Infection control

and infection control, not just for health care or laboratory facilities, but for any type of facility facing the potential presence of an infectious agent.

Where infection control ends and biorisk management begins Currently, some official guidance documents from the World Health Organization, the European Centre for Disease Prevention and Control and the UK National Health Service refer to existing infection control and prevention protocols when addressing how to clean and disinfect in the presence of Covid-19. While useful, they also can only be generic. For instance, here is the WHO guidance2

regarding proper cleaning in a

Covid-19 patient’s room: l Hospital-grade cleaning and disinfecting agents are recommended for all horizontal and frequently touched surfaces, e.g. light switches, door handles, bed rails, bed tables, phones, and bathrooms being cleaned at least twice daily and when soiled.

l Visibly dirty surfaces should first be cleaned with a detergent - commercially prepared or soap and

water - and then a hospital-grade disinfectant should be applied, according to manufacturers’ recommendations for volume and contact time. After the contact time has passed, the disinfectant may be rinsed with clean water.

l If commercially prepared hospital- grade disinfectants are not available, long-term care facilities may use a diluted concentration of bleach to disinfect the environment. The minimum concentration of chlorine should be 5000 ppm or 0.5 per cent, equivalent to a 1:9 dilution of 5 per cent concentrated liquid bleach.

l Cleaners and those handling soiled bedding and laundry should wear PPE, including mask, gloves, long sleeve gowns, goggles or face shield, and boots or closed toe shoes. They should perform hand hygiene before putting on and after removing PPE.

What is missing here? In essence, these or any other guidelines need to be customised for a specific situation and consequently be more detailed and specific.

A site risk assessment evaluates the cleaning and disinfecting needs where an infectious disease may be present and then determines which elements of infection prevention protocol apply and which additional actions are needed

July 2020 •

Tips and governmental or health authority guidance aside, to ensure a comprehensive and accurate approach to cleaning for reduced cross- contamination, GBAC’s biorisk management approach advocates for doing a thorough site risk assessment. A site risk assessment evaluates the cleaning and disinfecting needs where an infectious disease may be present and then determines which elements of infection prevention protocol apply and which additional actions are needed. One of the most important steps in addressing the risks associated with an infectious disease and the care environment is the stepwise approach of risk assessment.

That process, done within a specific facility, will identify the hazards, associated risks and, as part of the mitigation approach, steps, processes, PPE and other considerations needed to reduce or eliminate these risks through cleaning and disinfection. Here are simplified key steps based on GBAC’s risk assessment model: Step 1. Identify the hazards. These involve, for example, potential sites, areas, objects that are potentially contaminated with SARS-CoV-2, the virus causing Covid-19. Special focus needs to be on high-touch surfaces. Sometimes this can be done by observation of what people touch, when and the frequency. Step 2. Assess the risk associated high-touch surfaces. The risk is determined by how likely this surface will transmit the virus and, also, how likely it is that this surface becomes actually contaminated.


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