Infection Prevention & Control Guidelines for 6 final.pdf · An outbreak of a Coronavirus (SARS CoV-2) declared in Wuhan City, Hubei Province, China in December 2019 with probable

Page 0 of 29 MOH/DGDSC-DIPC/COVID-19 IPC guidelines /Vers 06

MOH/DGDSC-DIPC/COVID-19 IPC

guidelines /Vers 06/ 18 May, 2020

Infection Prevention & Control Guidelines for (COVID-19)

Ministry of Health Sultanate of Oman

The Department of Infection Prevention and Control

Directorate General for Disease Surveillance and Control

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MOH/DGDSC-DIPC/COVID-19 IPC guidelines /Vers 06

Table of Contents:

S.no Content Page

i Glossary 2

ii Introduction 3 1. Administrative intervention 3 2. Transmission precautions 4 3. Patient placement 5 4. Performing Aerosol-Generating procedure (AGP) 6 5. Patient Transport 6 6. Personal Protective Equipment(PPE) for Healthcare worker 7 7. Environmental cleaning and disinfection 7 8. Collection and Handling of Laboratory specimens from suspected or

confirmed COVID -19 patient 9

9. Medical waste 9

10. Textile (Laundry & Linen) 9 11. Managing the visitor to the patient 10 12. Management of Exposure to a suspected/ confirmed COVID-19 Cases 10 13. Guidelines for De-isolation of Patients with Suspected/ Confirmed COVID -19 14 14. Home isolation for contacts suspected/confirmed COVID-19 infection 15 15. Infection prevention and control messages to the public 16 16. IPC practice for management of dead-bodies 16 17. References 19 18. Annex1: Facility preparedness checklist

Annex2: Rational use of PPE Annex3: Management of contact Annex 4: De-isolation of confirmed COVID-19 case Annex 5: Recommended PPE for COVID-19 case Annex6: Log sheet Annex 7: line list sheet

20 23 24 25 26 28 29

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Glossary: Abbreviations

AIIR Airborne infection isolation room

AGP Aerosol generating procedures

BAL Broncho-alveolar lavage

CDIPC Central Department of Infection Prevention & Control

DGHS Director General of Health Services

COVID Corona Virus Infectious Disease

ED Emergency Department

HCF Health care facility

HCW Health care worker

HEPA High-efficiency particulate filter

IPC Infection prevention and control

PPE Personal Protective Equipment

PCR Polymerase chain reaction

PAPR Powered air-purifying respirator

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The Newly Emerging Coronavirus Disease 2019 (COVID-19)

Infection Prevention & Control Guideline for Healthcare Facilities

Introduction:

An outbreak of a Coronavirus (SARS CoV-2) declared in Wuhan City, Hubei Province, China in

December 2019 with probable link to a large seafood and animal market, suggesting zoonotic

origin of this virus. With spread of this infectious disease to more than 150 countries globally, the

World Health Organization (WHO) has declared this as a Pandemic.

The central infection prevention and control department issues this document as a guideline for

preparedness and management of suspected or confirmed cases of COVID-19.

Summary of Changes to the Guideline:

-Confirmed HCWs with COVID-19 who has mild disease can join the work after completing 14 days since

onset of illness if clinically improving and NO need to repeat PCR (page; 14&25).

-Inpatient who are not immunocompromised and/or critically sick can be de-isolated after completing

14 days since onset of symptoms without repeating PCR provided they had clinical improvement (page

24&25)

- De-isolation related algorithms were updated to reflect above changes (page 25)

Objectives:

This document provides guidelines for COVID-19 infection prevention and control practices to be

implemented when managing suspected or confirmed cases based on the best available scientific

evidence and expert consensus.

As the knowledge about this newly emerging virus is evolving, please refer to on-call service of

CDIPC (91313315) for any clarification or special scenario that is not covered within this guideline.

1. Administrative Interventions:

Health care facilities should observe and ensure that the facility is prepared for managing

suspected/conformed cases with COVID-19 infection (refer to the checklist in annex 1)

including the following:

1.1. ED and outpatient departments should implement infectious diseases triage (Reference

to triage guideline; https://www.moh.gov.om/en/home)

1.2. Display clear instructions in facility entrances (ED and OPD) for the patients and their

accompanies about the need to inform HCW of symptoms of acute respiratory illness

when they first register for care

https://www.moh.gov.om/en/home

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1.3. Segregate and provide space to ensure a distance (2 m) between patients with

symptoms of respiratory infections

1.4. Provide supplies to perform hand hygiene to all patients upon arrival to facility (e.g., at

entrances of facility, waiting rooms, at patient check-in) and throughout the entire

duration of the visit to the healthcare setting.

1.5. All persons with symptoms of respiratory infection adhere to respiratory hygiene* and

cough etiquette, hand hygiene, and triage procedures throughout the duration of the

visit

1.6. Ensure that HCWs are trained and competent in proper HH, donning and doffing of PPE

including N95

1.7. All HCWs working in high risk areas (e.g: ED, Medical Wards, intensive care units,

isolation rooms) should have N95 mask fit testing to ensure their proper size and shape

1.8. HCWs who failed N95 mask fit test should receive training on the use of PAPR (Powered

Air Purifying Respirators) or otherwise exempted from looking after suspected or

confirmed cases.

1.9. The case definition and algorithm issued by the MoH is available and disseminated to

all HCWs and training on cases recognition provided especially for triage staff. Refer to

(https://www.moh.gov.om/en/home)

2. Transmission Precautions:

2.1. Adhere to standard precautions including hand hygiene; assume that every person

coming to the facility is a risk for infection transmission.

2.2. Adhere to transmission based precautions in addition to the standard precautions:

2.2.1. Droplet & contact precautions: For suspected/confirmed COVID-19 patients who

are not critically ill.

2.2.2. Airborne & contact precautions: Should be implemented for

suspected/confirmed COVID-19 patients when they are;

Critically ill (e.g. pneumonia with respiratory distress or hypoxemia),

Critically or non-critically ill but anticipating aerosol- generating procedures for example;

- Bronchoscopy

* Respiratory Hygiene/Cough Etiquette

Cover your mouth and nose with a tissue or cover with your inner elbow when

coughing or sneezing.

