This document deals with protocol for cleaning all clinical and non-clinical areas and other objects that an HCW will come in contact with at a clinical facility.

COVID-19 virus can potentially survive in the environment for several hours/days.

Cleaning agents and disinfectants

COVID isolation room/ screening area	Disinfectant	Contact time	Frequency
High touch surfaces	Hypochlorite 0.5% (wipe)	10 min	Twice/ shift (4 hourly)
Floor	Clean (soap & water)and then Hypochlorite 0.5% (mop)	10 min	Once/ shift (8 hourly)
Wall, ceiling	Hypochlorite 0.5% (wipe)	10 min	Once daily
Linen (used)	Hypochlorite 0.1%	30 min	As on when
Toilet	Clean (soap & water)and then Hypochlorite 0.5% (wash)	10 min	Twice/ shift (4 hourly)
Corridor	Hypochlorite 0.5% (mop)	10 min	Once / shift (8 hourly)
Non-critical equipment (stethoscope, BP cuff, thermometer etc)	Alcohol wipes		After each use
Slippers	Soap and water first and then with Hypochlorite 0.1% (dip)	10 min	Once /day
Termination disinfection	Soap and water followed by 0.5% hypochlorite	10 min	As on when needed

Area and disinfectant to be used

All other non-Corona area (ward, ICU, EMS OPD etc)	Disinfectant	Contact time	Frequency
High touch surfaces	Bacillocid extra 0.25% (wipe)	10 min	Twice/ shift (4 hourly)
Floor	Clean (soap & water)and then Bacillocid extra 0.25% (mop)	10 min	Once/ shift (8 hourly)
Wall, ceiling	Bacillocid extra 0.25% (wipe)	10 min	Once daily
Linen (used)	Hypochlorite 0.1%	30 min	As on when
Toilet	Clean (soap & water) and then Lysol 7%(wash) or Hypochlorite 0.5% (wash) or Bacillocid extra 0.5%	10 min	Twice/ shift (4 hourly)
Corridor	Bacillocid extra 0.5%	10 min	Once / shift (8 hourly)
Non-critical equipment (stethoscope, BP cuff, thermometer etc)	Alcohol wipes		After each use
Slippers	Soap and water first and then with Hypochlorite 0.1% (dip)	10 min	Once /day
Termination disinfection	Soap and water followed by Bacillocid extra 0.5%	10 min	As on when needed

Hypochlorite should be used mainly on hard, non-porous surfaces (it can damage textiles and metals)

Table surfaces, slabs, walls, windows, equipment surfaces etc:

• Wipes are recommended over spray for all reachable surfaces and high-touch areas including stainless steel, rubber and equipment surfaces
• Spray is recommended for only non-reachable surfaces. Spray should be avoided in general, as coverage is uncertain and spraying may promote the production of aerosols.
• Floor: Mop is recommended.
• Wettest (Bucket) wipes- do not use for non-critical areas like fans, walls, doors etc. First, wipe with plain water and then can disinfect with Lysol.
• PPE: Housekeeping staff should wear appropriate PPE when handling and transporting used patient care equipment (gloves) or while cleaning/disinfecting corona ward (surgical mask, gown, heavy duty gloves, eye protection if risk of splash). Boots or closed work shoes)
• Housekeeping staff should wash their hands with soap and water immediately after removing the PPE, and when cleaning and disinfection work is completed.
• Dishes and eating utensils used by a patient with known or suspected infection: No special precautions other than standard precautions such as hand hygiene and wearing gloves when handling patient trays, dishes and utensils.

