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  General advice
  Hand Hygiene
   Respiratory Etiq...
   Personal Protect...
  Face Mask
  Masks Management
  Water Supply
  Chemoprophylaxis
  General Cleaning
   References
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  Table of Contents  
BRIEF COMMUNICATION
Year : 2020  |  Volume : 30  |  Issue : 3  |  Page : 185-187
 

Infection prevention and control guidelines for COVID


1 AIIMS, New Delhi, India
2 PGIMER, Chandigarh, Punjab, India
3 SGPGIMS, Lucknow, UP, India
4 ,

Date of Submission20-Apr-2020
Date of Acceptance08-May-2020
Date of Web Publication10-Jun-2020

Correspondence Address:
Prof. Narayan Prasad
Professor of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow; Hon. Secretary, Indian Society of Nephrology on behalf of Indian Society of Nephrology.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijn.IJN_165_20

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How to cite this article:
Mahajan S, Kohli H S, Gupta K L, Prasad N, Agarwal SK, On behalf of COVID19 Working Group of Indian Society of Nephrology. Infection prevention and control guidelines for COVID. Indian J Nephrol 2020;30:185-7

How to cite this URL:
Mahajan S, Kohli H S, Gupta K L, Prasad N, Agarwal SK, On behalf of COVID19 Working Group of Indian Society of Nephrology. Infection prevention and control guidelines for COVID. Indian J Nephrol [serial online] 2020 [cited 2020 Jul 15];30:185-7. Available from: http://www.indianjnephrol.org/text.asp?2020/30/3/185/286318




In the current situation, the best way to prevent novel coronavirus disease 2019 (COVID-19) is to avoid exposure to the virus. There is currently no evidence-based treatment and effective vaccine to manage and prevent COVID-19. With the information available now, the main route of spread is between human-to-human, either from a symptomatic affected person or from an asymptomatic carrier, via respiratory droplets or contact. There is still controversy of orofecal and airborne transmission. The limited health infrastructure available and the impending risk of a potentially explosive outbreak necessitates urgent measures to control this pandemic. Social distancing and the following recommendations are found to be most useful to control the pandemic.

The following recommendations apply for all general public as well as to patients with chronic kidney disease, on dialysis and following kidney transplantation.[1],[2]


  General advice Top


  1. Avoid agglomerations and closed crowded spaces
  2. Maintain a distance of at least 1-2 meters, especially from persons with respiratory symptoms
  3. Stay home if sick or with any respiratory symptoms or even if asymptomatic, if there is a history of contact with a suspected COVID patient
  4. Avoid non-essential travel
  5. Avoid touching various surfaces unnecessarily.



  Hand Hygiene Top


  1. Wash hands with soap and water for at least 20 seconds, especially after blowing the nose, coughing, sneezing, or being in any public place
  2. If the hands are not soiled and/or soap is not available, use a hand sanitizer containing at least 60% alcohol
  3. “My 5 moments for hand hygiene” (https://www.who.int/gpsc/5may/background/5moments/en) are a simple, effective guide on how to perform hand hygiene
  4. If soap or alcohol-based hand rub is not available, chlorinated water (0.05%) can be used, though repeated use can lead to dermatitis and should be watched out for
  5. Refrain from touching your eyes, nose and mouth with unwashed hands
  6. Dry your hands with tissue paper (preferably) or with a clean, dry cloth, single-use towel or hand drier as available.



  Respiratory Etiquette Top


  1. Nose and mouth should be covered with a tissue while coughing or sneezing or inside of a flexed elbow should be used. The tissue has to be disposed of in the trash immediately, followed by proper hand hygiene.



  Personal Protective Equipment Top


Personal protective equipment are alone or combination of multiple consumable used by the healthcare worker (HCW) and other individual and include:[2]

  1. Face mask
  2. Cap or hood
  3. Goggle
  4. Face shield
  5. Shoe cover
  6. Gown
  7. Full cover or cover all.


Given the area where the HCW is working and the degree of risk involved, decides what all components of PPE one should use. Three different levels of protection are shown in [Table 1]. The guidance for the use of PPE in different health setting has been shown in [Table 2].
Table 1: Different levels of protection

Click here to view
Table 2: Guidance for use of PPE in Different Healthcare Settings

Click here to view


However, as face mask are most commonly used PPE, little more details are usefull.