Dispose of tissue in the pedal bin.

Perform hand hygiene.


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- Sputum induction - Intubation and/or extubation - Cardiopulmonary resuscitation - Open suctioning of airways - Manual ventilation via ambu bagging through a mask before

intubation - Tracheostomy - Non-invasive ventilation

3. Patient Placement

Place suspected or confirmed COVID-19 patients as follows:

Patient who is not critically ill in a single isolation room with dedicated toilet facility

Critically ill patient in an Airborne Infection Isolation Rooms (Negative Pressure Rooms)

due to the high likelihood of requiring AGP

When single rooms are not available, cohort confirmed patients together ensuring at

least 1.2 meters between beds and there is dedicated toilet facility, DON’T cohort the

suspected cases as this may facilitate transmission of infection.

Ensure that ventilation in cohorting area is not shared with other non-infected patient

areas

Put visible and clear isolation sign for all HCWs, patients and visitors

Ensure availability of PPE at the entrance of isolation room

Restrict the movement and transport of patients out of the isolation room or area

unless medically essential

The use of designated portable X-ray, ultrasound, echocardiogram and other important

diagnostic machines is recommended when possible or otherwise ensure proper

cleaning and disinfection after each use

Use either disposable or dedicated equipment (e.g. stethoscopes, blood pressure cuffs

and thermometers). If sharing equipment is unavoidable, clean and disinfect it after

each patient use

3.10. Use the log sheet for all persons who enter the isolation room (Annex 6)

3.11. For specific high risk groups of patients (e.g. obstetric cases, dialysis, new born, etc.)

please consult the on-call person from CDIPC (91313315)

4. Performing Aerosol-Generating Procedures (AGP)

Performing AGP on suspected or confirmed COVID-19 patients can generate higher

concentrations of infectious respiratory aerosols than coughing, sneezing, talking, or

breathing. These procedures potentially put HCWs at an increased risk for COVID-19

exposure. The following are precautions for AGP on patients with suspected or confirmed

with COVID-19:

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Perform these procedures only, if they are medically necessary and cannot be

postponed

Limit the number of HCWs present during the procedure to only those essential for

patient care and support

Conduct the procedures in an airborne infection isolation room (AIIR) when feasible

and consider using portable High Efficiency Particulate Air (HEPA) filtration units for

further reducing the concentration of contaminants in the air

HCWs should adhere to standard precautions, including wearing gloves, gown, and

either a face shield that fully covers the front and sides of the face or goggles

HCWs should wear respiratory protection e.g. fitted N95 filtering respirator/ PAPR

(powered air purifying respirator) during AGP

Unprotected HCWs should not be in a room where an AGP is being conducted or was

conducted until sufficient time has elapsed to remove potentially infectious particles

Conduct terminal cleaning. Refer to section 7

5. Patient Transport:

Avoid the movement and transport of patients out of the isolation room or area unless

medically necessary. The use of designated portable X-ray, ultrasound, echocardiogram and

other important diagnostic machines when possible. If transport within or outside facility is

unavoidable, the following to be observed;

Patients should wear a surgical mask to contain secretions (N95 mask is not required

for this purpose)

Use routes of transport that minimize exposures of staff, other patients, and visitors.

For transport to other healthcare facility;

Use an ambulance with close door/ window between driver and patient compartment

Ensure that healthcare workers (HCWs) who are transporting patients wear appropriate PPE and perform hand hygiene when appropriate

As far as possible family members and close relatives to be discouraged from travelling in the same vehicle. If this is not possible, they must be evaluated for fever and lower respiratory symptoms and either is present they must wear a surgical mask during transport

Notify the receiving area of the patient’s diagnosis and necessary precautions as soon as possible before the patient’s arrival

Do not touch unnecessary surfaces in the vehicle

Clean and disinfect the vehicle according to the housekeeping policy of the healthcare facility

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6. Personal Protective Equipment (PPE) for Health Care Workers (HCWs)

6.1. Use appropriate PPE as per risk exposure (refer to annex 2 & 5)

6.2. The following PPE to be used by HCWs upon entry into patient rooms or care areas in

the respected order:

Gowns (clean, non-sterile, long-sleeved disposable gown)

Surgical mask (or N95 when airborne precautions are applied)

Eye protection (goggles or face shield)

Gloves

6.3. For patients on airborne precautions, any person entering the patient's room should

wear a fit-tested N95 mask. For those who failed the fit testing of N95 masks (e.g. those

with beards), an alternative respirator, such as a powered air-purifying respirator

(PAPR), should be used.

6.4. Upon exit from the patient room or care area;

Remove PPE at the doorway or in the anteroom except the N95 mask, after

leaving the patient room and closing the door

PPEs to be removed and discarded in sequence: 1. Gloves, 2. Goggles or face

shield, 3. Gown, and 4. Mask or respirator and perform HH after each step of

doffing

6.5. Never wear a surgical mask under the N95 mask as this prevents proper fitting and

sealing of the N95 mask thus decreasing its efficacy.

7. Environmental Cleaning and Disinfection

As the role of environment in the transmission of COVID-19 is not yet clear nor the

appropriate decontamination materials; the same measures used for MERS-CoV is

recommended:

Designate well-trained housekeepers for cleaning and disinfecting of patient

rooms/areas

Formulate a checklist to promote accountability for cleaning procedures

Housekeepers should wear PPE (surgical mask, gloves, long-sleeved gown, plastic

apron, fluid resistant boots)

Keep areas around the patient free of unnecessary supplies and equipment to facilitate

daily cleaning

Use approved disinfectant against SARS CoV-2, follow manufacturer's

recommendations for dilution (i.e., concentration), and contact time.

Recommended disinfectants:

Disinfectant Concentration Sodium hypochlorite (bleach)

NaDCC (Haz-tab) 1tab :1.5 l water Benzalkonium chloride

Ethanol

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7.6. The patient isolation room or cohort area to be cleaned and disinfected at three times

per day

Focus on high touched surfaces (e.g., bedrails, bedside and over-bed tables, TV control,

call button, telephone, doorknobs, commodes, ventilator and electronic monitor) in

addition to floors and other horizontal surfaces.

