What is the most appropriate PPE to wear when triaging/screening patients?

Screening is a relatively low risk activity that requires minimal PPE, compared to swabbing, or providing clinical care.

In triage and screening it is important to wear a well-fitted surgical mask and perform hand hygiene frequently. When screening it is relatively easy to make sure you stay at a safe distance of 1.5m from individuals though in some instances a physical barrier or divide can make you feel even safer.

For general (not suspected or confirmed COVID-19) patient treatment it is recommended you also wear a well fitted surgical masks, and perform frequent hand hygiene, particularly in times of community transmission. You don’t need to wear gowns, eye protection or N95 masks unless you are working in the areas dedicated for suspected / confirmed COVID-19 cases or in areas swabbing suspected patients.

If you had good screening processes in place all suspected and / or confirmed patients can be diverted specific areas for further care you make sure you can be wearing more PPE as needed.

See the attached guide for what PPE to wear when.

Back to top

What is the most appropriate PPE to wear to collect swabs?

Swabbing is a procedure that will likely cause droplets, will include contact and could potentially cause smaller aerosolised particles to spread so you need to wear PPE that protects you. This should include:

• N95 (or FFP2) mask

• Face shield or goggles (to protect your eyes)

• Long sleeved gown

• Disposable gloves

See the the PPE for Healthcare Workers guide for what PPE to wear and when.

PPE needs to be donned (put on) and doffed (taken off) in a safe way, please refer to the Putting on PPE guide for further information.

Back to top

What should we do if we do not have enough PPE or cleaning materials?

Each Province has a focal point for arranging for COVID-19 related PPE / supplies to be ordered or sent from the National stores. Some items such as disposable gloves and N95 masks can also be ordered from the AMS though COVID-19 specific PPE currently come from donations received and supplied Nationally.

The focal point (it may be a pharmacists or logistician or IPC professional) will be tracking and monitor their supplies constantly. They can then complete an order form and send it to the national team on the following centralised email: ncc.logistic.covid19@gmail.com

The national logistics team will prioritise their needs based on the figures the Provincial focal point supplies though in urgent times things can be processed and moved out within a few days.

It is important to understand that whilst PPE is critical, it is only one part of the protective strategies that facilities need to have in  place to protect staff. In many ways PPE is seen as the ‘last line of defence’. The key factors involve ensuring your facility has adequate screening processes in place, have planned isolation strategies (even if it is a home isolation strategy), have assessed administrative processes (such as assessing staffing needs and considered staff health) & reviewed environmental factors (such as making sure areas for testing and isolation are adequately ventilated and having processes to clean routinely).

Back to top

What are the recommended disinfectants that can be used in homes, workplace etc...

Like other coronaviruses SARS CoV-2 is an enveloped virus with a fragile outer lipid layer. This makes it highly susceptible to disinfectants unlike non-enveloped virus’ like rotavirus, norovirus and poliovirus.

Surfaces must first be cleaned with soap / water (or a standard cleaning detergent) then disinfectant applied. Disinfecting without cleaning first reduces the efficacy of the disinfectant. Cleaning with remove the dirt allowing the disinfectant to kill any remaining virus particles.

The recommended and standard disinfectant for use is sodium hypochlorite (chlorine bleach). It is readily available in PNG and can be easily and safely for use in healthcare settings.  

WHO states “The recommendation of 0.1% (1000 ppm) in the context of COVID-19 is a conservative concentration that will inactivate the vast majority of other pathogens that may be present in the health-care setting. However, for blood and body fluids large spills (i.e. more than about 10mL) a concentration of 0.5% (5000 ppm) is recommended.

Please refer to the Cleaning & Disinfection guide, the Disinfecting Surfaces guide and the National IPC Guidelines for more information.

Back to top

How long can you wait for clearance if an office or work place is contaminated? 

It is best to allow plan cleaning & disinfection after 30 minutes after the patient has left – this allows for droplets to settle making cleaning / disinfection more effective.  

