (end updated information)Airborne and contact precautions means use of the following PPE:P2/N95 respirator (see fit testing and fit checking below) long sleeved gown gloveseye protection (goggles or a face shield)The care of patients with severe coughing is not considered to require airborne precautions because:4viral load does not necessarily correlate with clinical condition coughing predominantly generates dropletssurgical masks used by patient, if possible, and healthcare worker provide adequate protectionOther considerations when performing AGPs on suspected and confirmed coronavirus (COVID-19) patients:AGPs should only be carried out when essential. All non-essential clinical/surgical procedures should be delayed until the acute coronavirus (COVID-19)infection has resolved or a suspected case has been cleared.Only healthcare workers who are needed to undertake the procedure should be present.Healthcare workers who would be considered at greater risk from coronavirus (COVID-19) should avoid performing AGPs.All unnecessary equipment should be removed from the room prior to performing the AGP.AGPs should be performed in single rooms with the door closed, or in negative pressure rooms if available.After an AGP has been performed, the room will need to be left for the maximum period of time required to achieve a 99% reduction in air contaminants regardless of the type of room it was performed in (negative pressure or standard single room). A table for determining time required based on the number of air changes per hour is available on the Centers for Disease Control and Prevention (CDC) website <;. Where this cannot be determined a minimum of 30 minutes will be required.Airborne and contact precautions should be used during any cleaning and disinfection of a room where there has been an AGP performed and the time required to clear airborne contaminants has not been achieved. If cleaning and disinfection of the room is performed after this time, then contact and droplet precautions can be applied.Cleaning and disinfection of the room should be undertaken following an AGP. See the Environmental cleaning and disinfection section below for further information.PPE donning and doffing should follow your organisational procedure. Guidance is available here. < refer to the operating room section if performing an AGP in this environment.6.8 PPE requirements for proceduresTable1: Healthcare worker PPE requirements for procedures performed on patients with or without suspected or confirmed COVID-19Procedure typePatient group High-risk suspected, probable or confirmed COVID-19Unconscious patient with COVID-19 status unknownAsymptomatic patients in quarantinePPE requirementsLow-risk suspected COVID-19Symptoms that may be consistent with COVID-19 but no epidemiological risk-factorsPPE requirementsPPE requirements Non COVID-19 No risk factors for COVID-19Cleared suspected or confirmed COVID-19Aerosol generating procedures:tracheal intubation and extubationnon-invasive ventilationtracheostomycardiopulmonary resuscitationmanual ventilation before intubationbronchoscopyhigh flow nasal oxygenopen airway suctioningsputum inductionnebulisation, andspecific respiratory procedures (for example, ENT, dental and faciomaxillary).Airborne and contact precautions:N95/P2 respiratorlong sleeved gownface shield or gogglesglovesAirborne and contact precautions:N95/P2 respiratorlong sleeved gownface shield or gogglesglovesTier 1 Precautions - Surgical Mask, Eye protection and standard precautions apply, type of PPE is dependent on blood and body fluid exposure but may include3:long sleeved gownglovesNote: N95/P2 respirator used if tuberculosis is a clinical concern (for example, bronchoscopy)All other proceduresall other surgical proceduresnasopharyngeal and oropharyngeal swabcolonoscopygeneral patient care activitiesAirborne and contact precautions:N95/P2 respiratorlong sleeved gownface shield or gogglesglovesContact and droplet precautionssurgical masklong sleeved gownface shield or gogglesglovesTier 1 Precautions - Surgical Mask, Eye protection and Standard precautions apply, type of PPE is dependent on risk of blood and body fluid exposure but may include:long sleeved gownglovesFurther information regarding AGPs may be found in the Australian Government’s document Guidance on the use of personal protective equipment (PPE) in hospitals during the COVID-19 outbreak < Looking after yourself when wearing PPEIt is important that HCWs look after themselves during this time of increased use of PPE. Upon removal of PPE, HCWs should remember to practice hand hygiene, hydrate themselves well and avoid touching their faces. Regular application of hand cream should be considered. HCWs who are sensitive to latex should ensure that they wear non-latex gloves.(start updated information) Skin injuries may occur in settings where healthcare staff are wearing PPE for prolonged periods. Mechanical forces (i.e. pressure and shear) can cause pressure injuries in healthcare providers wearing PPE, specifically respirators, face shields and goggles for long periods of time. The best prevention from injury occurring as a result of respirator use is to ensure that they are only used in clinical situations when required or necessary. Wherever possible, remove the respirator every 2 to 4 hours for up to 15 minutes following correct doffing procedures to give the skin a break and relieve pressure duration. Application of a liquid seal and/protectant, pH balanced moisturising lotion or barrier creams on skin surfaces in contact with PPE may aid in preventing friction injuries and treating abrasions.Further information on facial injury and extended use <;(end updated information)6.10 Dos and don’ts of PPE useAvoid touching PPE in use (such as re-adjusting eyewear or mask). If PPE needs to be touched, hand hygiene should be performed before and after.Masks should only be touched by the ties. Masks should not be worn around the neck.If wearing a face shield a mask should be worn concurrently7. HCW education and trainingThe education and training of HCWs is a critical infection control requirement.HCWs should know and be able to recognise the signs and symptoms of coronavirus (COVID-19). (start new information) HCWs should be trained in basic infection prevention and control practices and procedures relevant to their roles, including:standard precautions and transmission-based precautionshand hygieneappropriate selection of PPE including, correct mask/respirator selectioncorrect PPE donning and doffing procedures, including fit checking of P2/N95 respiratorssafe handling and disposal of sharps/wastesafe handling of linenenvironmental cleaning and disinfection (end new information)Coronavirus (COVID-19) infection control training modules for HCWs are available from the Australian Government Department of Health < should be trained in the appropriate and correct use of PPE. Sequencing of donning and doffing is key in ensuring HCWs don’t inadvertently contaminate themselves. More information about donning and doffing PPE < relating to cough etiquette/respiratory hygiene and hand hygiene should be displayed in a variety of clinical and non-clinical settings (for example, lifts, cafeterias, waiting areas, facility and ward entry points)The department’s website includes a Cough etiquette/respiratory hygiene poster < hygiene posters on the National Hand Hygiene Initiative website < relating to physical distancing and room capacity should be widely displayed in clinical and non-clinical settings.Appropriate signage is also important for directing people to triage/screening clinic settings. Coronavirus (COVID-19) wards should have limited access (for example, key pass or code) and should have clear signage.Doors to suspected/confirmed coronavirus (COVID-19)patient rooms should remain closed and signage “Contact and Droplet precautions” or “Contact and Airborne precautions” should