Wipe external surfaces of portable equipment e.g. X-rays, ECG etc. upon removal from

the patient's room.

Curtains are to be removed after patient discharge and placed in a water-soluble bag

then into red hamper bag for transport to the laundry as per national guidelines.

After discharge, follow standard procedures for terminal cleaning of an isolation room.

7.10. Decontamination of ambulance transporting suspected/ confirmed case of COVID-19

Disinfect the reusable medical equipment

Clean the surfaces with all-purpose detergent and water

Apply the surfaces with MoH supplied disinfectants (HAZTAB- 1tab to 1.5 liter and

Hycolin 1part to 19 parts of water) – observe for contact time

Rinse with water - if needed

Clean and disinfect the interior of the patient care compartment especially the

high-touch surfaces such as door handles and surfaces with visible contamination

of blood and body fluids.

Prevent aerosols generating cleaning procedures (e.g. spraying directly of

disinfectant on the surfaces, using pressurized water, vacuuming) when cleaning

and decontaminating.

Disinfect the ambulance’s exterior; patient loading doors and handles, and any

areas that may have been contaminated. The exterior of the ambulance does not

require a wiping with disinfectant.

Dispose of all waste during the procedure including PPE in yellow waste bag. Use

double bagging

Wash hands with soap and water

Additional cleaning methods can also be used e.g. hydrogen peroxide fogging.

Follow the manufacturers Information for Use (IFU).

Collection and handling of laboratory specimens

8.1. All specimens collected for laboratory investigations should be regarded as potentially

infectious and receiving laboratory sections should be notified to take appropriate

precautions.

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8.2. HCWs who collect or transport clinical specimens should adhere rigorously to Standard

Precautions to minimize the possibility of exposure to pathogens.

8.3. Precautions for collection of respiratory specimens depend upon the site of collection.

Nasopharyngeal swab and throat swab should be collected under contact and

droplet precautions (healthcare personnel should wear gloves, surgical mask,

eye-protection and long-sleeved gown)

Other respiratory specimens listed in section 2.2.2 as AGP in this guideline,

follow airborne and contact precautions. (healthcare personnel should wear a

fit-tested N95 respirator, eye protection, and long-sleeved gown)

8.4. Ensure that all personnel who transport specimens are trained in safe handling

practices and spill decontamination procedures.

8.5. Place specimens for transport in triple packing with the patient’s name label on the

specimen container (primary container), and a clearly written laboratory request form.

8.6. Ensure that health-care facility laboratories adhere to appropriate biosafety practices

and transport requirements

8.7. Deliver all specimens by hand whenever possible.

8.8. DO NOT use pneumatic-tube systems to transport specimens.

8.9. Document full name, date of birth of suspected COVID-19 patient of potential concern

clearly on the accompanying laboratory request form.

8.10. Notify the Central Public Health laboratory as soon as possible that the specimen is

being transported (hotline: 91313316)

9. Medical Waste

9.1. Contain and dispose of COVID-19 contaminated medical waste in double yellow bag

and follow the national guidelines of medical waste management.

Wear appropriate PPE (long-sleeved gown, gloves, surgical mask, closed footwear)

when handling waste.

Perform hand hygiene after removal of PPE.

10. Textiles (Linen and Laundry)

10.1. Place soiled linen in water-soluble bag then into red hamper bag for transport to the

laundry as per national guidelines

10.2. Contain linen in a manner that prevents the linen bag from opening or bursting

during transport and in holding area.

10.3. Wear gloves, surgical mask and gown when directly handling soiled linen and textile

10.4. Do not shake or handle soiled linen in a manner that might aerosolize infectious

particles

10.5. Wash and dry linen as per the MoH Laundry Services Policy

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11. Managing the Visitor to the Patient:

11.1. Consider visitors who have been in contact with the patient before and during

hospitalization as a possible source of COVID-19 infection for other patients, visitors,

and staff.

11.2. For persons with acute respiratory symptoms, facilities should develop visitor

restriction policies that consider location of patient being visited (e.g., oncology

units) and circumstances, such as end-of-life situations, where exemptions to the

restriction may be considered at the discretion of the facility.

11.3. Regardless of restriction policy, all visitors should follow precautions for respiratory

hygiene and hand hygiene.

11.4. Visits to COVID-19 patients in isolation should be scheduled and controlled as follows:

Screening visitors for symptoms of acute respiratory illness before entering the hospital.

Providing instruction, before visitors enter patients’ rooms, on hand hygiene, limiting surfaces touched, and use of personal protective equipment (PPE)

Visitors/attendants should not be present during aerosol-generating procedures.

12. Management of exposure to confirmed COVID-19 cases within health care facility:

In a healthcare facility; contacts can be HCWs, patients, and/or visitors, who had

unprotected exposure (without appropriate PPE for the encounter) to confirmed cases

of COVID-19.

Steps of contact management after a case has been laboratory confirmed

o Contact identification and listingo Classification of contacts into close contacts (high-risk exposure) or casual

contacts(low-risk) exposureo Contact tracing and assessment (i.e. communicate with the contact persons

and assess risk)o Contact management and follow -up (i.e. inform, advise, follow-up, including

testing if indicated)o The infection control team of the facility should trace all contacts within the

HCF, and follow them for symptoms (fever, cough and difficulty in breathing) for a total of 14 days from last exposure with the case.

12.1. High risk exposure:

Defined as close contact with COVID-19 case without appropriate PPE use within 2

meters OR contact > 2 meters without appropriate PPE while performing AGP

12.1.1. Symptomatic and High risk:

Isolate and maintain standard, droplet and contact precautions Recommended COVID-19 PCR (Nasopharyngeal and Oropharyngeal swab) at

least 24hours from last contact with confirmed case.

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If COVID PCR positive, manage as a confirmed case

If COVID PCR negative but strong clinical suspicion remains, repeat COVID-19 PCR 48hrs after initial PCR and look for alternative diagnosis

12.1.2. Asymptomatic and High risk:

Isolate at home / institution for 14 days

Monitor daily for symptoms of COVID-19

If symptoms develop within 14 days after exposure, manage as a symptomatic contact

12.2. Low-risk exposure:

Defined as close contact with confirmed COVID -19 case within 2 meters and

wearing appropriate PPE OR

Casual contact:

o person having casual contact with an ambulant COVID-19 case o Person having stayed in an area presumed to have ongoing,

community transmission.

