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Recommendations on The Management Practices of Hospital Environment Disinfection And Medical Waste in COVID-19

Aug. 26, 2020

Hospitals are currently the main battlefield for the treatment of COVID-19 patients, but they are also public buildings with the highest population density and cross-infection risk. They face severe challenges in terms of the source of infection, the route of infection, and the susceptible population. In order to strengthen the prevention and control of the pneumonia epidemic caused by the new coronavirus infection, effectively block the spread of the epidemic, better guarantee the safe and stable operation of the clinical front line, and ensure the realization of the goal of "zero infection", the Logistic Professional Committee of the Chinese Hospital Association organized hospital sense, logistics, After careful discussion, experts from the outpatient department and other hospitals formed the following recommendations, which are recommended for non-new coronavirus pneumonia admissions in hospitals. The designated infectious disease hospitals that accept patients with new coronavirus pneumonia and the admission and treatment areas for confirmed cases of new coronavirus pneumonia should carry out correct and effective operation and management in accordance with the relevant standards of infectious disease hospitals, regulations and design requirements of the administrative department of health and epidemic prevention.


1. Environmental disinfection measures

1. Disinfection of public areas

(1) Daily disinfection operations are implemented in accordance with the appendix: "Disinfection Frequency Table during Prevention and Control Period". Periodically wipe the surfaces and grounds frequently touched by personnel to keep the environmental surfaces clean and sanitary. 

(2) Wipe the ground with a chlorine-containing disinfectant with an effective chlorine of 500mg/L for 30 minutes. After disinfection with chlorine-containing disinfectant, wipe with clean water to remove residual disinfectant.

(3)Use 75% alcohol to wipe and disinfect the human body contact surfaces such as desktops, handrails, and elevator buttons. The action time is 30 minutes. After wiping with alcohol, wipe with a dry cloth to avoid corrosion of the surface of the article.

(4)To prevent the new coronavirus, disinfection should be done scientifically to prevent excessive disinfection and avoid chemical pollution.

(5)Public areas 10:00-15:00 Keep windows open for ventilation (open a small amount).

(6) The air conditioning system keeps running smoothly for 24 hours.


2. Elevator disinfection 

(1) To divert the flow of people, try to take open vertical vehicles such as escalators to reduce the use of box elevators.

(2) The box elevator must be ventilated for no less than 15 minutes a day.

(3) Wipe the escalator handrails and the handrails and buttons of the box elevator car with 75% alcohol, and spray disinfect the air, 2 times per day on average. Elevators in polluted areas are disinfected once every 2 hours on average.

(4) When the surface of the elevator is contaminated (such as contaminated by saliva, sputum, etc.), the surface of the car, especially the key position, should be disinfected. Use a chlorine-containing disinfectant with an effective chlorine of 500 mg/L or use 75% alcohol to wipe and disinfect, and the action time is 30 minutes. After disinfection with chlorine-containing disinfectant, wipe with clean water to remove residual disinfectant.


3. Restaurant disinfection

(1) Perform 75% alcohol disinfection and filming on the dining table before the meal is opened, and replace the film on the dining table immediately after closing the meal and disinfect again.

(2) Before the meal is opened, wipe and disinfect the floor with 84 disinfectant twice, and wipe and disinfect the tables and chairs with alcohol twice, and strengthen ventilation in the restaurant during closed meals.

(3) Use a special dining car to deliver meals to the fever clinic, and perform 75% alcohol wipe disinfection outside the restaurant after returning.


4. Laundry disinfection

(1) Fever clinic linens shall implement the washing standards for infected fabrics, strictly implement the principle of one-way logistics in the contaminated and clean areas, and the personal protective equipment worn by the staff in the contaminated and clean areas shall not be cross-used.

(2) The staff in the contaminated area should follow the principle of "standard prevention", do a good job of personal protection in accordance with the requirements of the "Hospital Isolation Technical Specifications", and wear necessary protective equipment (work clothes, isolation gown, hats, masks, gloves, waterproof aprons and Rubber shoes), perform hand hygiene as required.

(3) Workers in the clean area should wear protective gown ,protective shoe covers,maintain hand hygiene, and wear hats and disposable gloves according to actual needs.

(4) Use a special machine for washing. Disinfect the fabric before washing. The washing water temperature is 80°C and the time is 20 minutes.

(5) Infectious fabrics should be put in whole packages, not sorted, unfolded, and washed with bags; after each put into the washing machine, an effective disinfectant should be used to wipe and disinfect the cabin door and nearby areas of the special machine.

(6) At the end of the work day, use a chlorine-containing disinfectant with an effective chlorine of 1000mg/L or 75% alcohol to wipe and disinfect the ground and countertops in the contaminated area, and use a chlorine-containing disinfectant to spray disinfect the air; The floor, countertops and walls of the area are cleaned daily.