be clearly and prominently displayed. Examples of signage can be found on the Australian Commission for Safety and Quality in Health Care (ACSQHC) website < sequencing posters should be displayed at PPE stations. The department’s website includes an example of a PPE sequence < a patient may be undergoing an aerosol generating procedure signage should indicate no entry as a procedure is underway, and the number of people present in the room limited to essential people only.9. Respiratory Protection Program (RRP)9.1 Overview of the respiratory protection program(start new information) A Respiratory Protection Program (RPP) includes several elements designed to protect workers from workplace respiratory hazards, including airborne infectious agents, dust and other particles. Where it is identified that there is a risk of respiratory hazards, including coronavirus (COVID-19), at a workplace, employers must eliminate the risk to the greatest degree possible. The hierarchy of controls, dictates that the highest levels of protection for HCWs (and others) lies in the adoption of several elements ahead of PPE, for example; elimination of risk by isolating infected individuals, engineering controls such as ventilation and physical barriers, and administrative controls such as working from home, and staggering schedules. PPE is the lowest of all of the controls in the protection of HCWs.It is the responsibility of each employee that core elements outlined in the RPP guidelines are included in the establishment of workplace RPP in Victoria. All hospitals are required to establish a RPP by 31 October 2020.Where it is identified by a risk assessment that a HCW is required to use respiratory protection equipment (RPE), the health service has a responsibility to implement the RPP. Where is it not possible to eliminate the risk, it must be controlled so far as it is reasonably practicable. This includes fit-testing and fit-checking.Health services are responsible for:familiarising themselves and complying with this document and relevant standardsdocumenting and implementing a RPP in line with this documentproviding adequate resourcing to ensure the program’s continued effectivenessassigning and providing full support to the program administratorproviding, RPE (i.e. respirators) to minimise the risk to health and safety, including ensuring equipment is suitable for the nature of work and the hazardconsulting with workers when selecting RPEproviding education and training on the use of selected RPE undertaking HCW medical evaluation (as necessary) to support RPE selectionHCWs are responsible for:using RPE in accordance with the education and training they are providedreporting any damage, defects or non-function of the RPE providedreporting any physical or medical limitations that may have an impact on their ability to wear and use RPE correctlyFurther information regarding the complete Victorian Protection Program guidelines can be found under Victoria's Respiratory Protection Program < <;. (end new information)9.2 Fit testingFit testing refers to a standardised procedure for testing the seal achieved with an P2/N95 respirator. There are two ways of performing this test, either qualitative, using a hood and a fit test solution to determine whether the wearer can smell or taste the airborne substance, or quantitatively, using an instrument to measure the particulate levels inside and outside the respirator to calculate a fit factor. If fit testing is readily available, then it should be considered, however, if it is not reasonably practicable to conduct fit testing due to a shortage of supply of respirators it may be adequate to implement a program that includes:providing appropriate training in the selection, fit and use of a respirator, including fit checkingwhere possible, ensuring a range of respirator types and sizes are available for staff to try on before useensuring wearers are clean-shaven where the respirator touches the facemaking sure no clothing or jewellery gets between the respirator and the faceA fit-test does not remove the need for a fit-check with each mask use.A fit testing program is an important adjunct where the availability of a range of types or brands and sizes of respirators can be guaranteed.Staff should be trained in the appropriate use of P2/N95 respirators. This training should include how to safely don and doff a P2/N95 respirator and how to conduct a fit check with each use.There should be alternatives, for example, powered air purifying respirator (PAPR), available for staff working in high-risk environments who fail fit testing.In the longer term, fit testing should be part of an organisation’s on-boarding or orientation process, conducted for all staff required to use a P2/N95 respirator in the course of their work as part of a P2/N95 respirator training program.9.3 Fit checkingFit checking is the process of ensuring a P2/N95 respirator achieves a good seal once it has been applied and should occur each time a respirator is donned, even if fit testing has previously been undertaken.HCWs must perform fit checks every time they put on a P2/N95 respirator to ensure a facial seal is achieved.HCWs who have facial hair (including 1–2 day stubble) must be aware that an adequate seal cannot be achieved between the P2/N95 respirator and the wearer’s face. The wearer must either shave or seek an alternative protection.No clinical activity should be undertaken until a satisfactory fit has been achieved. Fit checks ensure the respirator is sealed over the bridge of the nose and mouth and that there are no gaps between the respirator and face. HCWs must be informed about how to perform a fit check.The procedure for fit checking includes:place of the respirator on the face so the top rests on your nose and the bottom is secured under your chin.place the top strap or ties over the head and position it high on the back of the head.pull the bottom strap over your head and position it around your neck and below your ears.place fingertips from both hands at the top of the nosepiece. Using two hands, mould the nose area to the shape of your nose by pushing inward while moving your fingertips down both sides of the nosepiece.check the negative pressure seal of the respirator by covering the filter with both hands or a non-permeable substance (for example, plastic bag) and inhaling sharply. If the respirator is not drawn in towards the face, or air leaks around the face seal, readjust the respirator and repeat process, or check for defects in the respirator.always refer to the manufacturer’s instructions for fit checking of individual brands and types of P2/N95 respirator.9.4 PPE spotters(start new information) PPE Spotters are staff who provide coaching on donning and doffing (putting on and taking off PPE. They are particularly important in the setting of high numbers or outbreaks of coronavirus (COVID-19) cases to ensure the appropriate use of PPE and to prevent HCW infection. Guidance from DHHS on PPE spotters includes the importance of a risk stratification system to guide health services in determining when a PPE Spotter is required, as well as setting clear expectations, roles and responsibilities to help ensure that the PPE Spotter is successful in monitoring compliance.More information is available on the Department’s website (end new information)9.5 The use of particulate filter respirators with valvesThere are a number of particulate filter respirators (PFRs) available which contain exhalation valves.These include but are not limited to:Elastomeric masksN99 masksExhalation valves are designed to open during exhalation to allow exhaled air to exit the respirator and then close tightly during inhalation. Exhalation valves allow the wearer to exhale more easily, however they also allow the wearer to exhale potentially infected or contaminated droplets. Exhalation valves are not appropriate