It goes without saying that their infection control policies need to be stringent and comprehensive. Clean Middle East speaks to Dr. Neesha Nair, Senior Manager - Medical Affairs, Quality Management, Aster DM healthcare and Shaheena Surani, Manager - Infection Control & Quality, Medcare Hospital, to learn more about the hospital’s infection control policies in the face of COVID-19.

How has Medcare been working to combat the current COVID-19 pandemic?

At Medcare hospital, our quality and infection control department have been on alert about the Coronavirus outbreak since mid-January and were closely monitoring the situation. As a part of increasing the internal preparedness even before WHO declared COVID-19 as a Pandemic, we alerted our clinical teams about this emerging infectious disease. We also established excellent rapport with local health authorities in all places we operate to make the war against COVID-19 more coordinated and effective.

We instituted several strategies and initiatives in line with national and international evidence-based recommendations. We also implemented an emergency response plan to handle the surge of COVID-19 patients. Appropriate planning tools were used to visualize and estimate the necessary resources required over the course of the pandemic.

A COVID-19 task force committee at the group executive leadership level and unit level has been formed to monitor the situation and take necessary actions accordingly. Smart technologies have been adopted to screen the patients for the early recognition of COVID-19 symptoms and to enforce appropriate infection control measures.

The entire workforce has been trained for the recommended infection control practices and social distancing methods. Work from home policy has also been adopted for the nonclinical departments to promote safety and reduce the spread of the virus. Staff were provided with an advanced level of personal protective equipment to ensure safety at all the times.

Telemedicine strategies have also been initiated to promote the wellbeing of the patients and reduce the crosstransmission. Patients and families are being educated in-house and through social media. Our hospitals are supporting the national disaster management committee of the UAE to cope with this crisis.

What kind of cleaning and hygiene protocols have you put in place to prevent cross contamination between positive, negative and potential COVID-19 victims?

Medcare Hospital has a robust environmental cleaning policy and protocol in place for COVID-19. All housekeeping staff are trained for cleaning and decontamination procedures. The hospital is also equipped with the recommended cleaning and disinfectant agents for COVID-19. Principles of infection control are embedded in the cleaning protocols to reduce the environmental contamination.

As current evidence suggests that viruses may remain viable for hours to days on surfaces, emphasis has been given for the frequent cleaning and disinfecting of high touch areas to reduce the cross-transmission. Separate staff has been allocated for the COVID unit who are trained on the use of personal protective equipment. Cleaning frequency and schedules are defined for each unit as per the departmental risk assessment. Well defined cleaning policies and standard operating policies are in place for the hospital vehicles and ambulance.

How has your cleaning regime changed in the last few months? What have you been doing differently?

Adherence to the infection control protocol and guidelines for cleaning and housekeeping practices were followed from the beginning in the hospital. Standard operating procedures for cleaning and disinfection for the COVID areas were developed based on the risk assessment and evidence-based practices. All available chemical and disinfection agents were studied in detail for their effectiveness towards the COVID-19 virus as per the national and international recommendations. All staff are trained for the same.

Advanced training for housekeeping staff was conducted for the transmission-based precautions which includes contact, droplet and airborne to block the chain of infection. All staff are provided with level 4 PPE and related training for donning and doffing in easy to understand languages and with the help of live demonstrations. Frequency of audits and monitoring has also been increased in order to promote staff safety and well-being and prevent contamination. Proper terminal disinfection protocols are also followed after discharge of each patient in order to provide a germfree environment for the next patient. Stocks are also managed in a way which ensures consistent availability of cleaning supplies and equipment.

What kind of training protocols did you have to put in place? How have you ensured employee safety?

Environmental cleaning and disinfection protocol related to COVID-19 has been implemented as per the infection control recommendations from DHA, CDC and WHO. Training modules and guidelines are developed as per the education and literacy level of the staff. Training has been conducted for all the housekeeping staff by the Infection control team in order to apply the infection control principle in their work practices.

Concept of cleaning from clean to dirty has been emphasized. Protocols were developed as per the hospital infection control risk assessment for prevention of COVID. Cleaning frequency of the environmental surfaces and high touch areas are defined. Competency is checked for all the housekeeping staff for the use of PPE and infection control practices.

