Coronavirus: Healthcare Infection Control Precautions for COVID-19 (formerly 2019 Novel Coronavirus or nCoV-19)

Human coronaviruses¹ are common throughout the world. Human coronaviruses commonly cause mild to moderate illness. Two newer human coronaviruses, MERS-CoV and SARS-CoV, have been known to cause severe illness. A novel coronavirus, COVID-19 (formerly 2019-nCoV), emerged in 2019 and is causing concern.

What is COVID-19 acute respiratory disease (COVID-19)?²

• Chinese authorities identified the new coronavirus originating in Wuhan, China.
  This virus has resulted in thousands of confirmed cases, the majority of which are in China, with additional cases being identified in a growing number of countries internationally. Effective January 27, 2020, the United States Department of Health and Human Services (DHS) declared a public health emergency for the entire United States to aid the nation’s healthcare community in responding to 2019 novel coronavirus. The Centers for Disease Control and Prevention (CDC) is working closely with state health departments on disease surveillance, contact tracing, and providing interim guidance for clinicians on identifying and treating coronavirus infections.
• Clinical signs and symptoms include fever and symptoms of lower respiratory illness (e.g., cough, shortness of breath).
• Early on, many patients in the outbreak in Wuhan, China reportedly had some link to a large seafood and animal market, suggesting animal-to-person spread. However, a growing number of patients reportedly have not had exposure to animal markets, suggesting person-to-person spread is occurring, though it’s unclear how easily or sustainably this virus is spreading between people. The situation with COVID-19 is still unclear and evolving rapidly. While severe illness, including illness resulting in numerous deaths, has been reported in China, other patients have had milder illness and been discharged. Person-to-person transmission has been reported in healthcare workers who were caring for some of the ill people in China.

What are the healthcare infection control precautions for COVID-19?³
Although the transmission dynamics have yet to be determined, CDC currently recommends a cautious approach to patients under investigation for COVID-19:

• Patients should be asked to wear a surgical mask as soon as they are identified and be evaluated in a private room with the door closed, ideally an airborne infection isolation room if available.
• Healthcare personnel entering the room should use standard precautions, contact precautions, airborne precautions, and eye protection (e.g., goggles or a face shield). The healthcare facility’s infection control personnel and local health department should be notified immediately.
• Meticulous hand hygiene and environmental hygiene play a key role in these isolation precautions. The EPA recognizes environmental surfaces as a vector for transmission of coronaviruses.
• The EPA and the CDC recognize environmental surfaces as a vector for transmission of coronaviruses. The CDC has developed a hospital preparedness checklist⁴ which recommends that hospitals assess the effectiveness of environmental cleaning and consider providing refresher training on environmental hygiene best practices as outlined in the CDC Toolkit: Options for Evaluating Environmental Cleaning.⁵
• CDC has developed a real time Reverse Transcription-Polymerase Chain Reaction (rRT-PCR) test that can diagnose COVID-19.

What hand hygiene products are effective against COVID-19?
For North America: Washing your hands often with soap and water is one of the best ways to avoid transmission of emerging pathogens. The World Health Organization recommends performing hand hygiene with soap and water or alcohol-based hand rub if soap and water are not available. The US Food and Drug Administration regulates claims on both medicated, antimicrobial soaps and on alcohol-based hand sanitizers. Claims related to efficacy against viruses are not allowed on any medicated, antimicrobial soaps nor on any alcohol-based hand sanitizers in the United States.

For Europe: For those residing in Europe, recommendations are performing hand hygiene by routinely washing your hands with soap and water or using alcohol-based handrub (ABHR) with a specific claim for efficacy against enveloped viruses is one of the best ways to avoid transmission of emerging pathogens. For Ecolab related products in Europe, please follow this link: https://en-uk.ecolab.com/articles/2020/01/a-novel-coronavirus. All recommended products are compliant with EN14476 or have limited spectrum activity against vaccinia virus according to EN 14476.

What disinfectants are effective against COVID-19?
For North America: COVID-19 is caused by 2019 Novel Coronavirus. The EPA has developed the “Guidance to Registrants: Process for making claims against emerging viral pathogens not on EPA-registered disinfectant labels”.⁶ This document provides general guidance to disinfectant manufacturers and addresses public concerns on a process that can be used to identify effective disinfectants for use against emerging viral pathogens. It permits manufacturers to make limited claims about their product’s efficacy against such pathogens once the EPA confirms the product meets the eligibility criteria outlined in the guidance. For a full range of products provided by Ecolab in North America, visit this link: https://www.ecolab.com/articles/2020/01/a-novel-coronavirus.

The products and services listed in this meet the criteria for claims against emerging viral pathogens and therefore can be used against 2019 Novel Coronavirus when used in accordance with the directions for use against the listed supporting virus on hard, non-porous surfaces.

For Europe: Disinfection of hard, non-porous surfaces is key to maintaining a safe environment, preventing the transmission of emerging pathogens. For a full range of products provided by Ecolab in Europe, visit this link: https://en-uk.ecolab.com/articles/2020/01/a-novel-coronavirus

All recommended products are compliant with EN 14476 or have limited spectrum activity against vaccinia virus according to EN 14476.  Additionally, Bioquell has decontamination options that are effective compliant with European regulatory guidelines. For example:

• Bioquell BQ-50 – decontaminates patient rooms and small spaces in your facility with proven 35% hydrogen peroxide vapor technology
• Bioquell RBDS – this rapid bio-decontamination service can swiftly and effectively eliminate pathogens from areas of any size throughout your facility