for use in the case of the wearer working in a sterile field such as an operating theatre, because exhaled particles can contaminate the sterile area. While these PFRs with exhalation valves may offer equivalent protection to the user, they will not protect others if the wearer is infected. For this reason, PFRs with exhalation valves will not protect the vulnerable from the health care worker, and are not appropriate for use and fit for purpose where the required protection is often bidirectional.While there could be a potential role for the use of PFRs with exhalation valves on wards with only coronavirus (COVID-19) infected patients, this does not protect against healthcare worker to healthcare worker infection. It has been reported that internationally some PFRs with valves are being utilised with staff wearing a surgical mask underneath the PFR in order to afford greater protection. This approach is however not endorsed as appropriate.9.5.1 Powered air-purifying respirators (PAPRs)(start new information) A PAPR is a battery-powered blower that provides positive airflow through a filter, cartridge, or canister to a hood or face piece. The type and amount of airborne contaminant will dictate the type of filter, cartridge or canister required for the PAPR. PAPRs are often supplied with a loose-fitting disposable or reusable hood that eliminates the need to perform fit testing and allows use by a broad range of individuals. Some of the more recent versions may be supplied and used without a hood. PAPR respirators use a rechargeable battery pack to power an air blower. This blower pulls contaminated air into the particulate or gas filter, then into the face mask. Depending on the model, this air may blow constantly or be activated by breath. Used air then escapes from the face mask through an exhalation valve. Selection of a PAPR should be done in the context of healthcare and fit for purpose for use in healthcare. Considerations include: If a health worker is required to remain in the patient’s room continuously for a long period to perform multiple procedures e.g. more than one hour, where practical and available, the use of a powered air purifying respirator (PAPR) may be considered for additional comfort and visibility. A number of different types of relatively lightweight, comfortable PAPRs are now available and where risk assessed as suitable should be used according to the manufacturer’s instructions. Particular care should be taken on removal of the PAPR, which is associated with a higher risk of contamination. Use of a PAPR requires health care worker training and competency assessment prior to implementation. A designated doffing assistant or colleague should be considered, especially in doffing with the powered air purifying respirator (PAPR) option. Reusable components of the PAPR should be reprocessed following use, according to the manufacturers’ recommendations and comply with Australian/New Zealand Standard 4187:2014 Reprocessing of reusable medical devices in health service organizations and local facility or service processes. These items must only be purchased in consultation with the facility infection prevention and control team and/or infectious disease advice in accordance with facility/service capacity to reprocess these items. PAPR with exhalation valves should not be used due to risk of unfiltered air or SARS-CoV-2 (from an infected wearer) coming out of the exhalation valve and may contaminate the surrounding environment and potentially expose other people.For more information see; (end new information)9.6 Options for staff who are unable to wear a surgical mask due to a medical exemptionOrganisations should have a process in place to risk assess employees who are unable to wear asurgical mask and provide suitable alternatives. Depending on the role, for those in public-facing roles, or non public-facing roles but where the employee works with colleagues in a shared space, this may include:Facilitating the ability to work from homeOffering hypo-allergenic surgical masksTrying different brands of surgical masks (different materials and chemicals used in manufacturing process)Redeployment to alternative duties that do not have a public-facing role or shared spaceFor those in non public-facing supportive roles, working with colleagues in a separate building from public-facing staff, this may include:Options as aboveCommercially available, reusable cloth masksEnvironment and equipment management10.1 Environmental cleaning and disinfectionEnvironmental cleaning and disinfection are crucial to preventing transmission of infection in the healthcare environment. Coronaviruses can persist on surfaces but can be effectively inactivated by appropriate cleaning and disinfection.10.1.1 Required agents for cleaning and disinfectionAs disinfectants are inactivated by organic material, cleaning of a patient consultation room or inpatient room should be performed first using a neutral detergent. Disinfection should then be undertaken using a chlorine-based disinfectant (for example, sodium hypochlorite) at a minimum strength of 1000ppm, or any hospital-grade, TGA-listed disinfectant with claims against coronaviruses or norovirus, <.au/disinfectants-use-against-covid-19-artg-legal-supply-australia> following manufacturer’s instructions.A one-step detergent/disinfectant product may also be used. Ensure manufacturer’s instructions are followed for dilution and/or use of products, particularly contact times for disinfection.Follow the manufacturer’s safety instructions for products used regarding precautions and use of safety equipment such as gloves, safety eye wear or gown.10.1.2 Fogging (wet or dry)(start new information) The department does NOT RECOMMEND the use of dry or wet fogging for coronavirus (COVID-19) cleaning and disinfection.Dry fogging, under high pressure with a fine bore nozzle, produces uniformly fine droplets. The droplet size is less than 10 microns. This leaves surfaces dry.Wet fogging is a broad term and refers to systems which use significantly lower pressures and variation in the bore size of the nozzle. In some systems the droplet size is between 10-30 microns but other systems the droplet size is greater than 100 microns (misting). Surfaces are always left wet.Fogging requires specialised training and equipment. While it may be used in some industries for routine environmental disinfection it is not a recommended disinfection process for coronavirus (COVID-19)for the following reasons:Fogging alone does not achieve the mechanical action of cleaning (removing dirt and grime).Physical removal of dirt is an important step prior to disinfection and should not be omitted.There are potential health and safety risks associated with aerosolised chemical disinfectants including skin, eye, and respiratory irritation. This risk is increased with prolonged exposure experienced by cleaners and vulnerable occupants such as infants and people with asthma.Fogging may leave high levels of toxic residues. Soft furnishings may continue to release the chemicals for a long time after treatment resulting in potential occupational exposure risks.There is significant risk that fogging will not give the disinfectant sufficient contact with the surface to disinfect it effectively.Factors that may inhibit adequate disinfection include the following: fogging is carried out too quickly, the mist is too fine and too close to the surface, or the air flow is too great.Disinfectant solutions used for fogging, if allowed to go into the HVAC system (heating, ventilation, air conditioning) may result in potential occupational exposures to other building users.Further information can be found at Safework Australia <;. (end new information)10.1.3 Alternative cleaning methods not outlined in this guidance(start new information) If an alternative option is suggested as a coronavirus (COVID-19) cleaning solution, due