Dental Practice Setup and Infection Control in Yorkshire and Humber

Reducing the risk of transmission of COVID-19

Version 7 Updated 25th June 2020 (Any updates will be highlighted below)

25.06.20 PHE update on ventilation

22.06.20 Updated to match Dental SOP - Transition to recovery

• Updated Preparation of the surgery and dental practice section, including Environment, Zoning, Patient Flow and Staff Flow

• Added section on Reusable Gowns

• Updated Infection Control section, including Surgery Set up, Ventilation and Process of Cleaning the Surgery

22.05.20 – Updated decontamination section: “Process of Cleaning the Surgery” (changes

highlighted)

• Clarified that all disinfection products should conform to EN standard 14476 for viricidal activity and that advice and support in terms of appropriate cleaning solutions can be sought from your local Infection Control team

• Added clarification on cleaning the doffing room and cleaning of electronic equipment

19.05.20 –

• Minor hyperlink error corrected in “Process of Cleaning the Surgery” (section 4.9.1 of infection control guidance)

07.05.2020 –

• Updated decontamination section: “Process of Cleaning the Surgery” *major update*

• Legionella section removed and created a new document “summary of managing Legionella in dental practice – COVID” (Available on HEE COVID-19 UDC Education Site)

01.05.2020 – Added new section: How to reduce the risk of Legionella and Legionnaires’ in

Dental Practices during the COVID-19 Pandemic

29.04.2020 – Added under ‘Patient Flow’ section, call patient prior to arrival:

• Ask patients to use the bathroom before setting off to reduce the frequency of use of dental surgery toilets and avoid contamination of areas

• As they arrive – consider Face to face triage, this can be in large room in practice or outside the dental practice (with appropriate PPE). This helps the dentist ensure the patient does need treatment. Once decided that treatment is required, the patient

should return back to car until the treating team are ready (in order to be able to record notes, prepare equipment and to ‘don’ appropriate PPE).

Contents Preparation of the surgery and dental practice ....................................................................... 3

Why do I need these precautions? ........................................................................................ 3

How should I set up the practice in preparation for treating urgent dental care patients? . 4

1. Environment ................................................................................................................ 4

2. Zoning .......................................................................................................................... 5

3. Patient flow ................................................................................................................. 6

4. Staffing ........................................................................................................................ 8

5. Staff flow ..................................................................................................................... 9

Infection Control in relation to COVID ................................................................................... 12

Surgery Set up ...................................................................................................................... 13

How should I set up dental surgery prior to urgent dental treatment? .............................. 13

How should I take and process intra-oral radiographs? ..................................................... 13

Surgery Cleaning and Equipment ......................................................................................... 14

How long should I wait prior to cleaning the dental surgery following an AGP? ................ 14

Ventilation ............................................................................................................................ 14

How should I clean the dental surgery following treatment? ............................................. 17

Process of cleaning the surgery ........................................................................................... 17

Equipment ........................................................................................................................ 23

Communal Areas .............................................................................................................. 23

Waste ................................................................................................................................ 23

The purpose of this document is to summarise the National Dental standard

operating procedure: Transition to recovery and Public Health England (PHE)

guidance in relation to practice setup and infection control in urgent dental

care. Please note that this summary is based purely on PHE and

NHSE & I national guidance which is regularly updated. Therefore, all members

of the dental team must regularly review the full guidance at:

https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-

prevention-and-control

https://www.england.nhs.uk/coronavirus/publication/dental-standard-operating-

procedure-transition-to-recovery/

Preparation of the surgery and dental practice

Why do I need these precautions?

Standard infection control measures can be insufficient to prevent cross-

contamination of this infection agent (COVID-19). The transmission of COVID-

19 is thought to occur mainly through respiratory droplets generated by

coughing and sneezing, and through contact with contaminated surfaces. The

predominant modes of transmission are assumed to be droplet and contact.

Airborne transmission can occur where aerosol generating procedures (AGPs)

are performed.

