Covid 19 Public Health Wales Guidlines
COVID-19 Cleaning and Disinfection within Residential Care Settings - Public Health Wales
Viruses are microorganisms that can infect humans and cause harm. Coronaviruses are pathogenic microorganism that causes respiratory infections in humans with the potential to be fatal. COVID-19 is the infectious disease caused by the current Novel Coronavirus.
The disease spreads primarily from person to person through small droplets from the nose or mouth. When someone with COVID-19 coughs, sneezes or speaks they expel the virus. The droplets are relatively heavy, do not travel far and quickly sink to the ground. The droplets can land on objects and surfaces around the person such as tables, doorknobs and handrails. People can spread the virus by touching a contaminated surface and then touching multiple other surfaces or people.
Recent studies on the viability of the virus indicates that the virus can survive on different surfaces for up to 3 days. It has been reported that it can survive on plastic surfaces and stainless steel surfaces for up to 72hrs, up to 24hrs on cardboard and less than 8hrs on copper.
Surfaces contaminated with Coronavirus can be easily cleaned with common household disinfectants that will kill the virus.
The Coronavirus has an outer layer called a viral envelope that protects the genetic material in the virus. Enveloped viruses are easier to kill than non-enveloped. When the outer envelope is destroyed the virus is easily inactivated. However, appropriate virucidal cleaning products that are active against enveloped viruses must be used.
Cleaning is the process of physically removing dirt or other matter from surfaces or objects. This will include the majority of bacteria, viruses and fungi but does not necessarily destroy a significant proportion of the microorganisms originally present. Cleaning is the initial process before disinfection. The reduction of this contamination will depend on many factors including the efficiency of the cleaning process and the initial level of organic residue (soiling) present.
Disinfection is the process that reduces the number of microorganisms to a level at which they do not present a risk to persons. They are often unstable and generally inactivated by organic contaminants e.g. blood, tissue and other body fluids. It is important to realise that successful disinfection is very much dependent on the number of microorganisms initially present and the effect of the disinfection process will be reduced if prior cleaning has not been performed
During an outbreak or when the risk of pathogenic microorganisms in the environment is increased, enhanced routine cleaning must be undertaken. This will involve cleaning and disinfecting the general environment more frequently with appropriate cleaning chemicals. It is also important to include commonly touched contact surfaces that are often forgotten such as handrails, light switches, door handles, door push plates, chair arms, telephones, IT equipment, and any area or equipment that may potentially be contaminated.
The latest guidance from Public Health Wales (PHW), Guidance to Prevent COVID-19 Among Care Home Residents and Manage Cases & Outbreaks in Residential Care Settings in Wales discusses cleaning and disinfection where there is a risk of Coronavirus and states one of these two options must be followed:
• Use either a combined detergent disinfectant solution at a dilution of 1000 parts per million (ppm) available chlorine, or,
• A neutral purpose detergent followed by disinfection (1,000 ppm available chlorine).
The generally accepted concentration of available chlorine for routine disinfection of cleaned surfaces is 1000 ppm as this concentration has been shown to be effective against the majority of microbial pathogens.
It has been established that many residential care settings within Wales are not using chlorine based disinfectants and are using alternative products. This can be for a variety of reasons, including ‘no bleach’ policies in some of the larger national residential settings.
The World Health Organisation (WHO) is currently advising the use of, among others, disinfectants based on chlorine, ethanol, hydrogen peroxide or quaternary ammonium compounds. In addition to this, different authorised disinfectants have their viricidal activity recognised by the authorities in each country. Within the United Kingdom (and the EU) the standard for virucidal activity is BS EN 14476.
The current (UK) Government guidance (produced by PHE, NHS & Devolved Administrations) on infection prevention and control, COVID-19: infection prevention and control guidance, discusses the use of disinfectants and requires:
• a combined detergent/disinfectant solution at a dilution of 1,000 parts per million available chlorine (ppm available chlorine, or
• a general purpose neutral detergent in a solution of warm water followed by a disinfectant solution of 1,000ppm available chlorine.
Only cleaning (detergent) and disinfectant products supplied by employers are to be used. Products used for disinfection must be prepared and used according to the manufacturers’ instructions and recommended product ‘contact times’ must be followed. If alternative cleaning disinfectants are to be used, they should only on the advice of the [infection prevention and control team] IPCT and conform to EN standard 14476 for virucidal activity.
Adequate cleaning and disinfection is vital in the control and spread of Coronavirus and it is important that manages of residential care settings know the products they use, understand if the products are suitable and that they are used correctly.