diligence is required.The efficacy of alternative disinfection methods, such as ultrasonic waves, high intensity UV radiation, and LED blue light against coronavirus (COVID-19) virus is not known.The Department does not recommend the use of sanitising tunnels. There is no evidence that they are effective in reducing the spread of coronavirus (COVID-19). Chemicals used in sanitising tunnels could cause skin, eye, or respiratory irritation or damage.The DHHS only recommends the use of the?disinfectants against coronavirus (COVID-19) that are registered as previously described in this document. In response to the pandemic, TGA has permitted SARS-CoV-2 and COVID-19 virus claims and the approved disinfectants can be found on ARTG <;. (start new information)10.2 Wearing PPE whilst undertaking cleaning and disinfectionThere is no need to leave a room to enable the air to clear after a suspected or confirmed coronavirus (COVID-19) patient/resident has left the room unless there was an AGP performed. If an AGP was performed, leave the room to clear for at least 30 minutes or as determined by the number of air exchanges per hour (see Tier 3 – Airborne and contact precautions above for further information). Collection of nose and throat swabs are not considered AGPs.(start new information) Tier 2 - Droplet and contact precautions should be used during any cleaning and disinfection of a room where there has not been an AGP.Tier 3 - Airborne and contact precautions should be used during any cleaning and disinfection of a room where there has been an AGP performed and the time required to clear airborne contaminants has not elapsed since the AGP was done. (end new information)10.3 Cleaning and disinfection of suspected of confirmed COVID-19 inpatient room, outpatient or community setting (for example, a general practice)The patient room should be cleaned and disinfected using the agents listed above at least once daily, following any AGP or other potential contamination and on discharge of the patient. Particular attention should be paid to frequently (high) touched surfaces and those in closest proximity to the patient (within 1.5 metres). Frequently touched items include handrails, bedside lockers, over-bed tables, door handles, taps, toilets, IV poles, call bells, and shared equipment.Cleaning and disinfection methods as below:Clean surfaces with a neutral detergent and water firstDisinfect surfaces using a disinfectant product as noted above. Follow the manufacturer’s instructions for dilution and useA one-step detergent/disinfectant product may be used as long as the manufacturer’s instructions are followedAll linen should be washed on the hottest setting items can withstand.Wash crockery and cutlery in a dishwasher on the hottest setting possible.10.3.1 On discharge/transferClean and disinfect as above and in addition:clean, disinfect and remove any shared equipmentdiscard all consumable items that are unable to be cleanedclean all surfaces of bed and mattressclean/disinfect all surfaces, furniture and fittingschange patient privacy curtains and window curtains (if fitted) and send for laundering/dry cleaning or discard if disposabledamp mop the floor or steam clean the carpetIn the case of an outbreak of coronavirus (COVID-19)advice should be sought from Infection Prevention and Control experts as to whether additional, enhanced cleaning/disinfecting of the facility is warranted.There is no requirement to wait before the next patient is seen / admitted as long as at least 30 minutes (or as determined by the number of air exchanges per hour – see Tier 3 – Airborne and contact precautions above for further information) has elapsed since an AGP was performed.10.4 Management of equipmentPreferably, all equipment should be disposable and either single-use or single-patient-use. Where possible reusable equipment should be dedicated for the use of the case until the end of their admission or cleared of coronavirus (COVID-19). Equipment must be cleaned and disinfected according to manufacturer's recommendations prior to use on another patient. Equipment used in clinical areas should have a smooth, non-porous, intact surface to facilitate cleaning/disinfecting. Equipment that cannot be cleaned/disinfected between patients should not be reused.10.4 Waste managementSegregate waste as per Environment Protection Authority Victoria (EPA) guidelines. Waste generated during healthcare provision of a coronavirus (COVID-19) patient is considered clinical waste as per Victorian clinical waste guidelines which are available on the EPA website <;. General and clinical waste may be disposed of in the usual manner as per standard precautions.10.5 LinenBag linen inside the patient’s room. Ensure wet linen is double bagged and will not leak. Reprocess linen as per standard precautions. In residential care/outpatient/community settings that do not use commercial linen services, linen should be washed on the hottest setting items can withstand. Linen should not be taken home for laundering by relatives.10.6 Food servicesNon-essential staff should be restricted from entering coronavirus (COVID-19) patient care areas. Food trays should be delivered to and removed from patient rooms by HCWs directly caring for the patient. Unused food items should be discarded.10.6.1 Crockery and cutleryDisposable crockery and cutlery are not necessary but may be useful in the patient’s room to minimise the number of contaminated items that need to be removed. Otherwise, crockery and cutlery can be reprocessed as per standard precautions. In residential care/outpatient/community settings, use a dishwasher on the highest setting possible. If a dishwasher is not available, wash with hot water and detergent, rinse in hot water and leave to dry.10.7 Medical records / Patient chartsStandard precautions apply to the management of all patient charts/ medical records. Where possible patient charts/records should remain outside patient rooms.HCWs should not perform any documentation outside of the patient room without first removing gloves and performing hand hygiene. Facilities that utilise electronic systems are to ensure shared computer equipment can be cleaned and disinfected between patients.Manage all paper medical records that have been in the patient’s room as potentially contaminated and ensure hand hygiene is performed after handling. There is no requirement to quarantine medical records prior to returning to health information services.11. General guidance for management of healthcare workers (HCWs)11.1 ScreeningHCWs should only attend work if they are well. Prior to going to work each day, HCWs should consider whether they feel unwell and should take their own temperature.Some health services may require HCWs to be screened (temperature and/or symptom check) on site prior to starting work. Those working in a Victorian public health service are required to report to their manager if they have any of the following symptoms prior to starting work or at any time while at work:temperature equal to and higher than 37.5 degrees Celsiussymptoms of acute respiratory infection, such as cough, sore throat, shortness of breath, runny nose, or anosmia or other signs outlined at Health services and general practice - coronavirus disease (COVID-19)/Current Victorian coronavirus disease (COVID-19) case definition and testing criteria < Staff attestations(start new information) Facilities should implement daily attestations by staff that they are symptom-free prior to commencing a shift or day’s work. This is to ensure that staff are not working while unwell. It reinforces the message to remain at home if you have any signs of being unwell and can be carried out at the same time as other necessary checks.It is recommended that all providers keep records of all daily attestations for a minimum six-week period for the purposes of informing contact tracing in the event of an active outbreak. (end new information)11.3 HCW testingIf a HCW develops symptoms consistent with coronavirus (COVID-19), they should self-isolate and seek appropriate medical care. All HCWs with fever or symptoms of acute respiratory infection should be tested for coronavirus (COVID-19), as per the testing criteria.