Monitor for 14 days from the time of exposure to COVID -19 case

Report immediately if symptoms develop within 14 days from the last exposure

If symptoms develop, manage as symptomatic contact

12.3. Management of exposed HCWs to confirmed COVID -19 case

Any HCW providing direct care for COVID-19 patient, or laboratory workers

handling specimens for COVID-19 test when listed in exposure list are to be

managed according to the categories below:

12.3.1. Symptomatic and high risk:

Isolate and maintain standard, droplet and contact precautions Recommended COVID-19 PCR (Nasopharyngeal and Oropharyngeal swab) at

least 24hours from last contact with confirmed case. Stop performing duties immediately

If COVID PCR positive manage as confirmed case Should not resume duties until cleared by IPC team in the facility If COVID-19 PCR Negative:

For mild disease: o Home/institutional isolation for total 14 days and assess for

clinical improvement For moderate to severe disease and/or clinical worsening since initial

negative:o Repeat COVID-19 PCR at least 48hrs after initial PCRo Look for alternative etiology and manage accordingly

12.3.2. Asymptomatic but high-risk contact:

Isolate at home / institution for 14 days

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Monitor daily for symptoms of COVID-19

If symptoms develop within 14 days after exposure, manage as a symptomatic contact

12.3.3. Low –risk exposure:

No need to exclude from work if asymptomatic

Monitor for symptoms for 14 days from the time of exposure to COVID19 case.

Report immediately if symptoms develop within 14 days from the last exposure.

If symptoms develop, manage as symptomatic contact.

12.4. Management of exposed patients to confirmed COVID-19 case

A patient admitted in the same cubical or engaged socially with the confirmed

COVID-19 case

12.4.1. Symptomatic:

Isolate and maintain standard, contact and droplet precautions

Recommended COVID-19 PCR (Nasopharyngeal and Oropharyngeal swab)

If COVID-19 PCR positive: manage as confirmed case

If COVID-19 PCR Negative:o Repeat PCR within 48hrs if clinically or radiologically worsening and

consider lowerrespiratory samples like BALo Look for alternative diagnosis

12.4.2. Asymptomatic:

Cohort or isolate the patient with appropriate isolation precaution (Standard, contact and droplet) for 14 days from last contact.

Report immediately if symptoms develop within 14 days of last exposure

If symptoms develop manage as symptomatic case, refer to points 12.4.1.

If Discharged, send the list to the IPC team at the DGHS of their governorate for evaluation, home quarantine and follow-up

Continue to monitor the patient for symptoms for 14 days after the last exposure

12.5. Patient’s attendants and visitors exposed to confirmed COVID-19 case

A visitor or attendant who was in the same room with the confirmed case

without using appropriate PPE.

IPC team to maintain log sheet for attendants and visitors. Refer to annex 6

Visitors and attendants in contact with the patient must be listed and

assessed for symptoms in co-ordination with IPC team at DGHS of their

governorate for evaluation, home quarantine and follow-up

Monitor for symptoms for 14 days in the community

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12.6. Management of exposed confirmed COVID-19 cases outside the HCF

All contacts outside the HCF should be followed by IPC in DGHS of

governorate.

Close contacts of confirmed COVID-19 cases in the community could be:o Passenger in an aircraft sitting within two seats (in any direction) of

COVD-19 cases

o Travel companions providing care for COVID-19 case

o Crew members serving in section of aircraft where case is seated o Persons sharing a closed work/home environment (e.g. household

family member or room-mate, a co-worker in same office) The management follows the same principles as for visitors in section 12.5.

13. Guidelines for De-isolation of Patients with Suspected/ Confirmed COVID -19

13.1. The currently available evidences from global experience with COVID-19 outbreaks

agreed that No single indicator may be effectively used to decide on de-isolation of a

suspect / confirmed case. There were notable operational challenges in de-isolation of

cases:

The lab testing capacity and test results turnover along with substantial numbers of suspect cases admitted for isolation and the need to hold patients for repeated testing while managing isolation room occupancy.

For patients who needed ongoing inpatient care for other reasons, we also need to address the risk of inadvertent nosocomial amplification, to reduce the risk of transmission from patients who had tested negative early in their clinical illness or those who continue to have persistent positive PCR despite clinical recovery.

13.2. This guidance is developed to help clinicians and infection control team to de-isolate COVID-19 patients safely and limit the risk of health care transmission:

De-isolation of a patient confirmed or suspected of COVID 19, means to discontinue following transmission-based precaution (Contact and Droplet precautions) while ensuring practice of standard precautions.

De-isolation does not necessarily mean discharge from the facility rather patient may be de-isolated based on the criteria below and continue to be managed as an inpatient for other clinical indications (e.g renal failure, blood pressure control or management of diabetes, etc.).

Discharging patients should be a clinical decision by treating physician in consultation with infection prevention and control (IPC) team regarding isolation precautions.

The criteria below is only for de-isolation considering the diagnosis of suspected or confirmed COVID-19, but patient should be assessed for need of transmission-based precautions for other reasons (e.g.: MDRO, suspected TB, diarrhea, protective isolation for immunocompromised). The de-isolation decision should always be coordinated and discussed with IPC team of the facility.

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13.3. For management of increasing number of patients requiring isolation and unavailability of single rooms consider the following:

Cohorting the confirmed cases in one area but NOT suspected cases as this may facilitates transmission.

Home isolation for suspect or confirmed cases if no specific inpatient clinical care is needed but ensure maintaining access to care in case of clinical worsening.

** Please report such cases to the governorate team of DGHS for follow-up of patients and testing results.

13.4. The criteria for the Clinical Improvement used in this guideline include two points:

The patient being Afebrile (temp< 38°C) ≥ 48hrs without antipyretics AND

Asymptomatic (apart from cough which can persist for long time)

13.5. Consider de-isolation of a Confirmed COVID-19 case including in HCWs if there is:

Clinical Improvement And

Completed 14 days of illness

13.6. A Negative PCR (Nasopharyngeal / Throat swab/ sputum sample) (Collected at least 14 days after illness onset) and clinical improvement is needed ONLY for admitted immunocompromised and critically ill patient (required ICU admission)

If repeated PCR is positive but patient is clinically and radiologically improving, the decision about de-isolation depends on discharge status:

o If patient is for discharge, advise for home isolation for 7 more days and no need to repeat PCR.

o If patient will remain admitted, then continue isolation and repeat PCR in 7 days if he/she is still inpatient.

