3.1. Definitions
Standard precautions
Standard precautions are the minimum infection prevention and control practices that should be used with all patients in all settings where clinical care is provided, regardless of known or suspected infectious status. Standard precautions help prevent risk of exposure to COVID-19.
Standard precautions should be used regardless of whether the patient is suspected or confirmed to have any infectious disease (including COVID-19) when handling blood and body substances. Body substances include blood, secretions (including respiratory secretions) and excretions (excluding sweat), regardless of whether they contain visible blood; non-intact skin; and mucous membranes.
Standard precautions consist of hand hygiene, respiratory hygiene and cough etiquette, use of PPE, routine environmental cleaning, handling of linen, handling and disposal of waste and sharps, cleaning shared equipment, reprocessing reusable medical devices and aseptic technique.
Transmission-based precautions
Transmission-based precautions are implemented in addition to standard precautions when interacting with and caring for patients who have suspected or confirmed transmissible infections including COVID-19 infection.
For more information on standard and transmission-based precautions, see Australian Guidelines for the Prevention and Control of Infection in Healthcare .
3.2. Hand hygiene
Hand hygiene is an important strategy in preventing transmission of many infections. Healthcare workers (HCWs) must perform hand hygiene in accordance with Australia’s national hand hygiene .
Patients and visitors should also be educated about the benefits of hand hygiene and be offered the opportunity to clean their hands when appropriate.
Alcohol-based hand rub (ABHR) should be used unless hands are visibly soiled, in which case hands should be washed with liquid soap and water. In the healthcare setting, ABHR must contain 60%–80% v/v of alcohol and be registered with the Therapeutic Goods Administration (TGA).
All HCWs in direct contact with patients or a patient’s environment should be ‘bare below the elbows’ where possible:
- Bracelets, wrist watches and rings with stones or ridges should not be worn. A single flat ring or band may be worn but should not interfere with effective hand hygiene practice.
- Long sleeves should be avoided. If worn, sleeves should be rolled or pushed up above the elbow so as not to interfere with effective hand hygiene practice.
- Fingernails should be kept short and clean and nail polish should not be worn.
- Artificial nails (gel or acrylic) should not be worn.
- Cuts and abrasions should be covered with a waterproof film dressing.
3.3. Respiratory hygiene and cough etiquette
When coughing or sneezing, the mouth and nose should be covered with a disposable, single-use tissue. Used tissues should be discarded immediately into a bin. If a tissue is not available, then the cough or sneeze should be directed into the inner elbow. Hand hygiene must be performed after coughing, sneezing, using tissues, or after contact with respiratory secretions or objects contaminated by these secretions.
Physical distancing is recommended and should be maintained as much as practicable. In healthcare facilities, patients with symptoms of respiratory infections should sit as far away from others as possible and be provided with a surgical mask to wear. Facilities may place these patients in a separate area, if available, while waiting for care.
3.4 Environmental cleaning
Coronaviruses can persist on surfaces. While the risk of fomite transmission of COVID-19 is extremely low, it is still important to maintain a hygienic environment in healthcare and residential care settings by environmental cleaning.
Cleaning is the process of removing dirt and germs from surfaces. The most effective way to do this is by rubbing or scrubbing the surface with warm water and detergent, followed by rinsing and drying.
Routine cleaning
Regular routine cleaning of surfaces should be continued as a standard practice to prevent the build-up of grime, dust, mould, and bacteria. Cleaning without disinfection is sufficient for most settings.
Routine cleaning schedules, especially for frequently touched surfaces, should consider the building’s usage, the function of the organisation, and any industry-specific legislation or standards. It is highly recommended that routine cleaning be undertaken at least daily. Increasing the frequency of cleaning, for example to twice daily, may also be considered in areas that have a higher risk of COVID-19 contamination, such as in outbreak situations, and high traffic areas with frequently touched surfaces.
Examples
Cleaning schedules should state the surface to be cleaned, the product used, the cleaning process and who has responsibility for cleaning.
Routine cleaning schedules should follow the recommended frequencies listed in Australian Guidelines for the Prevention and Control of Infection in .
Before cleaning, increase ventilation by opening doors and windows and using ventilation systems to increase fresh air circulation.
Methods for surface cleaning
When dusting surfaces, use a damp cloth to stop dust particles from spreading into the air.