(start new information) Asymptomatic testing of HCWs working in high-risk settings is a new measure to protect both patients and staff. Asymptomatic HCWs are not required to quarantine while awaiting the results of testing. (end new information)HCWs are required to self-quarantine for 14 days after close contact with a confirmed case of coronavirus (COVID-19) without the use of appropriate PPE or if they have been designated as a close contact in an outbreak setting (see Coronavirus disease 2019 (COVID-19), Case and contact management guidelines for health services and general practitioners/Contact Management/HCWs) < HCW clearanceIf a HCW is identified as a confirmed case of coronavirus (COVID-19), they must not return to work until they are advised by the department that they meet return to work criteria (see section ‘Return-to-work criteria for health care workers and workers in aged care facilities who are confirmed cases in the Case and contact management guidelines for health services and general practitioners/Contact Management/HCWs) <;).11.5 Higher risk HCWsHCWs who are in the most-at-risk population groups for COVID-19:Aboriginal and Torres Strait Islander people 50 years and older with one or more chronic medical conditionsPeople 65 years and older with chronic medical conditionsPeople 70 years and olderPeople with compromised immune systemsPregnant women, considered potentially vulnerable, particularly from 28 weeks gestation.11.5.1 Work options for healthcare workers in the higher-risk populationSeveral options exist for workers in this category, including:Being supported to work in non-clinical facing roles, or clinical roles away from suspected or confirmed coronavirus (COVID-19) cases.Where possible, working from home, using alternative communication methods such as teleconferencing or videoconferencing.If using shared office space, designing it to ensure four square meters of space is given to each staff member. Clean work surfaces regularly.Practicing physical distancing, hand hygiene and adhere to standard precautionsAlternatively, you may want to request leave or alternate working arrangements from your employer.In all cases, refer to your health service guidelines and apply clinical judgement when determining work restrictions. Seek advice from your health service’s occupational health and safety team.11.5.2 Pregnant HCWsPregnant women do not appear to be more likely to develop severe coronavirus (COVID-19) than the general population. It is expected that most pregnant women who develop coronavirus (COVID-19) will experience mild or moderate illness from which they will make a full recovery. However, there is currently limited information available regarding the impact of coronavirus (COVID-19) on pregnant women and their babies. Therefore, it would be prudent for pregnant women to practice physical distancing, ensure good hygiene practices and adhere to Standard and Transmission Based Precautions to reduce the risk of infection.Refer to Health services and general practice - coronavirus disease (COVID-19) / Advice for Clinicians/Vulnerable Groups < Uniforms and personal apparelUniforms are made from porous fabric and do not appear to be high-risk vectors for virus contamination and transmission.Recommendations for managing uniforms and personal apparel include:having dedicated work clothes (these may be scrubs or other personal clothing items)changing out of work clothes at the end of the shiftwashing clothes at home using a hot water wash with usual detergent.11.7 Use of mobile phones and other electronic devices in healthcare settingsMobile phones and other electronic devices such as tablets, laptops, touch-screens, remote controls, mouse and keyboards are potential vectors for contamination and transmission of virus.These devices should not be taken into clinical areas unless absolutely necessary.If required in a clinical area, consider a cover/keyboard cover that can be wiped over or a sealed plastic bag that can be discarded at the end of shift.Ensure mobile phones and other electronic devices are cleaned and disinfected regularly (particularly after use in coronavirus (COVID-19) suspected/positive area) following the manufacturer’s instructions. If no manufacturer guidance is available, consider the use of detergent/disinfectant wipes or alcohol-based wipes containing at least 70% alcohol. Further information, including cleaning of screens is available at How to clean and disinfect after a COVID-19 case in the workplace < hand hygiene is performed before and after using mobile phones and other electronic devices. (start new information) Do not use or answer (end new information) mobile phones when you are wearing personal protective equipment.Avoid sharing mobile phones, headphones or ear pods of any kind.12 General guidance for visitors to healthcare facilitiesTo reduce transmission of coronavirus (COVID-19), visitor restrictions and screening procedures to prevent unwell visitors entering facilities may be required. Advice regarding current restrictions is available at Health services and general practice - coronavirus disease (COVID-19) / Restrictions on hospital visitors and workers < SignageClear signage should be posted at the entrance to facilities and departments indicating the importance of hand hygiene, respiratory hygiene, cough etiquette and screening.12.2 ScreeningVisitors should be screened for the following and not allowed to enter the facility (with some exemptions) if they:have been diagnosed with coronavirus (COVID-19) and have not been discharged from isolation/quarantinehave arrived in Australia within 14 days of the planned visithave recently come into contact with a person who is a confirmed case of coronavirushave a temperature over 37.5 degrees Celsius or symptoms of acute respiratory infection.Residents in residential care facilities may have visitors if the guidelines above are followed and in addition:have had their annual influenza vaccination (if such a vaccine is available to them). For further information on visiting restrictions for residential care facilities, see Influenza vaccination advice for residential aged care staff and visitors on the department’s website<; 12.3 Visiting confirmed COVID-19 casesVisiting confirmed cases of coronavirus (COVID-19) is discouraged due to the high likelihood of contamination of the environment of the room of an infectious confirmed case. The decision to allow visitors to a suspected or confirmed coronavirus (COVID-19) positive patient is to be managed on a case by case basis in conjunction with the treating medical team and health service Infection Prevention and Control team. (start new information) It is particularly important for facilities to consider visitors for those patients who are critically ill or at the end of life, as the infection control challenges can be managed in these circumstances. (start new information)If visiting a suspected or confirmed coronavirus (COVID-19) patient, visitors should be trained on the risk of transmission and the use of infection prevention measures including hand hygiene and the use of PPE.Visitors should also be assisted to fit and remove PPE and be supervised while in the patient room to ensure compliance with infection prevention and control measures.A log of all visitors who enter the patient room should be maintained.13. Non-healthcare settingsThese settings include office buildings, retail businesses, social venues, building and industrial workplaces.Employers have a duty to provide and maintain, so far as is reasonably practicable, a working