In a room where AGP's have been performed on a known / suspect COVID-19 cases WHO guidance does not specify a time to wait before cleaning / disinfection can occur. WHO states that "It is not known how long the air inside an examination room remains potentially infectious. This may depend on a number of factors including the size of the room, the number of air changes per hour, how long the patient has been in the room, and whether an AGP was performed there. These factors need to be considered when decisions in the health-care facility are made on when someone who is not wearing PPE can enter the vacated room. General guidance on how long it takes for aerosols to be removed by different ventilation conditions is available here.

WHO does however specify that health workers performing AGPs or in settings where AGPs are performed among suspected or confirmed COVID-19 patients (including cleaners) must wear appropriate PPE ie particulate respirator, eye protection, gown and gloves. The PPE aspect is really important.

Back to top

How long can the virus stay alive on surfaces in the work place and at home?

Studies are ongoing though there are a number of factors that can impact how long the cirus can survive on surfaces – mainly heat, ventilation, the pH value and how frequently the surface is handled. In general it can be anywhere from 1 hour to 7 days, though on average is up to 72 hours.

See the Cleaning and disinfection of environmental surfaces in the context of COVID-19 website for further information.

Studies have evaluated the persistence of the COVID-19 virus on different surfaces. One study found that the COVID-19 virus remained viable up to 1 day on cloth and wood, up to 2 days on glass, 4 days on stainless steel and plastic, and up to 7 days on the outer layer of a medical mask. Another study found that the COVID-19 virus survived 4 hours on copper, 24 hours on cardboard and up to 72 hours on plastic and stainless steel. The COVID-19 virus also survives in a wide range of pH values and ambient temperatures but is susceptible to heat and standard disinfection methods

That is why cleaning & disinfection of all frequently touched surfaces, both in health facilities and homes, is so critical.

Back to top

Is it true that when a frontline worker is Covid Positive, the office or workplace is not safe to work in?

It is true that we need to go through certain processes to ensure the workplace is safe for those who need to continue to work. It is important to know though we can do a few simple things to make sure a workplace is safe once a case of COVID-19 is confirmed.

It is important for an assessment to occur to review the risk of virus transmission in the workplace. Ie: were there many people who shared the space whilst the person was unwell? Were distancing measures adhered to? Was there adequate supplies of soap / water? Were staff wearing masks at the time? What type of tasks were being performed? (ie: was it invasive clinical procedures or administration). It may in fact be the risk to others is extremely low. Not all interactions will be considered “close contacts” and not all interactions require others to quarantine.

For non-health facilities PHA contact tracing teams may able to help with this. In health facilities there are risk assessment forms that may be useful tools.

Once this is managed it is critical the workplace undergoes thorough cleaning & disinfection. This needs to occur once the individuals are out, with good ventilation and with adequate PPE. It may be workth reassessing the workplace following this to make sure there is adequate spacing, or the risks that may have been there before (such as poor screening or absent hand hygeine are implemented.

Following a through clean / disinfection the workplace may be used again. There is no need to close work places of helth facilities for extended periods.

Back to top

What is the most appropriate cleaning and disinfection of the environment if staff have tested positive? Should we fumigate or wipe surfaces with antiseptic soap/water and/or alcohol based solution?

Terminal cleaning either using 2 in 1 or we clean first than we disinfect with bleach 0.1%. We should never fumigate because it’s unsafe to the health of everyone.

In indoor spaces the application of disinfectants to environmental surfaces by spraying or fogging (also known as fumigation, fogging or misting) is not recommended for COVID- 19. WHO does not recommend spraying, fumigating or fogging for COVID-19.

WHO state “There is some evidence to show that spraying as a primary disinfection strategy is ineffective in removing contaminants outside of direct spray zone; in addition, the spraying of certain chemicals can pose a health risk to the health workers or cleaners using it.  Some countries have approved specific technologies for spraying in certain circumstances, though these methods do not replace manual cleaning processes (rather, they may supplement it)”.  

In general cleaning & disinfection (both routinely and following identified cases) is better undertaken using manual methods with cloths that can be disinfected following the process, or paper towels that can be disposed of.  

Back to top