Contact Droplet Airborne Prevent and control infection transmission via direct contact or indirectly from the immediate environment (including equipment). This is the most common route of infection transmission.

Prevent and control infection transmission over short distances via droplets (>5μm) from the patient to a mucosal surface or the conjunctivae of a dental team member. A distance of approximately 1-2 metres around the infected individual is the area of risk for droplet transmission which is why dental teams routinely wear surgical masks and

Prevent and control infection transmission via aerosols (≤5μm) from the respiratory tract of the patient directly onto a mucosal surface or conjunctivae of one of the dental team without necessarily having close contact.

Precautions now need to be taken for all patient encounters (not just patients

with suspected or confirmed COVID-19) at a time when there is sustained

community transmission of COVID-19, as is currently occurring in the UK, and

the likelihood of any patient having coronavirus infection is raised.

All urgent dental care centres will follow standard infection control precautions and transmission-based precautions (TBPs) to reduce the risk of transmission of coronavirus. In dental settings, there is guidance from HTM01-05 and NICE describing infection prevention and control measures that should be used by all staff, in all settings, always, for all patients. TBPs are additional infection control precautions required when caring for a patient with a known or suspected infectious agent and are classified based on routes of transmission. Robust COVID-19 infection control procedures, are set out in PHE guidance for pandemic coronavirus and key points from this guidance, as they apply in a UDC context, have been summarised in Appendix 3 of the national SOP for urgent dental care published by NHS England & NHS Improvement.

PHE have stated that there is insufficient evidence that COVID-19 is spread by

an airborne route, unless an aerosol generating procedure (AGP) is carried out.

However, further research into this area is currently ongoing.

The relevance of this in dental practice is that surgeries should be well

ventilated, keeping doors closed at all times. Appropriate PPE should be worn,

and social distancing should be maintained within the working environment

where possible. Any procedures should be carried out as efficiently as

possible, minimising AGPs, reducing unnecessary clinical interactions and

minimising time spent within 2 metres of both patients and staff.

How should I set up the practice in preparation for treating urgent dental care patients?

1. Environment

Each practice needs to consider their environment and walk through as if a

patient. There is a need to consider the path of entry in and out, with

minimal touching of surfaces, ideally with a member of staff escorting them

eye protection for treating patients.

through to allow for this. Points of entry and exit should be limited, to

ensure adherence to protocols clarified below.

There needs to be adequate signage clearly informing patients regarding

entry and exit, social distancing, the need to wait in their vehicles and the

limitations in numbers allowed in at any one time

Any areas which a patient may be seen in, or may pass through, including

waiting rooms, receptions and dental surgeries need to be kept clean and

clutter free. All non-essential items including toys, books and magazines

should be removed from reception and waiting areas. In dental surgeries,

all equipment or items not required for that treatment episode should be

removed to an area outside the treating surgery.

Regarding the use of fans, there has been an update from PHE on

25.06.2020. Please see the ventilation section for further details.

Whilst social distancing measures are in place, waiting rooms and reception

areas of the urgent dental care centres should allow for 2 metre

separation, ideally marked on chairs and flooring.

2. Zoning

The practice layout will need to be assessed, regarding entry and exit points, areas to ‘don’ (apply) and ‘doff’ (remove) PPE, and sufficient surgeries in order to treat further patients to allow time for any aerosol to settle and for cleaning to occur.

For all patients, physical (e.g. separate waiting areas and treatment rooms) and temporal (e.g. appropriately spaced appointments, sessions for specific patient groups) separation measures should be employed.

Consideration should be given to both patient group and the type of treatment being undertaken. Sites, areas and facilities should be demarcated clearly for specific patient groups they have been designated to receive (e.g. To separate patients who are shielded or at increased risk.)

Think about surgery layout, having a multi-surgery unit set up will allow for

dedicated donning, doffing areas and accommodate room turnaround

time. Having a dedicated donning and doffing zone is ideal, but not always

possible. PPE should be removed in an order that minimises the potential

for cross contamination.