To clean soft furnishings such as lounges, carpets, rugs, and drapes, use a vacuum cleaner fitted with a high-efficiency particulate air (HEPA) filter, if available.
Frequently touched surfaces in outdoor areas, such as dining furniture, should be cleaned routinely with detergent and water.
Cleaners should wear PPE appropriate to the risk. In addition to respiratory protection this may include disposable gloves, apron, and safety eyewear to protect against chemical or blood and body fluid splashes.
Disinfection
For most surfaces, routine cleaning with detergent and water is sufficient to physically remove soil, contamination, and organic material. When there is contamination with infectious matter, cleaning with detergent and water should be followed by disinfection using an appropriate disinfectant.
Any disinfectant used must be a hospital-grade product with claims against coronavirus, selected from the Therapeutic Goods Administration (TGA)’s Australian Register of Therapeutic Goods (ARTG) list: Disinfectants for use against COVID-19 in the ARTG for legal supply in Australia | Therapeutic Goods Administration .
Disinfection methods:
- Two step method – the surface is first cleaned with detergent and water and then disinfected using an appropriate disinfectant.
- One step method – the surface is cleaned and disinfected using a two-in-one detergent and disinfectant product. This may be either a liquid solution or impregnated wipes.
Storage, cleaning, and disposal of equipment
Ensure cleaning and disinfecting products are used according to manufacturer’s instructions and are cleaned and stored safely and correctly. This includes keeping a register of chemicals and safety data sheets. Ensure these safety data sheets are readily accessible.
After cleaning and disinfection, place disposable cloths and PPE in a plastic rubbish bag and dispose of the bag in the general waste. Reusable cleaning cloths and mops should be machine washed at the warmest possible setting, using normal washing detergent. Avoid shaking out the items before placing them in the washing machine.
Cleaning and disinfection in areas with COVID-19 risk
Cleaning and disinfection should be implemented in spaces that have been used by a suspected or confirmed COVID-19 case. This includes isolation rooms and outbreak areas. Cleaning frequency should be increased, paying particular attention to frequently touched surfaces.
Terminal cleaning
When patients with COVID-19 are discharged or transferred, the rooms or zones they have used should undergo terminal cleaning.
Cleaners should wear PPE appropriate to the risk. This may include respiratory protection, disposable gloves, apron, and safety eyewear to protect against chemical or blood and body fluid splashes.
Before cleaning the room, remove the patient’s personal belongings. Consider removing any fabric privacy curtains and window curtains for laundering. For disposable curtains, follow local policy or follow manufacturer’s instructions, including checking the expiry date.
Cleaning after procedures
Following an aerosol generating procedure (AGP) on a COVID-19 patient, cleaners should wait 35-60 minutes before entering the room, depending on the air changes per hour within the room. For more information, see 'Aerosol generating procedures' under section 5.3 on Managing staff, visitors and outbreaks.
For procedure rooms (for example, CT scan, MRI) and consulting rooms with short patient stays (for example, ED, Urgent Care, fever clinics), frequently touched surfaces should be cleaned and disinfected between cases. The area should also be cleaned and disinfected as per local policies, for example, at the end of the session or day.
Shared equipment
To reduce the risk of transmission, equipment should preferably be disposable and either single-use or single-patient-use. If reusable equipment is used, it should be dedicated for the exclusive use of the patient until the end of their isolation period, if possible.
Reusable equipment that is shared must be cleaned and disinfected between each patient according to manufacturer's recommendations and using a suitable disinfectant. Equipment that cannot be cleaned and disinfected between patients should not be reused.
Electronic devices in isolation and outbreak areas
Mobile phones and other electronic devices such as tablets, laptops, touchscreens, remote controls, mouse, and keyboards can become contaminated. These electronic devices should not be taken into isolation rooms or outbreak zones unless necessary for clinical care.
If electronic devices are required, consider using a cover that can be wiped.
Devices should be cleaned and disinfected after use with each patient, following the manufacturer’s instructions. If manufacturer’s guidance is not available, consider the use of alcohol-based wipes containing at least 70% alcohol.
Note:
- Hand hygiene must be performed before and after using mobile phones and other electronic devices.
- Do not use or answer mobile phones when wearing PPE and avoid sharing mobile phones, headphones, or ear pods of any kind.
