key: cord-0873634-p3d5v3v7
authors: Harris, Chelsea A.; Evan, Heather; Telem, Dana A.
title: A Practical Decontamination Framework for COVID-19 Front-line Workers Returning Home
date: 2020-05-01
journal: Ann Surg
DOI: 10.1097/sla.0000000000003990
sha: 2029674320d4920a281e3309e76c5e8b034f57ab
doc_id: 873634
cord_uid: p3d5v3v7

Supplemental Digital Content is available in the text

Hard surfaces: Experimental evidence indicates that SARS-CoV-2 survives better on hard surfaces, such as glass, metal, or plastic 3 . In some studies, coronavirus could remain infectious up to 9 days, with higher inocula (e.g. greater amount of virus) remaining infectious longer 4 .

However, the Centers for Disease Control and Prevention (CDC) reports that swabs taken from the Diamond Princess cruise ship had viral traces a full 17 days after passengers disembarked (though it remains unclear whether these traces were sufficient to be infective) 5 .

Porous materials: Soft, porous materials such as cardboard or fabric appear to be more resistant, as particles get trapped between fibers making it difficult for the virus to transfer again. In fact, one study found no viable SARS-CoV-2 remained on cardboard beyond 24 hours 3 .

Environmental Variation: Viral survival also depends on environmental conditions. Higher humidity (e.g. environments with 50% humidity relative to 30%) favored HCoV-229E survival, whereas temperatures above 86-1004 O F were more hostile for MERS-CoV 4 . Exposure to UV-C light also appears to degrade viral RNA 6 but may damage the charge on protective equipment like N95 masks 7 .

Although data suggest SARS-CoV-2 may persist on surfaces for days, there are many household that effectively kill the virus in around a minute. The World Health Organization (WHO) endorses cleaning products that are >62% ethanol (with other sources preferring those >75%), 0.5% hydrogen peroxide (commercially available topical solutions are usually around 3%), and 0.1% sodium hypochlorite (bleach) 6 . In addition, products with a US Environmental Protection Agency-approved emerging viral pathogens icon are expected to be effective against SARS-CoV-2, but consumers should adhere to the manufacturer's guidelines. A full list from the can be Copyright © 2020 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.

found here: (https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-

If bleach is selected, bleach dilution guidelines should be followed. (Table 1) A new batch should be made daily, especially if the solution is kept in a translucent container. Care should be taken when using bleach solution to avoid injury (wear gloves) or permanent damage to items.

Perfect guidelines for front-line workers do not exist. Much remains to be uncovered regarding how the virus behaves outside the hospital setting. Individuals will need to tailor their approach to the risk profiles of their family (e.g., immunocompromised children, elderly parents, twophysician homes) and the realities of their living spaces or finances. As has been widely touted, the most effective strategy is likely isolation. High-risk workers may aim to totally quarantine themselves from their families by either living in separate dwellings or partitioning their homes.

However, this set-up is both emotionally challenging, and in many cases, impossible. Thus, our strategies attempt to balance the aforementioned science, and practical constraints 9, 10 . Additional information can be found at the CDC (https://www.cdc.gov/coronavirus/2019-ncov/index.html) and WHO (https://www.who.int/health-topics/coronavirus#tab=tab_1) websites.

Preparing for A High-Risk Environment (Supplemental Figure 1  Wear a hair covering (e.g. cloth scrub cap all day)  For persons with longer hair, hair should be braided or pulled up into a bun.  Change into scrubs upon entering, and roll pants or stuff into socks to avoid contact with shoes. Best to change in the locker room.  Change into a pair of hospital-only shoes, preferably those that withstand decontamination solutions and do not require hands for donning/doffing.  Do not wear white coats/overwear when seeing patients  Use speakerphone as possible to avoid bringing phone to face  Regularly disinfect phone, pager, badge, eyewear, stethoscope, and surfaces with EPAapproved decontamination  Adhere to PPE donning and doffing protocols, using the buddy system to ensure compliance if no dedicated -dofficer‖ is available  Try to bring the fewest potentially contaminated inside  Remove shoes (handsfree if possible) leave in decontamination area  Remove clothing, and place directly in cloth laundry bag (do not shake), leave in decon area for now o Proceed directly to shower, if possible, designating one shower in home for highrisk workers o Detergent should be sufficient to disinfect clothing, water temperature >160 O F is also effective  Wipe phone, badge, credit cards, and keys  Wipe down any surfaces encountered  CDC guidance regarding universal mask use is evolving. Individuals may choose to wear a surgical mask to decrease transmission in high-risk conditions

Maintenance  Ensure that shared spaces have good airflow (e.g. air conditioner or an opened window)  Perform hand hygiene frequently. Especially before and after preparing food, before eating, after using the toilet, and whenever hands look dirty. o Flush toilets should be flushed with lid closed.  Clean all -high-touch‖ surfaces: counters, tabletops, doorknobs, bathroom fixtures, toilets, phones, keyboards, tablets, and bedside tables  Consider using dedicated linen and eating utensils for workers; cleaned with soap and water after use and may be re-used instead of being discarded. Figure 6 , http://links.lww.com/SLA/C190) Anticipate the need for an area to isolate yourself away from other members of your household. The time to create an isolation zone is not after you have become exposed or sick.

 If you share your home, the most important thing is to keep your home very clean and mandate handwashing before and after any communal task  If possible, designate a separate entrance for PUI  Isolate sleeping, person hygiene/toileting, and eating from the rest of the household  If symptomatic, wear a surgical mask at all times, and limit time outside of the room. 6' social distancing is not enough, as you need to limit ongoing exposure.  Avoid touching your face (masks may help cue this behavior)  Do not handle food others will eat  If laundry is not directly accessible to quarantined individual, pass laundry in cloth laundry bag, throw entire bag in wash, wash hands  Use video conferencing to communicate Copyright © 2020 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.

Detection of SARS-CoV-2 in Different Types of Clinical Specimens

Survival of influenza viruses on environmental surfaces

Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1

Potential role of inanimate surfaces for the spread of coronaviruses and their inactivation with disinfectant agents. Infection Prevention in Practice

Public Health Responses to COVID-19

Outbreaks on Cruise Ships -Worldwide

Evaluation of inactivation methods for severe acute respiratory syndrome coronavirus in noncellular blood products

Annex Use of disinfectants: alcohol and bleach. Infection prevention and control of epidemic-and pandemic-prone acute respiratory infections in health care WHO

Still have to drive? How to disinfect your car to cut coronavirus risk. The Seattle Times

To make using US cup measurements you need a 1:9 ratio Add 1/4c bleach to 2 ½ c water if using a 1% solution