Where there is no dedicated donning and doffing area:

• For non-AGP care o Donning PPE can occur in a clean surgery prior to patient

arrival o Doffing PPE can occur within the surgery, once the patient has

left the surgery.

• For AGP care o Donning can occur in a clean surgery prior to patient arrival o Doffing: PPE is to be removed in as systematic way before

leaving the dental surgery i.e. gloves, then gown and then eye protection. The FFP3 respirator must always be removed outside the dental surgery.

• Where possible, the doffing process should be supervised by a buddy at a distance of 2 metres to reduce the risk of the healthcare worker removing PPE and inadvertently contaminating themselves while doffing.

• The FFP3 (or equivalent) respirator should be removed in either the dedicated doffing area or outside the dental surgery in a safe area. All single-use PPE must be disposed of as healthcare (including clinical) waste.

3. Patient flow

To reduce the risk to patients and staff:

• Only one patient should enter the practice at any given time. Any patients waiting should remain outside, ideally in a vehicle until called. Where this is not possible, patients should maintain social distancing rules.

• If the patient is accompanied, the companion is to be asked to wait outside in a suitable environment such as a car. Where an escort is absolutely necessary (e.g. for consent), one escort should be allowed per patient and this escort should be from the patient’s household to

minimise exposure risk. The escort should also be screened regarding COVID-19 risk prior to entry.

• Consideration should be given to the setup of an external triage area, where patients can be reviewed prior to entering the building, or in a large room within the practice premises.

• Alternatively, a second stage triage can be implemented in each cluster, allowing for a review of the urgency of treatment and face-to-face assessment where indicated.

• When a patient is booked to attend a dental practice:

o Consideration needs to be made to reduce processes that would normally take place in reception, in order to reduce transmission. This can include medical history forms, taking payment, signing FP17 forms, booking further appointments etc.

o Call patients prior to arrival:

▪ Re-screen patients regarding COVID-19 risk and urgent dental care need

▪ Where an escort is needed for consent purposes this is allowed, however patients should otherwise attend on their own

▪ Confirm any exemptions and can go over any relevant forms over the phone (including medical history forms). Practices may need to confirm with NHS BSA regarding the need for physical signature on FP17 forms.

▪ Consider options for payment over the phone where possible (alternatives include contactless payments and bringing exact cash in a sealed bag).

▪ Ask patients to use the bathroom before setting off to reduce the frequency of use of dental surgery toilets and avoid contamination of areas

▪ As they arrive – consider Face to face triage, this can be in large room in practice or outside the dental practice (with appropriate PPE). This helps the dentist ensure the patient does need treatment. Once decided that treatment is required, the patient should return back to car until the treating team are ready (in order to be able to record notes, prepare equipment and to ‘don’ appropriate PPE).

• On entering the building:

o Patients (and escorts if necessary) should be asked to decontaminate their hands with alcohol-based hand rub

o Respiratory and cough hygiene should be observed by staff and patients/carers. Disposable tissues should be available and used to cover the nose and mouth when sneezing, coughing or wiping and blowing the nose – ‘Catch it, bin it, kill it’.

o Patient masks – there has been no guidance as yet from PHE, regarding the use of masks for patients in primary care. However, patients are currently advised to wear masks or face coverings in secondary care. This guidance is being looked at and may be updated in the near future.

• The patient flow should be designed that there is one path of entry and exit, minimising the distance travelled and time spent within the practice.

o Where this is not possible, it should be ensured that any risk of patients coming into contact with other patients is minimised

o If practices pathways are designed so that more than one patient is seen at once within the practice, separate entry and exit points or timeslots will be needed to shield and/or protect any patients that are classified under ‘vulnerable’ or shielded’

• The path through the practice should be designed such that the patient does not contact or touch any surfaces unnecessarily, eg. Door handles, hand rails etc. There should be relevant signage to identify this.

o A designated member of staff should therefore escort patients through the practice, with appropriate PPE (IIR mask minimum)

o A treating surgery will ideally be located in close proximity to the main entrance / exit as well as designated patient toilet facilities.