environment that is safe and without risks to the health of employees. This includes preventing, and where prevention is not possible, reducing, risks to health and safety associated with potential exposure to coronavirus (COVID-19).Some activities in the workplace that may pose a risk of exposure to coronavirus (COVID-19) can include:work that requires employees to be in close contact with otherssharing facilities such as bathrooms, kitchens and communal break areas.using shared tools or equipmenttravelling in lifts or personnel hoists13.1 Preventing COVID-19 in the workplaceThe practice of standard precautions including hand hygiene, respiratory hygiene, cough etiquette and regular environmental cleaning, as well as physical distancing the wearing of masks, and early recognition of cases should be adequate to prevent transmission of coronavirus (COVID-19) in non-healthcare settings. For more details visit the department’s website < Personal hygieneIt is critical that workplaces:promote hand hygiene, cough etiquette and respiratory hygienediscourage staff from working if unwellprovide adequate alcohol-based hand rub for staff and consumers to use. Alcohol-based hand rub stations should be available, especially in areas where food is on display and frequent touching of produce occurs.train staff on hand hygiene and correct use of alcohol-based hand rub13.3 COVIDSafe cleaning plan for businesses (start new information) It is a requirement that every facility and workplace have a COVID-Safe plan. This must include an action plan and protocols to manage cleaning and disinfection following notification of a confirmed coronavirus (COVID-19) case. Your plan should include the following:Engagement of suitably qualified cleaning personnelAllocating personnel responsible for overseeing the processList of cleaning agents, disinfectants, tools and equipmentEnsuring cleaning equipment is well maintainedValidated method of disinfectionProcesses for ensuring cleaning equipment is cleanStorage and accessibility of cleaning equipmentAvailability of PPEEducation and training of cleaning personnel which should include the following:knowledge of appropriate cleaning products and chemicals including safe handlingwaste and laundry managementhand hygienehow to safely put on and remove PPEFurther information on environment cleaning programs <; (end new information)13.4 What happens when there is a suspected or confirmed COVID-19 case (start new information) An employer may be advised by an employee that they have symptoms of coronavirus (COVID-19) or are a confirmed case or may be notified by the department that a confirmed case had attended the workplace.Employers are required to undertake a risk assessment to inform what actions should be taken once they are aware of either a suspected or confirmed coronavirus (COVID-19) case among employees or visitors. These actions can be undertaken before contact is made by the department. For details on confirmed cases in the workplace visit <; (end new information)13.4.1 Risk assessment(start new information) The aim of a cleaning risk assessment is to determineif a workplace needs to partially or fully closethe extent of cleaning required (if any).Unless it is unreasonable to do so:All areas used or likely to have been used by the suspected or confirmed case must be vacated for cleaning and disinfection whilst awaiting further instruction and assessment by the department.If any parts of the workplace remain open, the employer must ensure these areas do not pose any ongoing risk of transmission to other staff, visitors or contractors who visit the site.If this cannot be achieved, or if a suspected or confirmed case has accessed multiple areas across the site that cannot be effectively and safely vacated for cleaning and disinfection, the whole site must be vacated until further assessment by the department.The identified area(s) will need to be closed to prevent ambulant traffic prior to and during cleaning and disinfection. When cleaning and disinfection begins, if possible, outside doors and windows should be opened to increase air circulation. (end new information)13.4.2 Identify high touch surfaces(start new information) A high touch surface is one that is touched often by multiple hands and at risk of being contaminated and of spreading germs. See examples in Table 2 below.Identify the high touch surfaces in each of the areas that the suspected or confirmed coronavirus (COVID-19) case may have touched during their infectious period. The infectious period is taken as 48 hours before onset of symptoms. (end new information)Table 2: Examples of high touch points in workplaces (start new information)Examples of high touch surfaces in common areasExamples of high touch surfaces in kitchens Examples of high touch surfaces in bathrooms and toiletsLight switches, door handles, push plates, railings, lift buttons, counters, hot desks, shared phones and computer keyboards, shared office equipment buttons, EFTPOS machines and sign-in touch screens.Tap handles, soap dispenser pumps, dining tables, seat arms and backs, water fountain buttons, fridge, cupboard and drawer handles, microwave and electrical appliance buttons.Door handles, door locks and push plates, hand basin and shower tap handles and benches, soap dispenser buttons, hand dryer buttons, toilet and urinal flush buttons, toilet lid and seat front, sanitary bin lids and safety railings in accessible toiletsMinimal touch surfaces are those that are touched less often, for example, glass windows, ceilings,curtains or floors may not be required to be cleaned unless they are visibly soiled. (end new information)13.4.3 Develop a coronavirus (COVID-19) deep cleaning schedule(start new information) Create a list of all the high touch and minimally touch points that you have identified will need to be cleaned in each room/area that the infected case has been.The proposed coronavirus (COVID-19) deep cleaning schedule should be shared with a member of the department’s outbreak team to check that it will cover the environmental risks. This may coincide with an onsite assessment or via a telephone consultation where specific information about the site layout, and, following discussions with the facility manager, confirmed which areas are required to be cleaned and disinfected. (start new information)The coronavirus (COVID-19) deep cleaning schedule should be provided to the cleaning contract company or to the in-house cleaning manager and used to direct what should be cleaned and disinfected using Therapeutic Goods Administration (TGA) approved products and methods of application It is the employer’s responsibility to ensure that the area and all surfaces identified in the checklist are free of clutter and that waste has been disposed of appropriately before the coronavirus (COVID-19) response clean is performed. (end new information)13.4.4 Monitoring compliance(start new information) After the COVID-19 deep clean has been performed, the cleaning manager or department representative should check that the clean was performed to the expected standard. This can be assessed by checking all of the high touch and required minimal touch points were cleaned as per the coronavirus (COVID-19) deep cleaning schedule, that the agreed cleaning and disinfection products used and waste was removed.Cleaning guidelines for workplaces can be found under Appendix 7 of the Cleaning Guidelines for Workplaces < ; (end new information)13.4.5 Waste(start new information) Following a confirmed coronavirus (COVID-19) case at a workplace or facility, any waste generated by deep cleaning or clean up processes should be disposed as clinical rmation on how to dispose of clinical waste can be found at the EPA website: Coronavirus (COVID-19): disposing clinical waste: (COVID-19): Disposing of PPE at home and in the workplace: (end new information)13.4.6 Cleaning and disinfection