Measures during mopping

• Progress from the least soiled areas to the most soiled areas and from high surfaces to low surfaces
• Remove gross soil (visible to naked eye) prior to cleaning and disinfection
• Never shake mops: Minimise turbulence to prevent the dispersion of dust that may contain micro-organisms
• Use dust control mop prior to wet/damp mop. Do not use brooms
• Wash the mop under running water before doing wet mopping
• Do not ‘double-dip’ mops (dip the mop only once in the cleaning solution, as dipping it multiple times may re contaminate it)
• An area of 120 square feet to be mopped before re-dipping the mop in the solution
• Cleaning solution to be changed after cleaning an area of 240 square feet. (i.e. change solution for every room)
• Change more frequently in heavily contaminated areas, when visibly soiled and immediately after cleaning blood and body fluid spills.
• Cleaning sequence: Always clean should be proceeded in a top-to-down sequence i.e., ceiling based equipment first, walls, then floor based equipment and lastly the floor.
  • When cleaning the floor, begin at the end farthest from the door and move towards the door (in to out)
  • The cleaning staff should always move from clean to unclean areas and never vice versa
  • When cleaning individual equipment: clean from top to down
• Eight stroke technique for mopping: In open areas use a figure eight stroke in open and wide spaces, overlapping each stroke; turn mop head over every five or six strokes.
  • While in small spaces, starting in the farthest corner of the room, drag the mop toward you, then push it away, working in straight, slightly overlapping lines and keeping the mop head in full contact with the floor.
  • Repeat until entire floor is done.
• Disinfection: After cleaning, all equipment used for cleaning , wash with soap and hot water; followed by decontamination with 0.5 hypochlorite 10 min and then dry it in sunlight
• Change the mop head when heavily soiled or at the end of the day.
• Report adverse incident to supervisor
• Collect waste, handle plastic bags from the top (do not compress bags with hands)
• Clean hands on leaving the room.

Measures during surface wiping

• Go from clean to unclean area and top to down
• No. of strokes per wipe- vary depends on area and material and size of the wipe
• Use new wipe for each use
• Never do zig-zag cleaning, never do re-dipping of cloth

Dilutions of various disinfectants:

Disinfectant concentrations	Dilution protocol
Hypochlorite 1%	Readily available in JIPMER
Hypochlorite 0.5%	1Lt of 1% hypochlorite + 1 Lt water
Hypochlorite 0.1%	100ml of 1% hypochlorite + 900 ml water
Bacillocid Extra 1%	10ml in 1Lt
Bacillocid Extra 0.5%	5ml in 1Lt
Bacillocid Extra 0.25%	2.5ml in 1Lt
Lysol 7% (phenolic compound)	15ml Lysol + 1Lt water, or 60ml in 4 Lt

How to make Sodium Hypochlorite:

Household Bleach Solution	Dilution	Preparation	Chlorine(PPM)
Neat (5%) (5.25 - 6.15%)	None	-	50000
0.5% of Sodium Hypochlorite	1:10	1 volume of neat + 9 volumes of cold tap clean water	5000
0.05% of Sodium Hypochlorite	1:100	1 volume of neat + 99 volumes of cold tap clean water	500
1% of Sodium Hypochlorite	1:5	1 volume of neat + 4 volumes of cold tap clean water	10000
0.1 % of Sodium Hypochlorite	1:50	1 volume of neat + 49 volumes of cold tap clean water	1000

High touch surfaces should be cleaned and/or disinfected more frequently (clean 4 hourly or earlier):

• Bed rails
• Bed frames
• Moveable lamps
• Tray table
• Bedside table
• Door handles
• IV poles
• Blood-pressure cuff
• Wall area around the toilet in patient room
• Edges of privacy curtain
• Mobile and telephone
• Computer, mouse, key board
• Lift buttons
• Hand rails (stair case)
• Side rails of stretches Chair arms (including wheel chairs)

Summary:

Areas/Items	Agent	Process	Method/Procedure
Stethoscope	Alcohol-based rub/Spirit swab	Cleaning	Should be cleaned with detergent and water Should be wiped with alcohol based rub/spirit swab before each patient contact
BP cuffs & covers	Detergent Hot water	Washing	Cuffs should be wiped with alcohol- based disinfectant and regular laundering is recommended for the cover
Thermometer	Detergent and Detergent and Alcohol rub Individual thermometer holder	Cleaning	Should be stored dry in individual holder Clean with detergent and tepid water and wipe with alcohol rub in between patient use Store in individual holder inverted Preferably one thermometer for each patient
Injection and dressing trolley	Detergent and water Duster Disinfectant (70% alcohol)	Cleaning	To be cleaned daily with detergent and water After each use should be wiped with disinfectant
Mobile phones and landline phones	Alcohol wipes	Front and back	Twice per shift And also before leaving workplace Switch off during wiping
Ventilator Monitor Defibrillator USG machine	Detergent followed by Alcohol (Wettask wipe or Bacilliol-25 spray)		Disinfectant will work only when detergent removes the organic matter
Ventilator tubing	ETO or plasma sterilization	Sterilization	First do enzymatic cleaning and then send for ETO /plasma sterilization Check for type-V chemical
Ventilator- suction apparatus	Bacillocid extra 1%	Disinfection	Discard the suction fluid as per BMW rule, then immerse in detergent followed by water and finally in Bacillocid extra for 10-12 min

CLEANING AND DISINFECTION SOP:

Corona isolation ward/room (when patient is occupied)

• Floor - mop with sodium hypochlorite (0.5%, 5000ppm) three times a day
• Bacillol-25 spray for reusable dedicated equipment (e.g. thermometers) every once hour
• High touch area: Wipe with sodium hypochlorite (0.5%, 5000ppm)
• Low touch area (wall and ceiling): daily once
• Designate specific well-trained staff for cleaning environmental surfaces
• Wear appropriate PPE - heavy duty gloves, mask, eye protection (goggles/face shield), long-sleeved gown, apron (if gown is not fluid resistant), and boots or closed shoes
• The supervisor must use a checklist to promote accountability for cleaning responsibilities

Terminal disinfection (After Corona patient discharge or transfer or death)

• Clean with Soap and water followed by disinfection with 0.5% hypochlorite: All surfaces and floor including walls, ceiling, toilet etc that were in contact with patient or may have become contaminated during patient care followed
• Bacillol-25 spray for reusable dedicated equipment (e.g. thermometers)
• Do not spray or fog occupied or unoccupied rooms with disinfectant - potentially dangerous practice, that has no proven benefits
• Wear appropriate PPE - heavy duty gloves, mask, eye protection (goggles/face shield), long-sleeved gown, apron (if gown is not fluid resistant), and boots or closed shoes

Cleaning of dishes and eating utensils used by a Corona infected patient

• No special precautions other than standard precautions
• Wear gloves when handling patient trays, dishes and utensils

LAUNDRY INFECTION CONTROL SOP FOR COVID:

• Never carry soiled linen against body; place soiled linen in a leak-proof bag or bucket
• Hand hygiene and PPE (surgical mask, heavy duty gloves, plastic apron, boots)
• Dedicated laundry area should be there for cleaning soiled bedding, towels and clothes from patients with COVID-19
• Soiled linen should be placed in clearly labelled, leak-proof bags or containers, carefully removing any solid excrement and putting in covered bucket to dispose of in the toilet or latrine

• If Washing machine is there:

  Wash at 60-90°C with laundry detergent followed by soaking in 0.1% Sodium Hypochlorite for approximately 30 minutes and dried

• If no machine washing is there:

  • Soaked in hot water with soap/detergent in a large drum
  • Use a stick to stir and avoid splashing
  • Empty the drum and soak linen in 0.1% sodium hypochlorite for approx. 30 minutes
  • Rinse with clean water and let linen dry fully in the sunlight

LIFT INFECTION CONTROL SOP:

• 3-4 people per lift at a time: Maintain two arm distance
• Hand rub/wash before and after lift use
• Clean high touch area of lift such as lift-buttons, rails and adjacent-wall area, door every one hour
• Clean other area of lift every 8 hourly