• Any areas of the practice that are not determined as necessary for patient thoroughfare, should be zoned off to reduce this chance.

4. Staffing

Staffing should be minimised in order to allow for adequate social distancing where appropriate. As few staff as possible should be allocated to see

patients, particularly those shielded, to minimise contacts without compromising the safe delivery of care.

However, there will need to be sufficient numbers to allow for safe donning,

doffing, infection control and patient flow.

Example staffing levels include:

Each session will be comprised of 4 staff members, each with a specific designated role

1. The treating dentist

2. The ‘assisting’ nurse in surgery providing patient care with the dentist

3. The ‘runner’ nurse outside the surgery, to assist with passing required instruments and materials into the surgery and assist donning and doffing

4. A third ‘escorting’ nurse outside of the surgery, to develop radiographs and retrieve emergency drugs if necessary, assist with retrieving any equipment or materials outside of the surgery and escorting patients into and out of the practice.

5. Where larger practices can allow for more than one patient to be seen at a time, then 6 staff members can be utilised. This includes 2 dentists, 2 ‘assisting’ dental nurses and 2 ‘runner’ dental nurses to fulfil the roles outside the dental surgery. It is important that the two dental surgeries are located in different areas of the practice, where possible.

5. Staff flow

Ideal staff flow are as follows:

• Hand hygiene, washing thoroughly with soap and water, is essential to reduce the transmission of infection. All dental staff should decontaminate their hands with alcohol-based hand rub when entering and leaving urgent dental care services

• Social distancing should be maintained at all times as far as reasonably possible in the dental practice in all areas (patient and non-patient facing) and all staff should practise frequent hand washing. This will mitigate against the risks of droplet/contact transmission both between staff/patients and staff/staff.

• For non-clinical areas, such as reception or staff rooms, staff wearing a type IIR fluid resistant surgical mask may minimise the need to self-isolate under the Test and Trace requirements if someone in the practice subsequently tests positive for Covid-19. Whilst fluid resistant face masks (type IIR) may minimise the risk of transmission of COVID-19 they do not replace appropriate social distancing and frequent hand washing.

• There are some important case studies relating to this on the HEE Y&H site (click this sentence to access).

• Where a member of NHS staff tests positive for coronavirus, the starting point is that the Test and Trace self-isolation rules apply as anywhere else, and close contacts must self-isolate if the NHS test and trace service advises them to do so. Close contact excludes circumstances where full PPE is being worn in accordance with current guidance on infection, prevention and control (as above).

• Designated rooms and areas ideally should be identified as ‘donning’ (putting on PPE) and ‘doffing’ (Removal of PPE) areas and these remain fixed. Where this is not possible, please see the zoning section above.

• The ‘DON’ area is for dressing in appropriate Personal Protective Equipment (PPE). The ‘DOFF’ area is to remove PPE.

o Please see Yorkshire and Humber Urgent Dental Care PPE document and PHE Guidance and videos on donning and doffing (links below)

• Ideally plans should include use of multiple treatment rooms, in order to allow any aerosol to settle between patients, and alternating rooms between patients

o A minimum of two dental surgeries is required, however in the case of an AGP being performed then a minimum of three dental surgeries may be ideal, to give adequate time for cleaning to occur.

o In the case where more than one patient is being treated at once within the dental practice, a minimum of four or six dental surgeries required (as per above), with consideration for separate entry and exit pathways where possible.

• During dental treatment, the door must remain shut where possible and windows should be kept open, to aid ventilation and reduction of ≤5μm particles remaining within the air of the dental surgery. Windows should be kept open for at least an hour following treatment.

o Any procedures should be carried out with a single patient and only staff who are needed to undertake the procedure present in the room with the doors shut

• The team travels from a treatment room (after treating a patient) to the designated DOFF room in order to remove PPE*

• From this room, the team travels to the designated DON room in order to put on PPE.