If the repeat PCR is positive and the patient had worsened clinically and/or radiologically, to continue isolation and consider repeating PCR when improving but not before 7 days from last sample tested.

13.6. Consider the following criteria for de-isolation of a Suspected admitted COVID-19 case:

If initial PCR is Negative and clinically improving, then he/ she can be de-isolated

If patient’s initial PCR is Negative but is clinically and/or radiologically worsening, then do not de-isolate and repeat PCR using lower respiratory sample e.g. Sputum/ ET secretions/ Broncho-alveolar lavage (BAL)

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** Due to the observation of prolonged viral shedding in faeces in confirmed cases, careful

personal hygiene precautions after de-isolation are warranted especially in children and

immunocompromised patients

14. Home isolation for contacts confirmed COVID-19 infection

Discharged patients, visitors, and attendants exposed to confirmed COVID-19 cases, should be in home/institutional isolation and cared for as following:

14.1. Person and family members should be educated on personal hygiene and infection

control measures including frequent hand hygiene.

14.2. Person should be placed in a well-ventilated single-room in his home or if not

available to be in institutional isolation.

14.3. Only one assigned family member must care of the patient

14.4. Visitors and relatives are not allowed to be in contact with isolated person or come to

his/her home

14.5. Restricted movement within the house

14.6. Cover cough and sneeze with tissue or cough and sneeze on his sleeve.

14.7. Throw used tissues and immediately wash hands with soap and water or disinfect

with alcohol-based hand sanitizer

14.8. Wash hand as often thoroughly with soap and water

14.9. Family member giving care should wear surgical mask when attending the ill person,

and should dispose it after use and wash hands using soap and water or disinfect with

an alcohol-based hand sanitizer.

14.10. Avoid sharing household items e.g; dishes, drinking glasses, cups, eating utensils,

towels, bedding, or other items with other people at home

14.11. Clean and disinfect frequently touched surfaces in the patient room (e.g. bed frames,

tables etc.) daily with regular household bleach solution (1 part of bleach to 99 part of

water)

14.12. Clean the clothes and other linen used by the patient separately using common

household detergent and dry.

14.13. Avoid shaking the soiled linen or direct contact with skin

14.14. Use disposable gloves and gown when cleaning the surfaces or handling soiled linen.

Wash hands after removing gloves

14.15. Report any new symptoms or worsening to the nearest health center or the provided

contact number

** For the information sheet on home isolation and waste management please access

the (https://www.moh.gov.om/en/home)


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15. Infection prevention and control messages to the public :

Each individual is expected to practice the following general preventive measures for respiratory infections that are also applicable for COVID-19:

15.1. Avoid close contact with people who appear unwell, and have fever and cough.

15.2. Wash hands with soap and water or hand sanitizer thoroughly and often.

15.3. Practice good health habits including adequate sleep, eating nutritious food, and

keeping physically active.

15.4. While visiting farms, markets, barns, or other places where animals are present,

practice general hygiene measures, including regular hand washing before and after

touching animals, and should avoid contact with sick animals.

15.5. Avoid the consumption of raw or undercooked animal products, including milk and

meat. Animal products that are processed appropriately through cooking or

pasteurization are safe for consumption, but should also be handled with care to avoid

cross contamination with uncooked foods.

15.6. Any person with fever, cough, and /or sore throat should be advised to follow the

following steps:

15.7. Separate yourself from other people in your home or work as much as possible.

15.8. Cover your coughs and sneezes with tissue or you can cough or sneeze into your

sleeve.

15.9. Throw used tissues and immediately wash your hands with soap and water or

disinfect it with waterless alcohol-based hand sanitizer.

15.10. Wash your hands often and thoroughly with antiseptic soap and water.

15.11. Avoid touching your eyes, nose, and mouth with unwashed hands.

15.12. Avoid sharing household items e.g; dishes, drinking glasses, cups, eating utensils,

towels, bedding, or other items with other people in your home.

15.13. If you are severely ill, you should see a doctor and disclose to healthcare provider

any history of contact with sick person and or travel history.

16. Handling and Management of Dead bodies

Body of deceased person with COVID-19 may pose a potential risk of infection when

handled by either family members or municipality staff. As it is listed in risk

category 2; therefore standard precautions in addition to contact and droplet

precautions are recommended3

In our setting the religion and culture play a major role in washing and burying

practices. The team has obtained fatwa (religious opinion) from Ministry of

Endowments & Religious Affairs (Sheikh Dr. Kahlan Bin Nabhan Al Kharusi: The

Assistant Grand Mufti) to address the issue of management of deceased bodies with

infectious hazards from the religious aspect. Refer to fatwa in MoH website

https://www.moh.gov.om/en/web/directorate-general-of-disease-surveillance-

control/resources

https://www.moh.gov.om/en/web/directorate-general-of-disease-surveillance-control/resources

https://www.moh.gov.om/en/web/directorate-general-of-disease-surveillance-control/resources

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Explain to family members the reasons for prohibiting some practices that involve

high risk of disease transmission.

Identify a family member who has the influence in the family to ensure that family

members avoid dangerous practices during body viewing, washing such as

(abdominal thrust and evacuation of body fluids, etc.) and funeral.

For foreigners; the process should be coordinated with their embassy to advise

regarding burying in Oman Vs repatriation and ensuring adherence to infection

prevention and control measure during transport, handling and receiving the body

in the country of origin.