Staff are also trained on the proper use of disinfecting products such as dilution, material, compatibility, storage, shelf – life and safe use and disposal as per the manufacturer guidelines. We also conducted virtual interactive webinars with our staff to increase awareness and address queries.

Topics like social distancing, home quarantine ,cough etiquette and proper use of PPE have been covered. Inhouse videos scripted by our doctors and staff have been circulated. Desktops wallpapers are being used for displaying awareness material. Protocols are also in place for the daily self-monitoring and assessment of the staff working in the COVID area to take immediate actions for staff health and safety.

What is the kind of protective equipment provided to them?

Level 4 PPE is provided to all the housekeeping staff for environmental cleaning and disinfection of a COVID-19 patient’s room and surfaces. This includes coverall/gowns, N-95 mask, gloves, face shield and goggles, hair and boot cover.

How is this protective equipment disposed of? How is the Covid 19 affected waste dealt with?

Medcare Hospital is treating the hospital waste in a manner that reduces the transmission and crosscontamination. All the infectious waste and used protective equipment is disposed as per the hospital medical waste management policy. Dedicated pathways are defined to transfer the medical waste. A policy is also available on how to clean and disinfect the medical waste bins and the elevators.

Policies are available in the hospital for dealing with the waste of COVID-19 patients. All waste generated from the COVID-19 suspected and confirmed patients are considered infectious. Handling, storage, disposal and transportation of waste is done in a manner to prevent cross-contamination in the environment. All COVID-19 waste is disposed in the yellow bag as per the hospital medical waste policy. All wheelie bins and carts used to transfer the waste are cleaned and disinfected properly with hospital approved disinfectant after the use.

Tell us about linen care?

The hospital has standardized protocols for handling and transporting used linen from COVID-19 patients. All used linen is placed in water-soluble bags before putting it in a red hamper bag as per the hospital policy for the management of contaminated linen. Care is taken not to shake or dust the linen. The linen is transported in a covered cart to the collection point such that the risk of contamination is reduced. All patient linen are washed and disinfected as per the recommended temperature and with approved disinfectant. Appropriate PPE is used by the staff handling the contaminated linen.

What kind of chemicals are best for disinfection within a hospital? Any special equipment you are using?

As per the recommendations virkon, sodium hypochlorite or any disinfectant approved by the EPA and have a label claim to kill the virus could be used for the cleaning and disinfection in the hospital. Terminal cleaning is also recommended by the use of fumigation or mist with the hydrogen peroxide. Use of UVC for the terminal disinfection is also an approved method. In Medcare at the time of discharge of each patient terminal disinfection is performed with hydrogen peroxide through fumigation. All staff are trained to use the fumigation machine. Time and cycle is adjusted as per the room size and shape requirement.

What tips do you have for hotels and buildings that have been quarantined due to affected cases? How do you suggest they combat the spread of the virus?

Proper environmental measures and adopting the appropriate infection control measures are the key element to prevent further spread of the virus. Rooms with individual ventilation systems are preferable.All disinfectants used for cleaning purposes should be EPA approved. Consider more frequent cleaning and disinfection of public areas and facilities. Cleaning of high touch surfaces like doors,knobs, railings etc is important. Cleaning should include electronic items displayed or in use across the facility. Putting a wipeable cover on electronic items may be considered.

Protocols for room service should be altered when taking care of guests under quarantine.have amenities delivered at their door instead of provided room service. For hotels, it's important to train staff on segregation of laundry to minimize the possibility of diffusing virus through the air. Do not shake or dust dirty laundry. Plastic bags can be provided to guests for used linen and leave it outside the room for retrieval by staff. Hotels could provide 60-70% alcoholbased hand rub/gel for guest and staff use.

For all arriving guests body temperature should be monitored and a health condition and travel history survey should also be implemented. All staff on duty must wear surgical masks and should be trained to minimize physical contact (ie handshakes, hugs, etc.). Encourage use of personal mobiles over landline phones.

Those working at call centers or reception and using headsets should avoid sharing of such devices. Education to the patient and community is also paramount. Practicing the social distancing measures along with proper screening protocols can also help to combat the spread of the virus.