• Please see the zoning section above for where dedicated donning and doffing stations are not available.

• The team then travels to the next treatment room

• Prior to re-entering the used surgery, staff need to wait for adequate time for the aerosol to settle. In a primary care dental practice, with limited air changes, this may be up to 1 hour (see section below for clarification).

* Gloves and disposable aprons should always be removed after each patient contact. However, dependent on local risk assessment, some items of PPE may be left on for sessional use and only removed after the last patient of that session has been seen. Please see sessional use section of PPE document on HEE site

Staff uniform

The appropriate use of personal protective equipment (PPE) will protect staff uniform from contamination in most circumstances. Healthcare facilities should provide changing rooms/areas where staff can change into uniforms on arrival at work.

Where practices do not launder staff uniforms, then uniforms should be transported home safely. This could be a disposable plastic bag, which should then be disposed of into the household waste stream. An alternative could be the use of a pillowcase, as this can be put straight into the washing machine, and reduces the risk of contaminating the home environment. The

BDA advice leaflet “staying safe” provides useful information on this (linked below).

Uniforms should be laundered:

• Separately from other household linen

• In a load not more than half the machine capacity

• At the maximum temperature the fabric can tolerate, then ironed or tumbled-dried

Note: It is best practice to change into and out of uniforms at work and not wear them when travelling

Reusable gowns

Disposable gowns are recommended as they are easily disposed of at the

surgery and require no additional processes. However, where there is a

shortage of disposable gowns, reusable gowns may be used. After single

patient use, gowns should be transported in a disposable plastic bag. The

bag should be disposed of into the household waste. Reusable gowns should

be laundered: separately from other household linen; in a load not more

than half the machine capacity; and at the maximum temperature the fabric

can tolerate, then ironed or tumbled-dried.

Links for Further Reading:

https://www.gov.uk/government/publications/covid-19-personal-protective-equipment-use-for-

aerosol-generating-procedures

https://www.gov.uk/government/publications/covid-19-personal-protective-equipment-use-for-

non-aerosol-generating-procedures

https://bda.org/advice/Coronavirus/Documents/Staying%20safe%20poster.pdf

Infection Control in relation to COVID

Surgery Set up

How should I set up dental surgery prior to urgent dental treatment?

Due to the risk of droplet transmission and airborne transmission (during AGPs), opening a drawer in a dental surgery mid-treatment can risk contamination of the contents of that drawer.

Dental surgeries should therefore consider emptying drawers of materials and equipment and consider alternative means of accessing equipment for treatment. Where drawers cannot be emptied, they must not be opened during patient facing care, or during any fallow time.

Examples include:

• Setting up for the planned procedure, based upon robust triage, prior to patient attendance, with set instruments and materials pre-planned according to the procedure

• Keeping all extra equipment and materials outside the dental surgery, passed in through the door by a ‘runner’ nurse as requested (at no stage should the ‘runner’ nurse enter the surgery)

• Keeping a number of sealed boxes filled with a single procedure worth of equipment outside the surgery, ready to be passed in once required.

How should I take and process intra-oral radiographs?

Where intra-oral radiographs need to be taken:- For wet film and phosphor plate radiographic films:

• ‘Assisting’ nurse cleans/disinfects radiographic film, as per the normal disinfection protocol.

• ‘Runner’ nurse opens surgery door, and film can either be placed into a sealed box, held by the ‘runner’ nurse, or radiograph passed onto a trolley from outside the surgery

• This box or trolley can be taken to develop radiograph outside the surgery, ensuring the box, trolley and radiograph are cleaned and disinfected appropriately

For CCD radiograph imaging sensors proceed as usual with barrier protection and consider disinfection once barrier cover removed.