Ensure the following after death of patient COVID-19 in HCFs:

o IPC team is informed and communicates with the regional/governorate IPC team for arranging body wash and burial procedure under supervision, in the community

o Washing and preparation of deceased body of COVID-19 patient should be done by the regional municipalities in designated areas

o Family members who wish to perform body washing, should be supervised by DGHS IPC team

16.1. Precautions for preparing dead bodies of suspected/confirmed COVID-19 disease in the health care facility:

o Avoid direct contact with blood or body fluids from the dead body o Make sure wounds, cuts and abrasions, are covered with waterproof

bandages or dressings. o Avoid sharps injury, during examination of dead body, waste disposal and

decontamination o Do NOT touch your eyes, mouth or nose without hand hygiene o Perform hand hygiene, washing hands with liquid soap and water or proper

use of alcohol-based hand rub o Use personal PPE including Gloves, water resistant gown/ plastic apron over

water resistant gown, and surgical mask. Use goggles or face shield to protect eyes, if there are splashes.

o All tubes, drains and catheters on the dead body should be removed. Extreme caution should be exercised when removing intravenous catheters and other sharp devices. They should be directly disposed into a sharps container.

o Wound drainage and needle puncture holes should be disinfected and dressed with impermeable material.

o Oral, nasal and rectal cavities of the dead body have to be plugged to prevent leakage of body fluids.

o The body should be wrapped with a white sheet then placed in a robust and leak-proof plastic bag, which should be zippered closed

o The trolley carrying the body must be cleaned and disinfected after transport

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o Surfaces visibly contaminated with blood and body fluids should be clean and disinfected as per guidance in the environmental cleaning section

o All used linen should be handled with standard precautions. Used linen should be handled as little as possible with minimum agitation to prevent possible contamination of the person handling the linen and generation of potentially contaminated lint aerosols in the areas. Laundry bag should be securely tied up.

o Used equipment should be autoclaved or decontaminated with disinfectant solutions in accordance with the facility policy

16.2. Transport of deceased body: o The body should be transported by vehicle / ambulance prepared for this

purpose to the closest washing/burying area. o Persons who handle the body during transport should wear appropriate PPE

(long sleeved gown, gloves, surgical mask) ** Note: The driver does not need to wear protective clothing if there is no

contact with the body

o The transporting vehicle should be cleaned and disinfected as per the guidance for ambulance (refer to section 7.10)

16.3. Precautions for dead bodies of suspected/confirmed COVID-19 disease in cemetery:

o Washing should be done by trained municipality staff using PPE (Gloves, water resistant gown/ plastic apron, and surgical mask with goggles or face shield to protect eyes) in a designated area like (mosques, municipality washing areas, washing areas in the grave yard/Cemeteries)

o Family members who insist to perform body washing, should be supervised by trained municipality staff/IPC DGHS team and wear appropriate PPE (Gloves, water resistant gown/ plastic apron, and surgical mask with goggles or face shield to protect eyes)

o Minimize number of people viewing the body (close family members only) or attending funeral and restrict to close relatives.

o Viewing the body should be done without touching and kissing o The grave should be at least 2 meters deep. o The prayer for the death person can take place by a limited number of his

close relatives. o Ensure decontamination of environmental surfaces in body washing

area/mortuary.

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References: 1. Discontinuation of Transmission-Based Precautions and Disposition of Patients with COVID-19 in

Healthcare Settings (Interim Guidance) 2020: https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-hospitalized-patients.html

2. Coronavirus disease (COVID-19) technical guidance: Infection prevention and control https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/infection-prevention-and-control

3. Novel coronavirus (SARS-CoV-2). Discharge criteria for confirmed COVID-19 cases – When is it safe to discharge COVID-19 cases from the hospital or end home isolation: https://www.ecdc.europa.eu/sites/default/files/documents/COVID-19Discharge-criteria.pdf

4. Precautions for Handling and Disposal of Dead Bodies, Last reviewed: February 2020

https://www.chp.gov.hk/files/pdf/grp-guideline-hp-ic-precautions_for_handling_and_disposal_of_dead_bodies_en.pdf

5. Modes of transmission of virus causing COVID 19: implication for IPC precaution recommendations https://www.who.int/news-room/commentaries/detail/modes-of-transmission-of-virus-causing-

covid-19-implications-for-ipc-precaution-recommendations

https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-hospitalized-patients.html

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/infection-prevention-and-control

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/infection-prevention-and-control

https://www.ecdc.europa.eu/sites/default/files/documents/COVID-19Discharge-criteria.pdf



https://www.who.int/news-room/commentaries/detail/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution-recommendations

https://www.who.int/news-room/commentaries/detail/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution-recommendations

Page 20 of 29


Annex 1. Checklist for Implementing IPC measures in managing suspected or confirmed case of COVID-19 within health care facilities

Facility profile:

Name of Facility:

Date of assessment:

Bed capacity:

S.No Assessment tool Yes No NA Remarks 1. Administrative interventions

1.1 The management and leaders of healthcare facility are aware & implement the national COVID-19 guidelines and follow the instructions

1.2 The hospital management aware & implement the updated COVID-19 algorithms and forwarded to the HCWs

1.3 There is a process for auditing adherence to recommended hand hygiene and PPE use

1.4 There is HH facilities, including alcohol-based hand sanitizer are readily accessible in patient care areas, including areas where HCW remove PPE

1.5 HCWs are trained and educated regarding COVID-19 according to IPC updated guidelines:

Case definition

Isolation precautions

Contact tracing

Cleaning and disinfection

Hand hygiene and PPE

Handling dead bodies

2. Triage system in healthcare facility (HCF) 2.1 HCF are adhere to the triage system according to IPC triage guidelines

2.2 Signs are posted in facility entrances (e.g. ED, OPD) to instruct individuals with respiratory symptoms to immediately put on a mask and practice cough etiquette

2.3 Surgical masks are given to coughing patients and other symptomatic individuals upon entry to the facility

2.4 There is a mechanism to segregate persons with symptoms of respiratory infections in waiting area. Place them away from others

2.5 Alcohol based hand sanitizer for hand hygiene is available at each entrance and in all common areas

2.6 There is a triage pathways ensuring patients with confirmed or suspected COVID-19 are immediately isolated

2.7 Suspect and confirmed cases of COVID-19 are reported immediately as per national guideline by designated staff

3. Patient placement/ isolation precautions: 3.1 All COVID-19 suspected cases should be isolated in single room with

dedicated toilet under droplet and contact precautions

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3.2 Confirmed cases which critically ill should be isolated in airborne precautions