of carpets and soft furnishings(start new information) Ensure vacuum cleaner machines are fitted with HEPA filtration to prevent environmental contamination.If there are soft furnishings or fabric covered items (for example, fabric covered chairs or car seats) that have been identified to be a high touch surface and cannot be wiped clean or washed in a washing machine should be steam cleaned.Use hot water extraction cleaning equipment that releases at a minimum of 70 degrees Celsius under pressure must be used to ensure appropriate disinfection. Allow to dry thoroughly before re-use. (end new information)13.4.7 Management of linen, reusable cleaning equipment, crockery and cutlery(start new information) If there are items that can be laundered, such as towels, linen, mop heads, reusable cleaning cloths and toys launder them in accordance with the manufacturer’s instructions using the hottest setting possible. Do not shake dirty laundry as this may disperse the virus through the air. Dry items completely.Contain all linen and reusable cleaning equipment (that is, mop heads and cleaning cloths) before removal from the area in a plastic bag. Transport promptly for immediate washing.Wash crockery and cutlery in a dishwasher on the hottest setting possible. (end new information)13.5 Private accommodation facilities(start new information) Private accommodation facilities, such as private homes, multi-dwelling properties, student accommodation and boarding houses should have in place a environmental cleaning program. If a resident is a confirmed coronavirus (COVID-19) case they should be isolated from the other residents. The department’s website includes specific information on quarantine and isolation < and preparation of disinfectants has been previously described in this document. (end new information)13.5.1 Cleaning a private residence when a coronavirus (COVID-19) case remains on the premises(start new information) When a resident is sick and isolated within a home, the cleaning and disinfection of frequently touched (non-isolation) areas should continue daily by the other well residents. The living space designated for the coronavirus (COVID-19) resident should not be cleaned by other house members while the resident remains infectious. The other residents will be deemed close contacts by the department and will be in quarantine.Other residents may provide cleaning equipment to the confirmed resident if appropriate (that is if the confirmed coronavirus (COVID-19) resident is well enough to clean their own environment). If a bathroom area needs to be shared between a confirmed coronavirus (COVID-19) resident and other residents, the confirmed coronavirus (COVID-19) resident should clean and disinfect after each use. If the cleaning cannot be undertaken by the confirmed resident, a fellow resident, wearing a mask and gloves should wait as long as possible before cleaning and disinfecting and prior to being used by other residents.Clothing and bedding, if soiled, may be laundered in a domestic washing machine using the hottest possible setting (as previously described) and then dried in a tumble dryer. The confirmed coronavirus (COVID-19) resident should clean and disinfect all areas that they were in contact with whilst undertaking laundering.There may be some occasions when the confirmed coronavirus (COVID-19) resident needs to leave the isolation area. This may be to use the bathroom facilities or launder clothing and bedding. If this is essential, they should inform the fellow residents so they have time to apply a mask, they should also wear a mask, perform hand hygiene prior to leaving and ensure physical distancing of 1.5 metres is maintained. (end new information)13.5.2 Cleaning when the confirmed coronavirus (COVID-19) case is no longer infectious(start new information) When the resident is no longer infectious and has been cleared by The department and the other residents are no longer deemed close contacts, the following cleaning and disinfection should be undertaken as soon as possible.Using detergent and water, clean the furniture from cleanest to dirtiest (e.g. toilets are cleaned last) and high to low.Minimal touch surfaces such as walls may not need to be cleaned unless there is evidence of gross contamination with respiratory secretions. If required, clean only to touch height and include frequently touched surfaces.Cleaning cloths may be disposable or reusable.Using TGA listed/bleach disinfectant solution, clean the furniture from high to low (as above).Allow for contact time of disinfectant (refer to product information).Wipe off residual disinfectant.Items that may be laundered such as bedding, towels, cushion covers and reusable cleaning cloths should be placed in a domestic washing machine using the hottest possible setting (as previously described) and then dried in a tumble dryer or air dried (and if possible outside on a clothes line).Soft furnishings that cannot by laundered such as furniture, curtains and carpet may be spot cleaned with warm soapy water and vacuumed.Carpets should be vacuumed with HEPA fitted machines to prevent environmental contamination.Hard floors should be mopped with disinfectant solution.When cleaning is completed:clean and disinfect the reusable cleaning equipment such as mops and buckets, and vacuum cleaner by wiping down (steps 1-4)launder reusable cleaning clothsif disposable cleaning equipment is used, such as cloths and mop heads, discard into the general waste bin.Ensure adequate ventilation by opening windows for room/space aeration (start new information)13.5.3 Cleaning a multi-dwelling property or boarding house when a coronavirus (COVID-19) case remains on the premises(start new information) The site or property manager should maintain the environmental cleaning and disinfection schedule as out lined in environmental cleaning guidelines. (end new information)13.6 Outdoor areas13.6.1 Public areas (playgrounds, public barbecue areas, parks)(start new information) The risk of transmission from outdoor surfaces such as at outdoor facilities is low as the coronavirus (COVID-19) is unlikely to last for very long periods on outdoor surfaces, given exposure to wind, rain and sunshine (i.e. UV light). Place reminders for the public to adhere to hand and respiratory hygiene and physical distancing principles.Local Government Areas (councils) or property managers should have in place a program to clean and disinfect public toilets at least once per day. There should be processes in place toallow the public to report identified soiled surfaces.Maintain usual cleaning practices for public barbeques. Provide advice to users of public barbeques to clean them before and after use.Maintain usual cleaning practices for playgrounds and other similar outdoor areas.Spraying disinfectant on pathways, poles and paths is not an efficient use of resources and has not been shown to reduce the risk of coronavirus (COVID-19) transmission. (end new information)13.6.2 Pool areas, hot tubs or spas (private and public facilities)(start new information) There is no evidence that the virus that causes coronavirus (COVID-19) can spread directly to humans from water in pools, hot tubs or spas, or water play areas. Proper operation, maintenance, and chemical disinfection of pools, hot tubs or spas, and water playgrounds should kill the virus that causes coronavirus (COVID-19).Physical distancing of 1.5 metres and 4 square metre apply.For hydrotherapy practices, ensure clients and staff have risk assessments conducted to reduce risk. (end new information)14. Care of the deceased if coronavirus (COVID-19) is suspected or confirmed14.1 Deaths in healthcare settingsCare of the deceased death in the hospital should follow the health service’s own guidelines. Use the same level of infection prevention and control precautions to manage a deceased person as before their death.Any