(7) The ventilation frequency of indoor mechanical ventilation in the polluted area should reach 10 times/h, and the minimum fresh air volume should not be less than 2 times/h.

(8) If blood, body fluids or secretions are found in the work area, the visible contaminants should be removed immediately and cleaned and disinfected.

(9) Vehicles that transport contaminated bedding and clean bedding are not used interchangeably. 

(10) After transporting infectious fabrics, use 75% alcohol to disinfect according to the principle of one use, one cleaning.


2. Medical waste and domestic waste management

1. Safe collection

(1) The waste generated in the fever clinic area, including medical waste and domestic waste, are collected in a timely manner according to the types of medical waste to ensure the safety of personnel and control the risk of infection.

(2) When the outer surface of the packaging bag and sharps box containing medical waste is contaminated with infectious waste, a layer of packaging bag shall be added.

(3) It is strictly forbidden to squeeze when sorting and collecting used disposable isolation clothing, protective clothing and other items.

(4) Each packaging bag and sharps box should be attached or affixed with a Chinese label. The content of the label includes: medical waste generating unit, generating department, generation date, category, and "New Crown Medical Waste" in the special instructions.

(5) Before leaving the contaminated area, the surface of the packaging bag should be sprayed with a 1000mg/L chlorine-containing disinfectant to disinfect the medical waste generated in the contaminated area of the fever clinic (note that the spraying is even) or a medical waste packaging bag should be placed on the outside of it. ; The medical waste generated in the clean area shall be disposed of in accordance with conventional medical waste.

(6) In the laboratory medical waste, such as high-hazard wastes such as pathogen-containing specimens and related preservation solutions, it should be subjected to pressure steam sterilization or chemical sterilization at the place of generation, and then collected and treated as infectious waste.


2. Packaging container

(1) The outer surface of special medical waste packaging bags and sharps boxes should have warning signs. Before the medical wastes are contained, they should be carefully inspected to ensure that they are free from damage and leakage. The medical waste collection barrel should be pedal type with a lid.

(2) When the medical waste reaches 3/4 of the packaging bag or sharps box, it should be effectively sealed to ensure a tight seal.

(3) Double-layer packaging bags should be used to contain medical wastes, with gooseneck knot sealing, and layered sealing.

(4) Use a disposable storage box to collect "COVID-19" medical waste, place it in a special temporary storage location for medical waste, and burn it directly after transportation.


3. Safe delivery

(1) Before transporting medical waste, check whether the identification, label and seal of the packaging bag or sharps box meet the requirements.

(2) When transporting medical waste, staff should prevent damage to special packaging bags and sharps boxes for medical waste, prevent medical waste from directly contacting the body, and avoid leakage and spread of medical waste.

(3) At the end of each day of transportation, clean and disinfect the transportation tools and fill in the "Disinfection Record" with a chlorine disinfectant concentration of 1000 mg/L; when transportation tools are contaminated with infectious medical waste, they should be disinfected in time.


4. Storage and transfer 

(1) The temporary storage of medical waste should have strict sealing measures, and staff should be assigned to manage it to prevent non-workers from contacting medical waste.

(2) The medical waste should be stored in a separate area of the temporary storage place, and handed over to the medical waste disposal unit for disposal as soon as possible.

(3) Disinfection of the temporary storage of medical waste: the air is irradiated with ultraviolet light for disinfection (60 minutes/day), and the ground is disinfected with a 1000mg/L chlorine-containing disinfectant twice a day.

(4) The medical waste generation department, transport personnel, temporary storage staff, and medical waste disposal unit transfer personnel shall register and transfer layer by layer, record the number, and explain that it comes from COVID-19 infected pneumonia patients or suspected patients .


5. Transfer registration

(1) Strictly implement the management of hazardous waste transfer documents, and register for outbound medical waste. The registration content includes the source, type, weight or quantity of the medical waste, the handover time, the final destination, and the double signature of the person in charge, with special indication of "New Crown Medical Waste".

(2) The registration data is kept for 3 years.


6. Disinfection of the temporary storage of household garbage

(1) The temporary storage of domestic waste is transported by a professional domestic waste disposal and disposal company. Collectors in the hospital thoroughly disinfect the ground and walls every day (2 times/day).

(2) Floor: daily scrub with 500mg/L chlorine-containing disinfectant.

(3) Wall: Rinse with clean water daily.

(4) Transfer vehicle: Brush with 500mg/L chlorine disinfectant every day.


7. Fever clinic logistics route

The hospital should formulate medical waste removal routes, domestic waste removal routes, meal delivery routes, and linen transportation routes according to the actual situation, avoid crossing the routes, and make special personnel responsible for them.


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