3.3 When single isolation room insufficient, cohort patients with confirmed COVID-19 cases and maintain at least1.2 meter between beds

3.4 Isolations sign is posted in entrance door of isolation room/area

3.5 PPE and hand hygiene facility are available at entrance of isolation rooms

3.6 Adhere to guideline for aerosol-generating procedures (e.g. intubation, CPR, suctioning) to be performed in negative pressure room using appropriate PPE including N95

3.7 There is mechanism to minimize the number of HCW who enter the isolation room

3.8 There is a log record for HCWs entering isolation rooms

3.9 HCWs Adhere to the process for de-isolation of patients suspected/confirmed with COVID-19 according to IPC guidelines

4. Patient Transport (Intra/ inter facility) 4.1 The patient movement is restricted to isolation room unless medically

essential

4.2 Patients should wear a surgical mask to contain secretions during transport

4.3 Use an ambulance with close door/ window between driver and patient compartment

4.4 Notify the receiving area of the patient’s diagnosis and necessary precautions as soon as possible before the patient’s arrival

5. Personal Protective Equipment for HCWs 5.1 There is adequate supply of (PPE) including alcohol hand rub

5.2 HCWs adhere to rational use of PPE according risk exposure

5.3 HCWs using N95 mask for aerosol generating procedure

5.4 HCWs using PAPR if failed fit test for N95

6. Environmental cleaning and disinfection 6.1 There is a process in place to ensure proper cleaning and disinfection of

environmental surfaces and equipment

6.2 The housekeeping staffs are trained and competent to routine and terminal cleaning proper selection and use of PPE

6.3 There is a process in place for ensuring cleaning and disinfection of shared equipment after use according to manufacturer’s recommendations

7. Collection, handling and transport of laboratory specimens (Refer to CPHL guidelines).

7.1 HCWs who collect/transport/reception clinical specimens strictly adhere to Standard Precautions.

7.2 HCWs who collect specimens wear appropriate PPE (eye protection, medical mask, long-sleeved gown, gloves)

7.3 The respiratory specimen should be collected under aerosol generating procedure; personnel should wear a fit-tested N95 respirator

8. Medical Waste

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8.1 Contain and dispose of medical waste in yellow bag and follow the national guidelines

8.2 Wear disposable gloves when handling waste and wash hands

9. Textiles (Linen and Laundry) Refer to the national guidelines 9.1 Place soiled linen directly into the water soluble bag and into the red

hamper bag

9.2 Wear gloves and gown when directly handling soiled linens

9.3 Proper handling (don’t shake) of soiled linen to prevent aerosolizing infectious particles

10. Managing visitor within the HCF: 10.1 There is a system in place for visitors restriction within the facility

10.2 Maintain log record for all visitors who enter the patient isolation rooms

11 Management of exposed HCWs 11.1 Healthcare facility administration adhere to policies for monitoring and

managing HCW with potential for exposure to COVID-19

11.2 There is a process to track exposures and conduct active- and/or self-monitoring

11.3 There is a process to monitor signs and symptoms of exposed HCW for 14 days from last exposure

12 Discharge Planning 12.1 There are clear instructions for patient after discharge regarding home

care including for isolation/quarantine

12.2 There is coordination between the facility discharge team with DGHS to follow up the suspected/confirmed patient.

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Annex2: Rational use of personal protective equipment (PPE) for COIV-19 according the risk

exposure:

Personal Protective Equipment (PPE) Requirements for COIV-19

Patient Status

COVID-19 Confirmed

/Suspected

Type of Procedure

Aerosol Generating1

Routine

Care2

PP

E P

rod

ucts

N95 Mask

Face Shield/ Goggles

Use if expected splash only

Surgical mask

Gown & Gloves

1Aerosol Generating procedure: includes open airway suctioning, tracheostomy, sputum induction, non-

invasive positive pressure ventilation, intubation, CPR, bronchoscopy,

2Routine practices: apply to all non-aerosolizing generating activities: e.g. basic care, IV insertion,

catheter insertion, etc.

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Ministry of Health Directorate General for Diseases Surveillance & Control

Positive Negative

Symptomatic Asymptomatic

Report immediately if symptoms developed within 14 days from last exposure

If developed symptoms, follow symptomatic contact management

High risk

exposure1

Low risk

exposure2

Trace close contact of confirmed case Annex 7

Monitor all contact for 14 days from time of exposure to case

COVID-19 test

Follow confirmed case management

Isolation home/institutional for 14 days

Follow up daily for COVID-19 symptoms

If develop symptoms within 14days post exposure, follow symptomatic contact management

If strong clinical suspicion remains, then repeat test for COVID-19 PCR 48hrs after initial PCR

Find alternative diagnosis

1-High-risk exposure: Contact with confirmed COVID-19 case without appropriate PPE use within 2 meters OR

contact more than 2 meter and without taken appropriate PPE while perform AGP. 2-Low-risk exposure: Contact with confirmed COVID-19 case within 2 meters and wearing appropriate PPE OR a person identified having casual contact with an ambulant COVID-19 case

© Ministry of Health, Oman, 2020

Management of contacts for a confirmed COVID-19

Annex 3: Management of contacts for a confirmed COVID-19

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© Ministry of Health, Oman, 2020

Annex 4: De-isolation of a confirmed COVID-19

Ministry of Health Directorate General for Diseases Surveillance & Control

De-isolation of a confirmed COVID-19

Positive Negative

Inpatient

Outpatient

Continue isolation and

reassess when clinically improving

Improved

clinically 1 Not

improved

clinically

Assess clinically patient condition

Completed 14 days from onset of

symptoms

Continue isolation

Repeat COVID PCR as per guide in page 14

Can come out of home/institution isolation after completing 14 days from onset of illness

No need to repeat PCR for de-isolation

De-isolate patient

1Improved clinically need include two points:

The patient being Afebrile (temp< 38°C ) ≥ 48hrs without antipyretics

AND

Asymptomatic (apart from cough which can persist for long time)

Mild/ Moderate

ill patient Immune-compromised/

critically ill patient

De-isolate patient

No need to repeat PCR for de-isolation

Repeat COVID-19 PCR

Page 26 of 29


Annex 5: Recommended PPE when caring for a patient suspected or confirmed COVID-19 case

Item Description USE

Gloves Gloves, examination, nitrile, powder-free, non-sterile. Cuff length reach well above the wrist. Sizes, S, M, L

Perform hand hygiene, then put on clean, non-sterile gloves upon entry into the patient room or care area. Change gloves if they become torn or heavily contaminated.

