Information on COVID 19

1 Introduction

The current COVID-19 epidemic is caused by the coronavirus SARS-CoV-2, which belongs to the coronovirus family ( c oronoviridae) , a large family of RNA viruses. To date, the SARS-CoV-2 virus has been detected in respiratory, faecal and blood samples. The main route of transmission of the SARS-CoV-2 virus is directly through droplets produced when an infected person coughs or sneezes and indirectly through contact with infected surfaces (through hands which, without prior hygiene, touch the mucous membranes of the nose , mouth and eyes).

2. Presence of SARS-CoV-2 virus in the environment

Data on the time and conditions affecting the survival of the SARS-CoV-2 virus in the environment are currently limited. A study conducted at a Chinese hospital during the COVID-19 pandemic on the contamination of areas treated for COVID-19 infection showed that positive samples for the virus were found in Intensive Care Units (ICUs), delivery rooms and nursing clinics. The SARS-CoV-2 virus was also detected on computer keyboards and door knobs. The virus was detected with a frequency of 15.4% in gloves and 1.7% in masks or glasses.

Other recent studies, which have examined the survival of SARS-CoV-2 on surfaces, show that the virus survives up to: 4 hours on copper, 24 hours on cardboard and 2-3 days on plastic or stainless steel surfaces, but with significantly reduced viral load. Also, a study performed in rooms of patients with COVID-19 infection showed different levels of environmental contamination, ranging from 1 positive environmental sample for SARS-CoV-2 virus in 13 samples and 13 positive environmental samples in 15. Finally, controlled laboratory production experiments aerosol showed that the environmental stability of SARS-CoV-2 virus reaches 3 hours in the air after aerosol production.

The above data confirm the presence of the SARS-CoV-2 virus in the surrounding area of ​​patients with COVID-19 and reinforce the view that surfaces and objects play a role in the spread of the virus. Adequate cleaning and disinfection of the environment is therefore considered necessary to limit the spread of the SARS-CoV-2 virus.

3.Environmental measures to control the spread of COVID-19 infection

Environmental measures to control the spread of the virus include:

• adequate ventilation of the premises
• systematic cleaning and disinfection of used surfaces, objects, equipment and clothing (bedding, towels, clothing)
• waste management

4.Instructions for ventilation, cleaning and disinfection of healthcare facilities exposed to SARS-CoV-2 virus

4.1. General recommendations for ventilation

• Cooperation with the technical service is necessary to establish guidelines for the protection of workers and patients, depending on the way of ventilation / air conditioning of each room and the presence or absence of HEPA (high efficiency particulate air) filters.
• The time that the air in a room without negative pressure remains  potentially  contagious is not known and may depend on various factors, such as the size of the room, the number of air changes per hour, the length of time the patient has been in the room. , if the patient had a severe cough or sneeze and if an aerosol-producing operation was performed ¹ . Therefore all these factors must be taken into account for the ventilation time of the room.
• Potential air pollution is reduced from 100% to less than 1% within 30 minutes for a room with active ventilation 10 to 12 air changes per hour (ACH) and within 1 hour for a room with active ventilation 6 air changes per hour (ACH ).
• Recycling of air without ensuring its continuous cleaning with HEPA filters should be completely avoided, especially in aerosol production areas. More information on measures to ensure Public Health from viral and other infections when using air conditioners are available in a relevant circular of the Ministry of Health at the following link: https://www.moh.gov.gr/articles/health/dieythynsh- dhmosias-ygieinhs / metra-prolhpshs-enanti-koronoioy-sars-cov-2/7108-lhpsh-metrwn-diasfalishs-ths-dhmosias-ygeias-apo-iogeneis-kai-alles-loimwksei-s-kata-th klimatistikwn-monadwn .
• The use of portable units with HEPA filters to filter the air near the patient’s point is an appropriate solution, where required.
• The spaces  with natural ventilation, which examined patients  with suspected or confirmed COVID-19 infection, must be  adequately ventilated  and the doors constantly closed unless it is autonomous space (building or isobox) outside the hospital building, where the door can be left open, if the general conditions allow (eg distance from adjacent buildings, presence of passers-by).
• The  space L with natural / passive ventilation which have not been handled generating aerosol  in cases of suspected or confirmed infection COVID-19 is recommended to be  ventilated with fresh air for 1 hour to accept new patient who is not suffering from infection  COVID -19  (eg CT scan if there is no active ventilation system with specific air changes per hour) .  Cleaning can be done in 1 hour if the cleaning staff wears the required personal protective equipment.

[1] Manipulations that may cause aerosol include: endotracheal intubation, intubation, non-invasive mechanical ventilation, tracheotomy, manual ventilation (AMBU use), bronchoscopy, open aspiration, resuscitation, nebulization, placement cardiopulmonary resuscitation.

• The  space L with natural / passive ventilation which have been handled producing aerosol in cases of suspected or confirmed COVID-19 infection recommended  ventilated with fresh air for 1-3 hours to accept new patient who is not suffering from COVID -19 infection  . These sites do not include sites where a SARS-CoV-2 pharyngeal smear is obtained, because a nasopharyngeal or pharyngeal sampling for the SARS-CoV-2 virus is not considered as an aerosol production operation in itself. This practice is sometimes included in the list of aerosol-producing treatments, as it may cause the patient to cough and / or sneeze at the time of sampling and therefore increase the risk of exposure to the personnel collecting the sample as it is close to patient.
• The ventilation times mentioned in the two paragraphs above do not concern the personnel of the sanitary unit, who can normally enter the mentioned areas, wearing the necessary personal protective equipment, as the case may be.