For more information, see How to clean your personal items used at work.
Alternative cleaning methods NOT covered in this guideline
Cleaning and disinfection methods such as ultrasonic waves, ultraviolet germicidal irradiation (UVGI), anti-microbial surface coatings and anti-viral blue light (aBL) continue to be developed. These technologies may not be sufficient for infection prevention and control in the context of COVID-19 and are not currently recommended as primary methods of disinfection.
New products and technologies must be registered by the Therapeutic Goods Administration (TGA) and should be implemented with due diligence. They should be used only as a supplement to the cleaning methods recommended above. They should not be used in lieu of good IPC practice.
Fogging and fumigation are not currently recommended as methods of disinfection.
3.5. Waste management
Health services should have an established waste management program for the collection and removal of general waste and clinical waste that complies with EPA (Environment Protection Authority Victoria) guidance and statutory regulations.
Waste generated in clinical settings should be segregated as per EPA advice IWRG612.1: Clinical and related waste – operational .
For additional guidance, see Managing coronavirus waste from a on EPA's website.
In most cases, COVID-19 waste can be disposed of as general waste. This includes used PPE generated in non-clinical care settings such as residential community care homes or general workplaces. In the context of COVID-19, PPE waste can be disposed of as general waste unless it is contaminated with blood or body fluids (this includes respiratory secretions).
Disposable components of equipment and other consumables are considered general waste unless they are contaminated with body fluids. For example, in healthcare settings, PCR and RAT swab sticks and containers are clinical waste, whereas the packaging and uncontaminated components are general waste.
Healthcare workers must refer to and always comply with their organisation’s policies and procedures.
3.6. Management of linen
Management of linen from a suspected or confirmed COVID-19 case should be in accordance with standard precautions and routine procedure.
Handle soiled laundry with minimum agitation (do not shake dirty laundry) to avoid contamination of the air, surfaces, and persons.
Linen that is heavily soiled with blood, body substances or other fluids (including water) should be contained in clear leak-proof bags.
Personal clothing that is usually laundered by the family should be placed in a plastic bag for transport.
Clothing, linen, mop heads and soft toys from health service settings should be laundered through a laundry service that is compliant with AS/NZS 4146:2000.
For residential settings, laundry should be washed at the hottest temperature the items can withstand. Use usual detergent and dry items completely.
Curtains and bed screens
Reusable and disposable curtains and bed screens should be changed if they are soiled or contaminated.
Consider replacing reusable curtains after transfer or discharge of suspected or confirmed COVID-19 cases.
Disposable curtains should be checked with the manufacturers for their efficacy against COVID-19; if unsure, dispose after transfer or discharge of suspected or confirmed COVID-19 cases.
Healthcare worker (HCW) uniforms
If at any time a HCW’s clothing becomes contaminated with blood or body fluid, the clothing should be removed as soon as practical and before the HCW attends to other patients. If skin is contaminated with blood or body fluid, the HCW must remove contaminated clothing or PPE, wash any affected skin (if skin is broken refer to organisation policy on blood exposure), then perform hand hygiene.
Recommendations for managing uniforms and clothing:
- have dedicated work clothes (such as scrubs or a uniform)
- change out of work clothes at the end of the shift before leaving the building
- perform hand hygiene after handling dirty items of clothing
- launder uniforms after each wear using the hottest temperature that the items can withstand. Use usual detergent and dry items completely.
3.7. Signage
Appropriate signage about infection prevention measures should be displayed in clinical areas and in non-clinical areas such as lifts, administrative areas, cafeterias, waiting areas, facility, and ward entry points.
At the entry to patient care areas with COVID-19 risk, signage should indicate that transmission-based precautions and PPE are required.
In clinical and non-clinical areas, signage about physical distancing should be widely displayed.
3.8. Occupational exposure to COVID-19
The occupational exposure risk for COVID-19 is via inhalation of or splash to eyes, nose, or mouth with respiratory particles. Where such an exposure occurs, notify the immediate supervisor or manager for management via organisational processes and carry out first aid immediately:
- eyes—rinse thoroughly while eyes are open with water/normal saline
- mouth—spit out and rinse with water several times.
Caring for a patient whilst wearing the correct PPE is not considered an occupational exposure in this context.
Reviewed 22 November 2023