person having contact with the body of a person with suspected or confirmed coronavirus (COVID-19) must perform hand hygiene before and after interacting with the body and the environment and wear PPE appropriate for droplet and contact precautions. This includes a gown, disposable gloves, a surgical mask and appropriate eye protection.Additional precautions may be required, for example airborne and contact precautions, if conducting an autopsy. This will be dependent upon the risk of generation of aerosols.For more details regarding care of the deceased, refer to the guidance Handling the body of a deceased person with suspected or confirmed COVID-19 available on the Department’s website < Deaths in the communityIn the event of an unexpected death of a person with suspected or confirmed coronavirus (COVID-19) at home, family members should be advised that:they may view the body but must continue the same precautions as when they were living with the person. Family members should not touch or kiss the body.relevant authorities should not touch the body unless equipped with appropriate PPE upon arrival at the place of deaththey must leave the room (or vicinity) or maintain a distance greater than 1.5 metres when handling or transferring the body for transportationThe area of death must be cleaned and then disinfected using standard household bleach. Further information on cleaning and disinfection can be found on the department’s website < there is a suspicion that the deceased may have had undiagnosed coronavirus (COVID-19), or on request of paramedics or other first responders, the medical practitioner certifying a death in the community should take a nasopharyngeal AND/OR oropharyngeal swab for PCR testing of the deceased for coronavirus (COVID-19) and advise first responders and the family of the test results. Positive test results must be notified to the Department on 1300 651 160, 24 hours a day, to allow contact tracing to occur.14.3 Advice for funeral workersAdvice for funeral industry workers may be found in the document Handling the body of a deceased person with suspected or confirmed COVID-19 <. Management of an unconscious community collapseThe underlying principles for cardiopulmonary resuscitation (CPR) remain the same, what has changed with the coronavirus (COVID-19) pandemic is the risk to rescuers. Any attempt at resuscitation is better than no attempt. Many sudden cardiac arrests occur in the community and many will be unrelated to coronavirus (COVID-19).For lay rescuers who are unable or unwilling to do rescue breathing, compression only CPR (+/- defibrillation) is acceptable, ensuring that a mask is being worn correctly.(start new information) A flowchart for basic life support for adults in the community is available < ; (end new information)Recommendations include commencing chest compressions as soon as possible and not delaying early defibrillation of shockable rhythms. A flowchart for cardiopulmonary resuscitation of adults with confirmed COVID-19 in healthcare settings is available < clinical flowcharts are also available < any attempts at resuscitation, rescuers must adhere to current advice about hand washing, cleaning and decontamination of equipment.See also the Australian Resuscitation Council website < will be continually updated but current suggestions can be found on the International Liaison Committee on Resuscitation website < includes the suggestions that:Chest compressions and CPR have the potential to generate aerosols (weak recommendation, very low certainty evidence)In the current COVID-19 pandemic lay rescuers consider chest compressions and public access defibrillation (good practice statement)In the current COVID-19 pandemic, lay rescuers who are willing, trained and able to do so, consider providing rescue breaths to infants and children in addition to chest compressions (good practice statement)15. Where can I find more information?15.1 Cleaning and disinfectionVictorian Department of Health and Human Services Infection Prevention Control Resources < to clean and disinfect after a COVID-19 case in the workplace: Information for cleaners, business owners and managers < Government Coronavirus (COVID-19) Environmental cleaning and disinfection principles for health and residential care facilities < Government Coronavirus (COVID-19) Information about routine environmental cleaning and disinfection in the community < Educational resources15.2.1 COVID-19Australian Government, Department of Health COVID-19 infection control training module for all healthcare workers < Infection prevention and controlFurther infection prevention and control resources <https:dhhs..au/infection-prevention-control-resources-covid-19> The Australian Commission on Safety and Quality in Healthcare (ACSQHC) has developed 10 infection prevention and control modules for healthcare workers who require more detailed information on infection prevention and control. These modules are based on the content of the Australian Guidelines for the Prevention and Control of Infection in Healthcare.An orientation module on the basics of infection prevention and control is also available. This module is suitable for staff working in both clinical and non-clinical settings. All modules can be found on the ACSQHC website <;.(start new information) Foundations of infection prevention and control course by the Australasian College of Infection prevention and control (ACIPC) (end new information)15.3 Latest COVID-19 informationInfection Control Expert Group updates <; Victorian updates <; National updates <; International updates < ; World Health Organisation (WHO) resources < Personal protective equipmentA guide to the conventional use of PPE < appropriate use of personal protective equipment for coronavirus (COVID-19) in the work environment FAQ < of personal protective equipment for workplaces in the coronavirus (COVID-19) environment < PPE for maternity and newborn services < Protective Equipment (PPE) – infection control and supply <;. Includes ‘How to put on and take off your PPE’ poster and video.16. ReferencesPublic Health England (May 2020) Guidance—Reducing the risk of transmission of COVID-19 in the hospital setting <; viewed 20 May 2020Chow TT, Kwan A, Lin Z, Bai W. Conversion of operating theatre from positive to negative pressure. Journal of Hospital Infection (2006) 64, 371-378Park J, Yoo SY, Ko JH, Lee SM, Chung YJ, Lee JH, Peck KR, Min JJ. Infection Prevention Measures for Surgical Procedures during a Middle East Respiratory Syndrome Outbreak in a Tertiary Care Hospital in South Korea. Scientific Reports (2020) 10:325 Australian Government Department of Health. Guidance on the use of personal protective equipment (PPE) in hospitals during the COVID-19 outbreak. Australian Health Protection Principal Council, 19 June 2020 < Government Department of Health, Therapeutic Goods Administration. Reuse of face masks and gowns during the COVID-19 pandemic, 21 May 2020 < find out more information about coronavirus and how to stay safe visit DHHS.vic – coronavirus (COVID-19) < you need an interpreter, call TIS National on 131 450For information in other languages, scan the QR code or visit DHHS.vic –Translated resources - coronavirus (COVID-19)< any questionsCoronavirus hotline 1800 675 398 (24 hours)Please keep Triple Zero (000) for emergencies onlyTo receive this document in another format phone 1300 651 160 using the National Relay Service 13 36 77 if required, or email Infection Prevention Control Cell <COVID19InfectionControl@dhhs..au>Authorised and published by the Victorian Government, 1 Treasury Place, Melbourne.? State of Victoria, Australia, Department of Health and Human Services, 26 October 2020. ISBN 978-1-76096-213-5 (online/pdf/Word)Available under ‘Infection control guidelines’ at Infection prevention control resources <; ................
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