Environmental cleaning and disinfection in South Africa-evidence or ritual - Prof Shaheen Mehtar Infection Control Africa Network and ...
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Environmental cleaning and disinfection in South
Africa- evidence or ritual
Prof Shaheen Mehtar
Infection Control Africa Network and
Stellenbosch University, Cape Town
Disclosure I have no financial relationships with commercial entities producing healthcare related products and/or services Disclaimer The content of this presentation references the recommendations in WHO guidance and other relevant documents. The content is subject to revision as new evidence on COVID-19 becomes available.
Objectives § To present the statistics for COVID-19 in Western Cape § To review evidence based environmental cleaning and disinfection guidance in South Africa § Areas of contention or uncertainty.
South Africa (21 June 2020)
CFR- 1.8%
1930
97302
51608
53%
Western Cape Province
COVID-19 facilities at Tygerberg Hospital, Cape
Town
• Total number of beds = 1374
• Number of acute beds designated
for COVID-19= 1000 or more
– Routine admissions restricted
• Additional COVID 19 beds = 60
• Number of ICU for COVID-19= 60,
using 28 due to staff shortages
• Acute staff shortages=
approximately 25-30% due to
COVID-19 related matters
• Additional environmental cleaning
staff = 20
Environmental cleaning and disinfection
Section 1: Standard Precautions
COVID-19: cleaning and disinfection
• SARS CoV2 - fragile enveloped virus.
– easily destroyed by detergent, heat
and chemicals
• Cleaning & disinfection frequency
– General areas – twice a day
– ICU- 4 times a day
• Wipe over with disinfectant
– 1000 ppm chlorine
– 70% alcohol
• NO spraying of any surface
• NO spraying of outdoor surfaces
• NO spraying of humans (disinfection
tunnels
Available in: https://www.who.int/publications-detail/cleaning-and-disinfection-of-environmental-surfaces-inthe-context-of-covid-19
No touch technologies (WHO 2020) Vapourised hydrogen peroxide • No-touch technologies for applying chemical disinfectants (e.g. vaporized hydrogen peroxide) in health-care settings such as fogging-type applications. • These technologies developed for use in health-care settings are used during terminal cleaning (cleaning a room after a patient has been discharged or transferred), when rooms are unoccupied for the safety of staff and patients • Used in prescribed fixed volume water or air requiring repeated exposure
Are there any no touch technologies used at TBH?
• No fogging of UV systems used in the clinical areas for COVID-19 (no evidence it works)
• Used by engineers for their offices and rooms- fogging with alcohol!
Indications at TBH
• Terminal cleaning is indicated for MDROs or C difficile (ICUs)
– Wash and clean the room and contents
– Wipe over with disinfectant
– Clear the room of all the equipment
– Hydrogen peroxide used for fogging
– Allow contact time
– Ventilate the area
– Restock.
• Not easy to do, laborious and time consumingImpact of disinfectants
On humans The environment
• Toxicity: Affecting eyes, skin and • Accumulation in water ways and
respiratory tract following exposure detrimental effect on plants, birds and
• Children- contact dermatitis, animals. e.g
exacerbation of asthma – Quaternary ammonium compounds
• Chemical exposure from residual – Triclosan
chemicals on surfaces after fogging – Chlorine (high concentrations)
• No evidence of reduced transmission • Increase in antimicrobial resistance
following environmental fogging or – Cross resistance to antimicrobial agents
spraying – Increased resistance -Gram negative bacilli
– Increased resistance in Staph aureus
(MRSA)Disinfection tunnels and spraying of humans Problem Disinfectant tunnels at entrances to public transport (Gautrain and Soweto Taxi rank) have been installed. No evidence of spraying chemicals of humans reduces the risk of transmission Evidence • A literature review, including WHO and PAHO recommendations, studies from West Africa during the 2016 Ebola outbreak, and chemical exposure amongst cleaning staff demonstrated toxic effects of chemicals, especially halogen based compounds causing skin, eye and respiratory irritation. • Chlorine and other chemicals converts to hydrochloric acid (HCL) leading to damage of the airways. • Respiratory damage can potentially increase the risk of SARS-CoV2 acquisition and may enhance disease. South African legislation protecting humans and the environment: Hazardous Substance Act (1973); Occupational Health & Safety Act (1993); National Environmental Management Act (1998) Recommendations. 1. There is no evidence that spraying of humans prevents transmission. 2. Chemical spraying of humans by any route, including disinfectant tunnels is strongly condemned as it is damaging to eyes, skin and the respiratory tract and increases the risk of acquisition of SARS-CoV2.