Surgery Cleaning and Equipment

How long should I wait prior to cleaning the dental surgery following an AGP?

Guidance within the National Dental Transition To Recovery SOP (Appendix 1) recommends that when an AGP has been carried out the dental surgery is left vacant one hour in a neutral pressure room before performing a terminal clean. Windows to the outside in neutral pressure rooms can be opened.

Ventilation

Most dental surgeries are neutral pressure rooms. Windows in neutral pressure rooms should be opened, or extractor fans that vent to the exterior should be used as air passing externally will be highly diluted and is not considered to be a risk.

Air conditioning and air filtration systems

Please see the update from PHE below on fans and AC systems. There is currently insufficient evidence to indicate transmission of viable virus through air vent and air conditioning (AC) systems. It is key to check that your AC systems are not recirculating air between different rooms as this is not currently recommended. However, if your AC has been decommissioned and not used for a prolonged period, you should contact a competent person to assess the risk of both legionella and pseudomonas. It is difficult to make general recommendations for devices that remove viable microbes from air, either by filtration or microbicidal action. This is because: there is variability in the rate they pass air through the device, the removal or inactivation will vary according to filtration or microbicidal efficacy, and over time filters will become progressively blocked. Microbicidal treatment such as UV can get obscured by a build-up of dust and the spectrum of UV emission, critical for microbicidal efficacy, can change over time.

Update from PHE on fans and air conditioning 25.06.2020

On fans,

Answer: “Fans, as such, are not a problem in these environments, not

withstanding the CAS E&F Alert 11/01/19 on fans. In fact, were there is poor air

circulation within a volume, it may be beneficial to move air towards windows

and mechanical extract. Fans should not be directed towards doors, driving air

into other rooms. Fans will not cool staff wearing water repellent PPE, so they

will be of limited practical value in ITU settings, and are therefore not

advised. PPMs on the maintenance, and cleaning of fans and their blades

should continue, with frequency based on risk assessment with IPC input”

On fixed air conditioning units [wall or ceiling mounted recirculating air

coolers “split units”]

Question: “Can I use split air conditioning in Covid-19/Covid-19 suspect area?”

Answer: “Split-air conditioning, were there is poor air circulation within a

volume, may be beneficial to mix air such that is benefits from air changes

provided by mechanical extract. Split-air conditioning will cool staff wearing

water repellent PPE. Evidence indicates overheated staff are clinically less

effective.”

On portable air conditioning

Answer: “Portable air conditioning, as such, is not a problem in these

environments. In fact, where there is poor air circulation within a volume, it

may be beneficial to move air towards mechanical extract. Portable air

conditioning should not be directed towards doors, driving air into other rooms,

nor should its pipework impede fire doors. Portable air conditioning should be

used with the advice of your Water Safety Group (HTM 04) cognisant of the risk

of legionella. PPMs should be conducted on the device, including daily emptying

of the reservoir, that is recorded.”

A dental surgery can have varying number of air changes per hour, depending on ventilation, and opening of doors and windows. Therefore, in order to be

safe, it is recommended to open all windows, leave the room following the completion of treatment and close the door. Wait one hour prior to entering the room again. Guidance on the PHE site (as linked below) states that a minimum of 20 minutes is adequate for hospital settings, however the number of air changes in hospital facilities is quite often higher than in a primary care dental practice.

Clarification on air changes and primary care dental practice

The rate of clearance of aerosols in an enclosed space is dependent on the extent of any mechanical or natural ventilation – the greater the number of air changes per hour (ventilation rate), the sooner any aerosol will be cleared.

The time required for clearance of aerosols, and thus the time after which the room can be entered without a filtering face piece (class 3) (FFP3) respirator, can be determined by the number of air changes per hour (ACH)

It has been found that in a dental practice, the ACH can vary between 2 and 10 changes per hour, depending on ventilation, opening of doors and windows and movement of people in and out of the room.