4.2. General recommendations for cleanliness and disinfection

• Systematic and proper cleaning with the usual procedure (use of detergent, water and mechanical abrasion) and disinfection of surfaces and objects in health care areas, is crucial. It is noted that spraying the area or nebulizing as a method of disinfection is not recommended .
• The basic principles of cleanliness and disinfection apply to the cleanliness and disinfection of premises and equipment, which each health service area should have established by applying the necessary procedures regarding:
• the manner of cleaning and disinfection, including the use of appropriate personal protective equipment, as appropriate;
• the types / categories and quantities of cleaners and disinfectants used depending on the space, surface or equipment and the required level of disinfection (high, medium, low),
• the management of cleaning equipment and
• staff training.
• All surfaces potentially contaminated with SARS-CoV-2 virus (including objects) must first be cleaned with neutral detergent and water and thorough mechanical abrasion and then – after drying – disinfected, depending on compatibility of the material in the disinfectant, with:
  • Disinfectant preparation, with proven action against invertebrates , approved by the competent bodies, always following the manufacturer’s instructions and national legislation, regarding the effective (application for as long as recommended) and safe use of the product,

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• Fresh solution of sodium hypochlorite with a concentration of 0.1-0.5%  (1000 ppm – 5000 ppm of available chlorine) for  at least 1 minute , depending on the space, the desired level of disinfection and the procedures of the sanitary unit.
  • In case the initial concentration of sodium hypochlorite is 5%, the final concentration of 0.1% (1000 ppm of available chlorine) is achieved with a dilution of 1:50 (20ml: 1000ml). Respectively the final concentration of 0.5% (5000 ppm of available chlorine) is achieved by diluting 1:10 (100ml: 1000ml).
  • In case the initial concentration of sodium hypochlorite is different from 5% the calculation of the required dilution for a final concentration of 0.1% – 0.5% (1000 ppm – 5000 ppm of available chlorine) is obtained with the following formula:

[% initial concentration of sodium hypochlorite  ∕  % desired final concentration] – 1 = Total parts of water for each part of sodium hypochlorite].

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• Ethanol-based solution, in a concentration of 70-80%, for at least 1 minute,  especially for surfaces that are likely to be damaged by the use of sodium hypochlorite or some other disinfectant.

4.3. During hospitalization of a suspected or confirmed case of COVID -19 infection 

• Ventilated areas, where patients with possible or confirmed COVID-19 infection are treated, should be adequately ventilated and their door kept closed at all times.
• The patient’s main hospital and isolation room should be cleaned at least once a day. Cleaning should start in the cleanest areas and end in the dirtiest.
• It is recommended that the cleaning equipment be disposable or exclusive. Disposable cleaning equipment (which is disposable) must be treated as contaminating waste. If the cleaning equipment (eg cleaning cloths) is not disposable, it must be cleaned and disinfected after each use.
• In case of leakage or spillage of biological fluids on a surface, the surface must be cleaned immediately with the usual procedure of the sanitary unit.
• Toilets, sinks and toilets in general should be carefully cleaned and disinfected to avoid splashes.
• Frequent cleaning and disinfection (at least 2 times a day) of frequently touched surfaces (eg knobs, keyboards, etc.) is recommended.

4.4. After the discharge of a confirmed case for COVID -19 infection 

• After the patient leaves the hospital, a general cleaning of the ward should be performed, after the room is adequately ventilated (according to the recommendations of paragraph 4.1.).

4.5. Medical equipment

• The use of disposable medical equipment is recommended where possible.
• In case the medical equipment is not disposable, the use of exclusive equipment for the care of patients with COVID-19 infection is recommended.
• In case the medical equipment used is reusable and used:
  • exclusively for the care of patients with confirmed COVID-19 infection, to be cleaned and disinfected according to the procedures of the health unit (always taking into account the multi-  resistant pathogens that may coexist with the SARS-CoV-2 virus)
  • for the care of other patients (excluding patients with confirmed COVID-19 infection), to be  cleaned and disinfected  after each use  in a patient with possible or confirmed COVID-19 infection  .

4.6. Bed linen, towels, curtains and clothing

• Used bedding, towels, curtains and clothing should be placed in a bag according to infectious clothing procedures.
• The clothes should be washed in the washing machine at a temperature (60 ^ο -90 ^ο C) using detergent. If the nature of the fabric does not allow the use of high temperature, bleach or other suitable fabric disinfectant should be added to the wash.

4.7. Waste management

• All waste / waste from the care of patients with possible or confirmed COVID-19 infection should be treated as infectious hospital waste and managed in accordance with the procedures of the health facility and national legislation.

4.8. Cleaning staff and personal protective equipment

• Cleaning and disinfection must be performed by qualified personnel, trained in the use of personal protective equipment and in particular in its proper selection, application, use, removal and disposal.
• The required personal protective equipment for cleaning staff includes:
  • For areas that are not handled that produce aerosol
    • Surgical mask or mask of high respiratory protection FFP2 / Ν95 / ΚΝ95 if available (always taking into account exposure factors such as: the presence or absence of a patient in the room, if there has been adequate ventilation, etc.)
    • Waterproof robe
    • Gloves
    • Eye protection (goggles or face shield), especially if there is a risk of splashing on organic material or chemicals
    • Closed work shoes
  • For areas that are handled that produce aerosol
    • High respiratory protection mask FFP2 / FFP3 / Ν95 / ΚΝ95
    • Waterproof robe
    • Gloves
    • Eye protection (goggles or face shield), especially if there is a risk of splashing on organic material or chemicals
    • Closed work shoes
    • Hand hygiene should always be followed after cleaning, disinfecting and disposing of personal protective equipment: washing with soap and water for at least 20 seconds or, if this is not possible, using an antiseptic solution containing 60-95% ethanol.

ΠΗΓΗ: https://eody.gov.gr/