How to prevent getting COVID-19 infection if you are a healthcare worker

Hand hygiene measures are especially important for healthcare workers (HCW) as they come in direct contact with suspected as well as confirmed patients of the COVID-19 infection. They should follow the WHO’s ‘My 5 Moments for Hand Hygiene’ which involves washing or cleaning of hands:

• Before touching a patient
• Before doing cleaning or aseptic procedures
• After getting exposed or when at a risk getting exposed to body fluid 
• After touching a patient
• After touching patient surroundings.

Hand hygiene includes either cleaning hands with an alcohol-based hand sanitizer or with soap and water. When the hands are not visibly soiled, they can be cleaned using alcohol-based handrubs. When the hands are visibly soiled they should be washed with soap and water.

Healthcare workers who deal with soiled bedding, towels and clothes of patients who are infected with COVID-19 should take of the following safety measures:

• They should wear appropriate personal protective equipment (PPE) before coming in contact with both the patients and their soiled laundry. which includes boot covers, surgical hoods for the head, N-95 respirator (mask), protective goggles or face shield, long-sleeved water-resistant gown and surgical gloves.
• They should not carry the soiled linen in their hands. They should use a leak-proof container with a clear label pasted on it. 
• If the linen has any solid excreta on it such as faeces or vomit, the person should scrape it off carefully with a flat, firm object and dispose of it in the designated toilet. Health careworkers should make sure that they do not dispose of the excreta in the regularly used toilets.
• The laundry should be put in separate washing machines. Soiled laundry should be washed with warm water (60-90°C) and disinfecting detergent.
• If washing machines are not available, the soiled linen should be soaked in hot water and soap in a large drum. The person should use a stick to stir the laundry and avoid splashing. If hot water is not available, the HCW can also soak the dirty linen in 0.05% chlorine for approximately 30 minutes. Then rinse with clean water and dry fully under sunlight.
• Healthcare workers should remove their PPEs only after the cleaning of laundry is done.

Healthcare workers who deal with collecting, handling and transporting of clinical specimens of the COVID-19 suspected and confirmed cases should adhere to the following standard precautionary measures to reduce the risk of exposure to the virus:

• Healthcare workers who are collecting the nasopharyngeal or oropharyngeal swab specimens from the suspected and confirmed COVID-19 infected patients should be well-trained for the procedure. 
• They should be wearing PPEs all the time until the sample reaches the lab. If possible, the procedure should be done in an isolated room. 
• They can ask the patients to cover their mouth with a mask if a nasopharyngeal sample is being taken. 
• The person should be cautious while collecting the sample as there are chances that the patient might cough or sneeze after the swab is inserted into the mouth or nose.
• The samples should be handled carefully to the transport personnel who, again, should be wearing PPE. The transportation team should be well-trained in safe handling practices and spill decontamination procedures (required if the sample spills while transporting).
• The transporting staff should place the samples in a leak-proof specimen bags called secondary containers that have a separate sealable pocket for the specimen. Then this specimen container should be placed in an outer bag called the primary container which has the patient’s name or registration number label on it.

The safety of the healthcare workers also depends on the environment they are working in. Cleaning of healthcare facilities or isolation wards housing patients with suspected or confirmed cases of COVID-19 should be done on a regular basis. There are many disinfectants that are active against enveloped viruses and can be used for the cleaning of surroundings including those used for the cleaning of hospitals.

• Ethyl alcohol with 70% for cleaning and disinfecting the reusable diagnostic equipment such as thermometers. Once used, this equipment should be cleaned thoroughly before using on another patient.
• Sodium hypochlorite at 0.5% (equivalent 5000ppm) should be used for disinfection of frequently touched surfaces in isolation wards and other medical facilities.