Safe handling of linen and food services, waste Wear appropriate PPE for the task Linen: Washed at 50 o C or higher. – Automated washing machines recommended – Hand washing with soap and water as high as can be tolerated. (gloves) Food: cutlery & crockery: disposable crockery not necessary. – Automatic dish washer – Hand washing in hot water and detergent as can be tolerated (gloves) Healthcare waste: infectious waste – PPE – Disposable medical devices – Send via usual route of infectious waste
• Purpose: Review of challenges with environmental contamination in LMICS • Source(s) of contamination- associated with poor governance – Inadequate infrastructure- (non compliance with WASH) – Human resources – Inadequate funding – Poor understanding of transmission of pathogens and lack of IPC measuress – Low awareness and priority given to the role of the environment
Summary
§ A fragile virus- remember the route of transmission
§ Do not need extensive disinfection
§ Keep the environment clean and dry with frequent cleaning
§ Disinfection following cleaning- wipe. Do not spray
§ Maintain safety of staff with good hand hygiene, appropriate PPE and
frequent educationReferences
1 WHO. (2020). Coronavirus disease (COVID-19) advice for the public: Myth busters
https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters
2 Mehtar, S., Bulabula, A. N., Nyandemoh, H., & Jambawai, S. (2016). Deliberate exposure of humans to chlorine-the aftermath of Ebola in West Africa. Antimicrobial resistance and
infection control, 5, 45.
https://doi.org/10.1186/s13756-016-0144-1
3 Trina Wood. (2017). Common Antiseptic Ingredients De-Energize Cells and Impair Hormone Response
https://www.ucdavis.edu/news/common-antiseptic-ingredients-de-energize-cells-and-impair-hormone-response/
4 C. Federico Molina, Walter D. Machado, Federico Marquetti y Eugenio A. Quaia. Toxicidad del amonio cuaternario para microorganismos utilizados en el tratamiento biológico
anaerobio de efluentes. http://www.eeaoc.org.ar/upload/publicaciones/archivos/357/20131204135727000000.pdf
5 Alicia Culver, Chris Geiger, Deanna Simon. SF Environment. Safer products and practices for disinfecting and sanitizing surfaces.
https://sfenvironment.org/sites/default/files/fliers/files/sfe_th_safer_products_and_practices_for_disinfecting.pdf
6 UNICEF, WHO. (2020). Water, sanitation, hygiene, and waste management for the COVID-19 virus.
7 EPA. (2020). List N: Products with Emerging Viral Pathogens AND Human Coronavirus claims for use against SARS-CoV-2 https://www.epa.gov/pesticide-registration/list-n-
disinfectants-use-against-sars-cov-2
8 R.F. Kahrs. Principios generales de la desinfección. Rev. sci. tech. Off. Int. Epiz. (1995). 14 (1), 143-163. https://www.oie.int/doc/ged/D8972.PDF
9. PAHO/CDE/CE/COVID-19/20-0012 • © Pan American Health Organization, 2020 THE USE OF TUNNELS AND OTHER TECHNOLOGIES FOR DISINFECTION OF HUMANS USING
CHEMICAL ASPERSION OR UV-C LIGHT
10. WHO: Cleaning and disinfection of environmental surfaces in the context of COVID-19, interim guidance, 15 May, 2020. https://www.who.int/publications-detail/cleaning-and-
disinfection-of-environmental-surfaces-inthe-context-of-covid-19
11. South African laws governing safety of workers (humans) and the environment
• Hazardous Substance Act (1973);
• Occupational Health & Safety Act (1993);
• National Environmental Management Act (1998)
12 MMWR /April 24, 2020/ Vol. 69 /No 16. Cleaning and disinfectant Chemical Exposures and Temporal Association with COVID-19- National Poison Data System, United States, Jan
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