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Coronavirus: Healthcare Infection Control Precautions for 2019-nCoV

Ecolab Healthcare Infection Control Precautions for 2019-nCoV

Human coronaviruses1 are common throughout the world. Human coronaviruses commonly cause mild to moderate illness. Two newer human coronaviruses, MERS-CoV and SARS-CoV, have been known to cause severe illness. A novel coronavirus, 2019-nCoV, emerged in 2019 and is causing concern.

What is 2019-nCoV acute respiratory disease (2019-nCoV)?2

  • Chinese authorities identified the new coronavirus originating in Wuhan, China.
    This virus has resulted in thousands of confirmed cases, the majority of which are in China, with additional cases being identified in a growing number of countries internationally. Effective January 27, 2020, the United States Department of Health and Human Services (DHS) declared a public health emergency for the entire United States to aid the nation’s healthcare community in responding to 2019 novel coronavirus. The Centers for Disease Control and Prevention (CDC) is working closely with state health departments on disease surveillance, contact tracing, and providing interim guidance for clinicians on identifying and treating coronavirus infections.
  • Clinical signs and symptoms include fever and symptoms of lower respiratory illness (e.g., cough, shortness of breath).
  • Early on, many patients in the outbreak in Wuhan, China reportedly had some link to a large seafood and animal market, suggesting animal-to-person spread. However, a growing number of patients reportedly have not had exposure to animal markets, suggesting person-to-person spread is occurring, though it’s unclear how easily or sustainably this virus is spreading between people. The situation with 2019-nCoV is still unclear and evolving rapidly. While severe illness, including illness resulting in numerous deaths, has been reported in China, other patients have had milder illness and been discharged. Person-to-person transmission has been reported in healthcare workers who were caring for some of the ill people in China.

What are the healthcare infection control precautions for 2019-nCoV?3
Although the transmission dynamics have yet to be determined, CDC currently recommends a cautious approach to patients under investigation for 2019 Novel Coronavirus:

  • Patients should be asked to wear a surgical mask as soon as they are identified and be evaluated in a private room with the door closed, ideally an airborne infection isolation room if available. 
  • Healthcare personnel entering the room should use standard precautions, contact precautions, airborne precautions, and eye protection (e.g., goggles or a face shield). The healthcare facility’s infection control personnel and local health department should be notified immediately.  
  • Meticulous hand hygiene and environmental hygiene play a key role in these isolation precautions. The EPA recognizes environmental surfaces as a vector for transmission of coronaviruses.
  • The EPA and the CDC recognize environmental surfaces as a vector for transmission of coronaviruses. The CDC has developed a hospital preparedness checklist4 which recommends that hospitals assess the effectiveness of environmental cleaning and consider providing refresher training on environmental hygiene best practices as outlined in the CDC Toolkit: Options for Evaluating Environmental Cleaning.5
  • CDC has developed a real time Reverse Transcription-Polymerase Chain Reaction (rRT-PCR) test that can diagnose 2019-nCoV.

What hand hygiene products are effective against 2019-nCoV?
Washing your hands often with soap and water is one of the best ways to avoid transmission of emerging pathogens. The World Health Organization recommends performing hand hygiene with soap and water or alcohol-based hand rub if soap and water are not available. The US Food and Drug Administration regulates claims on both medicated, antimicrobial soaps and on alcohol-based hand sanitizers. Claims related to efficacy against viruses are not allowed on any medicated, antimicrobial soaps nor on any alcohol-based hand sanitizers in the United States.

What disinfectants are effective against 2019-nCoV?
2019-nCoV is caused by 2019 Novel Coronavirus. The EPA has developed the “Guidance to Registrants: Process for making claims against emerging viral pathogens not on EPA-registered disinfectant labels”.6 This document provides general guidance to disinfectant manufacturers and addresses public concerns on a process that can be used to identify effective disinfectants for use against emerging viral pathogens. It permits manufacturers to make limited claims about their product’s efficacy against such pathogens once the EPA confirms the product meets the eligibility criteria outlined in the guidance.