Clearance of aerosols is dependent on the ventilation and air change within the room. Once an end to dispersion can be defined (such as the patient leaving the room), a single air change is estimated to remove 63% of airborne contaminants and similarly with each subsequent air change. After 5 air changes, less than 1% of the original airborne contamination is thought to remain.

Links for Further Reading:

https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/06/C0575-dental-

transition-to-recovery-SOP-4June.pdf

https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-

control/reducing-the-risk-of-transmission-of-covid-19-in-the-hospital-setting

https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-

control/transmission-characteristics-and-principles-of-infection-prevention-and-control

How should I clean the dental surgery following treatment?

Decontamination following treatment should follow HTM01 05.

Dental care professionals working in urgent care settings should be trained in all aspects of infection prevention and control (IPC) and fully familiar with HTM01 05 for decontamination. Cleaning staff should also be trained in IPC measures. In addition to this, decontamination should be carried out by staff trained in the appropriate PPE. In some instances, this may need to be trained clinical staff rather than domestic staff, in which case, clinical staff may require additional training on standards and order of cleaning.

Process of cleaning the surgery

Please refer to:

Appendix 1 of the National Transition to recovery SOP -

https://www.england.nhs.uk/coronavirus/wp-

content/uploads/sites/52/2020/06/C0575-dental-transition-to-recovery-SOP-

4June.pdf

Section 4.9.2 of PHE COVID-19: infection prevention and control guidance

which updates the SOP

https://assets.publishing.service.gov.uk/government/uploads/system/uploads

/attachment_data/file/886668/COVID-

19_Infection_prevention_and_control_guidance_complete.pdf

Decontamination following treatment should follow HTM01 05

No fallow time is required after a non-AGP procedure.

In addition, when an AGP has been used, it is recommended that the room is

left vacant with the door closed for one hour before performing a terminal

clean following HTM01 05.

All disinfection products should conform to EN standard 14476 for viricidal

activity. Advice and support in terms of appropriate cleaning solutions can be

sought from your local Infection Control team.

Windows to the outside in the room can be opened to aid air circulation.

Please see HTM01 05 Sections 6.37-6.74

The Infection prevention and control guidance states (page 20) that only if the

room needs to be put back into use urgently, then it is recommended that the

room is cleaned as in Section 4.9.1 (page 19) as though the patient is still in the

same room and that this decontamination should take the form of –

After cleaning with neutral detergent, a chlorine-based disinfectant should be

used, in the form of a solution at a minimum strength of 1,000ppm available

chlorine.

If an alternative disinfectant is used within the organisation, the local

infection prevention and control team (IPCT) should be consulted on this to

ensure that this is effective against enveloped viruses.

https://assets.publishing.service.gov.uk/government/uploads/system/uploads

/attachment_data/file/881489/COVID-

19_Infection_prevention_and_control_guidance_complete.pdf

Additional considerations for decontamination following an AGP

If possible, only one person should undertake the room decontamination and

the responsible person should be trained and familiar with the relevant

processes and procedures:

Before entering the room

• Perform hand hygiene then put on a disposable plastic apron and gloves,

a fluid resistant surgical mask, and eye protection.

• Collect all cleaning equipment and clinical waste bags before entering

the room

On entering the room

• Keep the door closed with windows open to improve airflow and

ventilation whilst using detergent and disinfection products.

• Bag all disposable items that have been used for the care of the patient

as clinical waste.

• Close any sharps containers wiping the surfaces with the appropriate

agent

Cleaning process

• Use disposable cloths or paper roll or disposable mop heads, to

systematically clean and disinfect all hard surfaces or floor or chairs or

door handles and reusable non-invasive care equipment in the room.

• Ensure that any products used are in line with HTM01 05. If

consideration is given to use of non-chlorine-based products or they are

incompatible with equipment manufacturers guidance, you should

ensure that any detergent and disinfection products should conform to

EN standard 14476 for viricidal activity. Advice and support in terms of

appropriate cleaning solutions can be sought from your local Infection

Control team.

