Infrastructure Guidance for COVID-19/COVID-19 Infection Prevention and Control
Infection prevention and control for COVID-19
Infection prevention and control in the context of Covid-19 should focus on three pillars: exposure reduction by workflow, cleaning disinfection and decontamination, and use of personal protective equipment.
General Concern:
Contact and droplet spread
Transmission of SARS-CoV-2 virus occurs via contact and droplet spread. The virus has been shown to persist on surfaces for extended periods of time and is known to be efficient at infecting people. Waste products: As SARS-CoV-02 is carried in body fluids and fecal matter, disposal of contaminated items (tissues) and cleaning regimes (spaces, garments, linen) should be accommodated carefully in the workflow design and infrastructure provision.
Limited Concern:
Water and Sewerage Contamination
The International Water Association (Link to Report) concluded that water and sewerage contamination is not considered to be a key risk factor for Covid-19. The panel expressed concern for how waste and specifically wastewater (medical) would be handled by places (e.g., hostels, hotels) that are used to serve as interim Covid-19 quarantine or testing facilities or accommodation. These are places other than hospitals that are used in the interim for such purposes and do not usually handle medical wastewater. Such facilities should be monitored carefully.
Airborne Transmission
Under exceptional circumstances, where the risk of airborne transmission arises the following should be considered. Where aerosolising activities have a potential of contaminating occupied spaces with partially diluted or undiluted contaminated air, or where this is indeterminate, aerosolising activities should be designated to an alternate area. In the event that an alternative is not available, some treatment regime (air filtration or air disinfection) may be necessary.
As SARS-CoV-2 is not considered airborne, general respiratory protection against airborne transmission is not considered necessary, except where aerosolisation of particles may be likely. The following procedures have been identified as having the potential for liberating infectious aerosols.
- tracheal intubation,
- non-invasive ventilation,
- tracheotomy,
- cardiopulmonary resuscitation,
- manual ventilation before intubation and bronchoscopy
- diagnostic sampling as patients can be induced to cough and sneeze
Administrative controls
Site Layout
ACS will accommodate a variety of clinical, logistical, support and auxiliary services associated with the render of care. Functions to be accommodated are:
Clinical services
Triage, rapid assessment of persons entering the facility, to expeditiously identify and render the appropriate service. Inpatient accommodation organised according to cohorting principles, discussed below. Testing and diagnostics, including laboratories and x-ray.
Pharmacy
Logistical
Staff entry, preparations to transition from outside to clinical work environment, including pause areas for relief. Emergency services, visitors Goods, supplies and storage Waste removal
Support services
Support services key to the provision of clinical services should be separated, so that the risks and associated with that particular activity can be managed. Support services are:
- Kitchen
- Laundry
- Mortuary
Support services can be provided off-site, in which case safe, secure and efficient transfer and logistical arrangements should be designed.
Auxiliary services may be provided on or near the ACS site. This included overnight accommodation for staff who may not wish to return home to avoid exposing their families, or who need rest between shifts, or for discharged patients awaiting transport home, volunteers who have recovered from SARS-CoV-2. Limited psychosocial services and allied health services may also be provided on or near ACS for example by approved NGOs.
Spatial configuration and layout can ensure unnecessary cross-over of function is avoided. This entails systematic separation of functions and managed transition between activities to facilitate consistency of care, an orderly, efficient work environment, less waste and reduced risk for improved outcomes. To achieve this, functional relationships should first be considered at the site level before being considered at the unit level.
