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Table of Contents
LETTER TO EDITOR
Year : 2020  |  Volume : 6  |  Issue : 2  |  Page : 175-176

Disinfection of environment in health-care settings: In COVID era


Department of Community Medicine, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Chengalpattu, Tamil Nadu, India

Date of Submission09-Jul-2020
Date of Decision08-Sep-2020
Date of Acceptance10-Oct-2020
Date of Web Publication24-Dec-2020

Correspondence Address:
Dr. Raja Danasekaran
Department of Community Medicine, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Chengalpattu - 603 103, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJCFM.IJCFM_77_20

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How to cite this article:
Danasekaran R, Rajasekar VD. Disinfection of environment in health-care settings: In COVID era. Indian J Community Fam Med 2020;6:175-6

How to cite this URL:
Danasekaran R, Rajasekar VD. Disinfection of environment in health-care settings: In COVID era. Indian J Community Fam Med [serial online] 2020 [cited 2021 Apr 19];6:175-6. Available from: https://www.ijcfm.org/text.asp?2020/6/2/175/304801

Sir,

Coronavirus disease 2019 (COVID-19) is a respiratory illness caused by SARS-CoV-2. The disease is mainly transmitted by close contact and respiratory droplets, while the role of surface contamination, especially in health-care settings, is not conclusively proven. Keeping in view about the role of fomite transmission in case of other coronaviruses, the World Health Organization has given guidelines about the measures to be taken in health-care settings to avoid such spread. Environmental surfaces, mainly areas where COVID cases are managed, and medical procedures (bronchoscopy, endotracheal intubation, etc.) being carried out are more likely to be contaminated with the virus. Therefore, those areas must be demarcated and disinfected properly as per guidelines in order to avoid further transmission.[1]

First, the environment has to be cleaned with soap and water mechanically in order to remove the dust, debris, and other organic matters. Then, a recommended disinfectant (like sodium hypochlorite) has to be applied in the right concentration (e.g., 1% sodium hypochlorite) and should be left for the recommended contact time (at least 10 min), so as to kill all the microbes. Metallic surfaces like door handles can be disinfected with 70% alcohol where bleach is not suitable. Proper disinfection of the environment involves adequate training, monitoring, and feedback of the staff involved. Appropriate personal protective equipment (PPE) need to be worn while preparing or using disinfectants to avoid exposure to chemicals. PPE which are advised include uniforms with long sleeves, closed work footwear, aprons, heavy-duty rubber gloves, triple-layer medical mask, and face shield.[2] Special care needs to be taken while doffing the PPE so as to avoid self-inoculation with contaminated PPE or hands and a separate doffing room needs to be set up which has to be disinfected regularly.[3]

Hypochlorite products such as sodium hypochlorite solution display a broad spectrum of action against majority of the microbes. As per the recommendations of National Guidelines for Infection Prevention and Control in health-care settings by the Government of India, 1% sodium hypochlorite solution can be used for disinfection of surfaces that might have got contaminated with the organism during patient care. Chlorine solutions decay rapidly in accordance with time and hence have to be prepared daily. [Table 1] shows some of the common surfaces that could get contaminated with the SARS-CoV-2 and the recommended method of disinfection.[4],[5]
Table 1: Guidelines for environmental disinfection in health-care settings

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Spraying or fogging using some disinfectants is not recommended, because of their ineffectiveness over the organic matter, in addition to the risk of adverse health effects among the workers. Some no-touch disinfectant methods such as ultraviolet irradiation and use of vaporized hydrogen peroxide are being tested and approved in some places but only for terminal disinfection and that too with prior removal of organic matter by cleaning. Furthermore, spraying disinfectants over people need to be avoided under any conditions, as it may lead to serious health consequences. All touchable surfaces have to be disinfected, but those high-touch surfaces (such as bed rails, door handles, and switches) have to be disinfected frequently.[2]

Appropriate disinfectants have to be selected for health-care settings, while taking into consideration their efficacy against other health-care-associated infections too, apart from SARS-CoV-2. Even though there is not much evidence on the role of fomite risk in nonhealth-care settings (such as homes, schools, offices), high-touch surfaces need to be identified and disinfected regularly. Due to the fact that the Coronavirus can survive in the environment for days, disinfection of the environment, especially the health-care settings where COVID-19 patients are managed becomes imperative.[6],[7]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
World Health Organization Modes of Transmission of Virus Causing COVID-19: Implications for IPC Precaution Recommendations; 2020. Available from: https://www.who.int/news-room/commentaries/detail/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution-recommendations. [Last accessed on 2020 Jun 10].  Back to cited text no. 1
    
2.
World Health Organization. Cleaning and Disinfection of Environmental Surfaces in the Context of COVID-19. Available from: https://www.who.int/publications/i/item/cleaning-and-disinfection-of-environmental-surfaces-inthe-context-of-covid-19. [Last accessed on 2020 Jun 10].  Back to cited text no. 2
    
3.
National Centre for Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India. COVID 19 Outbreak- Guidelinesfor Setting up Isolation Facility/Ward. Available from: https://ncdc.gov.in/WriteReadData/l892s/42417646181584529159.pdf. [Last accessed on 2020 Jun 10].  Back to cited text no. 3
    
4.
National Centre for Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India. National Guidelines for Infection Prevention and Control in Healthcare Facilities. Available from: https://www.mohfw.gov.in/pdf/National%20Guidelines%20for%20IPC%20in%20HCF%20-%20final%281%29.pdf. [Last accessed on 2020 Jun 10].  Back to cited text no. 4
    
5.
National Centre for Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India. Guidelines for Disinfection of Quarantine Facility (for COVID-19).Available from: http://pbhealth.gov.in/Guidelines%20for%20disinfection%20of%20quarantine%20facility%20(for%20COVID-19).pdf. [Last accessed on 2020 Jun 10].  Back to cited text no. 5
    
6.
Ramesh N, Siddaiah A, Joseph B. Tackling corona virus disease 2019 (COVID 19) in workplaces. Indian J Occup Environ Med 2020;24:16-8.  Back to cited text no. 6
  [Full text]  
7.
Kampf G, Todt D, Pfaender S, Steinmann E. Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents. J Hosp Infect 2020;104:246-51.  Back to cited text no. 7
    



 
 
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