• Where your usual products are not effective against enveloped viruses,

use either:

a combined detergent disinfectant solution at a dilution of 1000 parts

per million (ppm) available chlorine (av.cl.)

OR,

a neutral purpose detergent followed by disinfection (1000 ppm av.cl.)

Advice and support in terms of appropriate cleaning solutions can be

sought from your local Infection Control team.

• Follow manufacturer’s instructions for dilution, application and contact

times for all detergents and disinfectants.

• For any reusable non-invasive equipment that needs decontamination,

follow the guidance here (Also see diagram below)

On leaving the room

• Discard detergent or disinfectant solutions safely at disposal point.

• Any cloths and mop heads used must be disposed of as single use items.

• Clean, dry and store re-usable parts of cleaning equipment, such as mop

handles and buckets after decontamination

• Dedicated or disposable equipment must be used for environmental

decontamination and disposed of as infectious clinical waste. Disposable

products are preferred at this time, but where it is safe to do so, items

may be reused e.g. dedicated mops should be colour coded according to

HTM01 05 for each area according to the guidelines.

• Remove and discard PPE as clinical waste.

• Perform hand hygiene.

• Rooms/areas where PPE is removed must be decontaminated, ideally

timed to coincide with periods immediately after PPE removal by groups

of staff (at least twice daily).

Cleaning of communal areas and other considerations

• Particular attention should be paid to regular and thorough cleaning of

communal areas, including door handles.

• If a suspected case spent time in a communal area, for example, a

waiting area or toilet facilities then these areas should be cleaned with

detergent and disinfectant (as above) as soon as practicably possible,

unless there has been a blood or body fluid spill which should be dealt

with immediately. Once cleaning and disinfection have been completed,

the area can be put back in use.

• Electronic equipment, including mobile phones, desk phones and other communication devices, tablets, desktops, and keyboards (particularly where these are used by many people), should be decontaminated at least twice daily with 70% ethyl alcohol or product as specified by the manufacturer NB. Gloves should be removed and hands decontaminated before touching equipment.

Summary

Decontamination Additional comments

Non-AGP • Follow routine HTM01-05 -

ensure products are active

against enveloped viruses

(conform to EN standard

14476 for viricidal activity

and check with IPCT

service)

No fallow time required

AGP

• One hour settle time after

patient leaves

• Follow routine HTM01-05

ensure products are active

against enveloped viruses

(conform to EN standard

14476 for viricidal activity

and check with IPCT

service)

AGP

(1 hour settle

time not

possible)

Not

recommended

• Surgery needed urgently -

one hour settle time after

patient leaves not possible

• Surgery should be cleaned

following the guidance set

out in Section 9.4.1 of

infection prevention and

control guidance

Surgery decontamination

follows the guidance as

though the patient is still

in the room, including

wearing PPE suitable for

AGP.

https://assets.publishing.service.gov.uk/government/uploads/system/uploads

/attachment_data/file/877533/Routine_decontamination_of_reusable_noninv

asive_equipment.pdf

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Products must be prepared and used according to the manufacturers’ instructions and recommended product ‘contact times’ must be followed. If alternative cleaning agents/disinfectants are to be used, they should only on the advice of the IPCT and conform to EN standard 14476 for viricidal activity.

Equipment

Patient care equipment should be single-use items if possible. Reusable (communal) non-invasive equipment should as far as possible be allocated to the individual patient or cohort of patients.

Reusable (communal) non-invasive equipment must be decontaminated:

• between each patient and after patient use

• after blood and body fluid contamination

• at regular intervals as part of equipment cleaning

Communal Areas

Care should be taken such that patients do not touch any surfaces, door

handles or items unless necessary. Where patients have touched handles or

sat down on chairs in communal areas, these should be cleaned appropriately

as per the guidance in HTM01-05.

Waste

Dispose of all waste as clinical waste.

Waste from a possible or a confirmed case must be disposed of as Category B waste.