Remove and discard gloves when leaving the patient room or care area, and immediately perform hand hygiene.

Gown Single use, fluid resistant, disposable, length mid-calf to cover the top of the boots, light colours preferable to better detect possible contamination, elastic cuff to anchor sleeves in place.

Put on a clean disposable gown upon entry into the patient room or area. Change the gown if it becomes soiled. Remove and discard the gown before leaving the patient room or care area.

Mask surgical

Medical/surgical mask, high fluid resistance, good breathability, internal and external faces should be clearly identified,

Surgical masks should be worn when in close contact and droplet precaution. The mask acts as barrier and minimizes contamination of nose and mouth by droplets.

Surgical mask should; cover both nose and mouth, Not allowed to dangle around the neck, Not touched once put on, changed when moist or damaged, discarded after use, perform hand hygiene after discard it.

Goggles (protective)

Good seal with the skin of the face, Flexible frame to easily fit with all face contours with even pressure, Enclose eyes and the surrounding areas, Accommodate wearers with prescription glasses, Clear plastic lens with fog and scratch resistant treatments, Adjustable band to secure firmly so as not to become loose during clinical activity, Indirect venting to avoid fogging, May be re-usable (provided appropriate arrangements for decontamination are in place) or disposable.

Put on eye protection (e.g., goggles, a disposable face shield that covers the front and sides of the face) upon entry to the patient room or care area. Remove eye protection before leaving the patient room or care area. Reusable eye protection (e.g., goggles) must be cleaned and disinfected according to manufacturer’s reprocessing instructions prior to re-use. Disposable eye protection should be discarded after use.

Face shield Made of clear plastic and provides good visibility to both the wearer and the patient, Adjustable band to attach firmly around the head and fit snuggly against the forehead, Fog resistant (preferable), Completely cover the sides and length of the face, disposable.

Put on a disposable face shield that covers the front and sides of the face upon entry to the patient room or care area. Remove face shield before leaving the patient room or care area. Discarded after use, perform hand hygiene after discard it.

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Particulate respirator (N95 mask)

N95 or FFP2 respirator, or higher Good breathability with design that does not collapse against the mouth (e.g. duckbill, cup shaped) "N95" respirator according to US NIOSH, or "FFP2" according to EN 149

Use respiratory protection (i.e., a respirator) that is at least as protective as a fit-tested NIOSH-certified disposable N95 filtering facepiece respirator before entry into the patient room or care area.

Disposable respirators should be removed and discarded after exiting the patient’s room or care area and closing the door. Perform hand hygiene after discarding the respirator.

Staff should have fit-tested if using respirators with tight-fitting facepieces (e.g., a NIOSH-certified disposable N95) and trained in the proper use of respirators, safe removal and disposal.

Powered Air Purifying Respirators (PAPR)

A hooded respirator with a full face shield, helmet, or headpiece, with a self-contained filter.

For patients on airborne precautions or when performing

aerosol generating procedures.

High-risk staff who failed N95 mask fit test (e.g. those with

beards), should receive training on the use of PAPR

(Powered Air Purifying Respirators) or otherwise exempted

from looking after suspected or confirmed cases.

PAPR must be cleaned and disinfected according to

manufacturer’s reprocessing instructions prior to re-use.

Alcohol-based hand rub

Contain ethanol, isopropanol, n-propanol or a combination of two of these products; contain 60%-80% alcohol.

HCWs should apply the 5 moments for hand hygiene;

before touching a patient, before any clean or aseptic

procedure, after body fluid exposure, after touching a

patient, and after touching a patient’s surroundings,

including contaminated items or surfaces.

Follow the correct technique of hand hygiene

Wash hands with antiseptic soap and water when they are

visibly soiled

Fit Test Kit Qualitative or quantitative fit test, bitter or sweet solution use

To evaluate effectiveness of seal for tight fitting

respiratory protection devices

A fit-tested respirator particulate mask (N95 or higher) is

required for all HCWs who will potentially care for patients

in airborne isolation.

A fit check or seal check is a quick check performed by the

wearer each time use the respirator

After passing a fit test with a respirator, the staff must use

the exactly same model, style, and size respirator on the

workplace.

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Facility:

Ward:

Bed Number:

If the patient moves to another area such as Radiology, Theater, etc…, please use another log sheet

Log sheet to be sent to infection control team

Date Name (HCWs, Housekeeping,

Visitors/family members, etc...)

Staff

Number

Time in Time out

Patient’s Sticker

Annex 6: Log sheet for all persons enter to COVID-19 patient rooms

Page 29 of 29 MOH/DGDSC-DIPC/COVID-19 IPC guidelines /Vers 06

Facility Name: Ward:

S.N

Personal Data

COVID-19

Daily Progress Use Legend: SF=Symptoms Free; F=Fever; C=Cough; SOB=Shortness of breath;

DB=Difficult breath; Died=Death; HOS=Hospitalization; Test : COVID-19 tested

Name Age/Sex

Designation Mobile # Test result

Day 1 D/M/Y

Day 2 D/M/Y

Day 3 D/M/Y

Day 4 D/M/Y

Day 5 D/M/Y

Day 6 D/M/Y

Day 7 D/M/Y

Day 8 D/M/Y

Day 9 D/M/Y

Day 10 D/M/Y

Day 11 D/M/Y

Day 12 D/M/Y

Day 13 D/M/Y

Day 14 D/M/Y

1

2

3

4

5

6

7

8

9

10

Patient’s Sticker

Annex 7: Line Listing Record for Close Contacts with COVID-19 Case

Documents

Infection Prevention & Control Guidelines for 6 final.pdf · An outbreak of a Coronavirus (SARS CoV-2) declared in Wuhan City, Hubei Province, China in December 2019 with probable