The products in the table below meet the criteria for claims against emerging viral pathogens and therefore can be used against 2019 Novel Coronavirus when used in accordance with the directions for use against the listed supporting virus on hard, non-porous surfaces. Contact your Ecolab Account Executive for additional product information.

DAZO™ fluorescent marker is an objective method to evaluate the thoroughness of the cleaning process, rather than the presence of organic material or pathogens.5 Other environmental monitoring methods intended to measure organic load (e.g. ATP)6 or bacterial burden (e.g. bacterial cultures) do not detect viruses. Even with the best EVS staff in the world, without an effective environmental hygiene monitoring tool such as DAZO fluorescent marker, there is no way to determine the effectiveness of their cleaning practices.

ECOLAB PRODUCT NAME ITEM NUMBER (Package Size) DILUTION RATE CONTACT TIME EPA REG. # SUPPORTING VIRUS
A-456 II™ DISINFECTANT CLEANER 6166931 (2x1.3L)
 0.5-1 oz/gal  10 minutes 6836-78-1677 Norovirus (Feline calicivirus surrogate)
NEUTRAL DISINFECTANT CLEANER 6027314 (4x1gal)
6101205 (1x2.5gal)
6114541 (2x1.3L)
6100836 (50x1oz Pour Pak)
 0.5-1 oz/gal 10 minutes 47371-129-1677 Adenovirus
OXYCIDE™ DAILY DISINFECTANT CLEANER 6000189 (2x96oz)
3 oz/gal 3 minutes 1677-237 Norovirus (Feline calicivirus surrogate)
QUATERNARY DISINFECTANT CLEANER 6063304 (4x1gal)
0.5-1 oz/gal
10 minutes
6836-78-1677 Norovirus (Feline calicivirus surrogate)
TB DISINFECTANT CLEANER RTU 6143556 (12x32oz)
Ready-to-use
3 minutes
1839-83-1677 Poliovirus
VIRASEPT™ 6002314 (12x32oz)
Ready-to-use
4 minutes
11677-226 Rhinovirus

What work is still ongoing?

  • Screening of travelers from China.
    The United States is temporarily denying entry to foreign nationals who visited China in the 14 days prior to their arrival to the United States. Restrictions also apply to US citizens who have been in China's Hubei province, the epicenter of the coronavirus outbreak, in the two weeks prior to their return to the United States. Upon their return, those citizens will be under a mandatory quarantine of up to 14 days. US citizens returning from the rest of mainland China in the 14 days prior will undergo health screenings at selected ports of entry and be under self-monitored quarantine for 14 days.
  • Determining the origin of the virus, which could lead to recommended guidance related to transmission from animals
  • Determining disease progression among ill people and how they may have acquired the infection
  • Determining the frequency and likelihood of person-to-person transmission

For More Information:
World Health Organization, Coronavirus: www.who.int/health-topics/coronavirus


References:
1. Centers for Disease Control and Prevention, Coronavirus Summary. www.cdc.gov/coronavirus/index.html 
2. Centers for Disease Control and Prevention, 2019 Novel Coronavirus.  www.cdc.gov/coronavirus/2019-nCoV/summary.html 
3. Centers for Disease Control and Prevention, Interim Healthcare Infection Prevention and Control Recommendations for Patients Under Investigation for 2019 Novel Coronavirus. www.cdc.gov/coronavirus/2019-nCoV/infection-control.html 
4. Centers for Disease Control and Prevention, Hospital Preparedness Checklist for Suspected or Confirmed 2019-nCoV Patients. www.cdc.gov/coronavirus/2019-ncov/hcp/hcp-hospital-checklist.html
5. Centers for Disease Control and Prevention, Options for Evaluating Environmental Cleaning. www.cdc.gov/HAI/toolkits/Evaluating-Environmental-Cleaning.html
6. Environmental Protection Agency, Emerging Viral Pathogen Guidance for Antimicrobial Pesticides. www.epa.gov/pesticide-registration/emerging-viral-pathogen-guidance-antimicrobial-pesticides

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