  Face Mask Top


Use of face mask and type of face mask is probably the most controversial issue in current pandemic. Its use usually takes into consideration that in which area person is working and what is availability of mask. One should follow the guidelines being provided by the local health authority.[3]

  1. Any individual should wear face mask if he has respiratory tract infection, if he cares for those with respiratory symptoms or when entering a healthcare provider's place
  2. There are two broad category of face mask; three-layer surgical mask and N-95 mask
  3. A triple-layered surgical mask is sufficient for personal protection in usual situation in healthcare setting
  4. N-95 mask is necessary for following situations:


    • If HCW is working in COVID screening area
    • If HCW is performing an aerosol generating procedure like endotracheal intubation, adjustment of C-PAP or ventilator settings, nasogastric tube insertion, cardio-pulmonary resuscitation, etc.
    • While respiratory sample collection of suspected COVID-19 patient
    • While caring for known COVID-19 positive patient.



  Masks Management Top


  1. Mask must cover mouth and nose minimizing all gaps between the mask and face
  2. Do not touch the mask when in use
  3. Remove masks by removing the lace from behind. If in contact with the front of the mask/damp mask-perform hand hygiene and replace the mask
  4. If face masks are not available, homemade masks like scarfs can be used as a last resort, and it should cover the entire front and sides of the face and should extend to the chin or below
  5. Do not reuse masks


    • Most of the masks are single use mask, including N-95 mask. However, in situ ation where there is shortage of N-95 mask, there are guidelines to process N-95 mask for reuse. Such guidelines are available on CDC website. Out of various procedures suggested, one should follow process for reuse as suggested by local health authorities.



  General Cleaning Top
[4]

  1. Like other coronaviruses, COVID-19 can survive on various surfaces for 2 hours to 9 days, depending on a number of environmental factors
  2. Clean frequently used objects/surfaces daily like phones, tablets, handles, keyboards, and switches, etc.
  3. Common disinfectants such as 70% ethanol or sodium hypochlorite (0.5%) and diluted household bleach (1 part bleach to 9 parts water) used for one minute should be effective
  4. List of household detergents effective against COVID-19 is available in https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2
  5. Cleaning with soap and water can be done if surfaces are dirty
  6. Clothes of COVID-19 suspected patients should be machine washed separately with warm water at 60-90°C and following any contact with such clothes, proper hand hygiene should be performed.



  Water Supply Top


  1. Though COVID-19 has not yet been detected in drinking water, like other coronaviruses, chlorination and disinfection with ultraviolet light as done in conventional, centralized water treatment methods should be effective
  2. If a centralized supply is not available, household water treatment methods, including boiling, using nanomembrane filters, chlorine, or UV irradiation, may be used.



  Chemoprophylaxis Top
[5]

The National task force for COVID-19 by Indian Council of Medical Research (ICMR) has recommended the use of hydroxy-chloroquine ONLY for prophylaxis in high-risk population viz. asymptomatic HCWs involved in the care of suspected/confirmed cases of COVID-19 and asymptomatic household contacts of laboratory confirmed cases. The doses recommended are 400 mg twice a day on day one followed by 400 mg once a week for seven weeks for health care workers and 400 mg twice a day on day 1, followed by 400 mg once a week for three weeks for asymptomatic household contacts of confirmed cases. However, in view of various side effects of the drug, it should only be given under prescription by registered medical practitioner. Further, as of now efficacy of the drug in above given setting has not been proven by randomized controlled trial.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Water, sanitation, hygiene, and waste management for the COVID-19 virus: Interim guidance. 2020. Available from: https://apps.who.int/iris/handle/10665/331499. [Last accessed 2020 Mar 19].  Back to cited text no. 1
    
2.
Appropriate use of various types of Personal Protective Equipment. Available from: https://www.aiims.edu/images/pdf/notice/PPE%20guideline%20chart%20final_1.pdf. [Lats accessed on 2020 Apr 15].  Back to cited text no. 2
    
3.
Advice on the use of masks in the community, during home care and in healthcare settings in the context of the novel coronavirus (2019- nCoV) outbreak: Interim guidance. 2020. Available from: https://apps.who.int/iris/handle/10665/330987. [Last accessed 2020 Mar 20].  Back to cited text no. 3
    
4.
CDC general practice recommendations. Available from: https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html. [Last accessed 2020 Apr 08].  Back to cited text no. 4
    
5.
Recommendations for empiric use of hydroxyl-chloroquine for prophylaxis of SARS-CoV-2 infection. National task force for COVID-19.  Back to cited text no. 5
    



 
 
    Tables

  [Table 1], [Table 2]



 

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