Are there decontamination best practices for healthcare workers leaving the workspace? 

Posted on April 12, 2020 by Kate Jackson

Summary

There are currently no reports of transmission of COVID-19 via contaminated clothing or shoes. While there are no official guidelines regarding decontamination processes for physicians leaving the workspace, several organizations have proposed disinfection processes that may be prudent. 

I.   Background

  • Based on what is currently known about the novel coronavirus (SARS-CoV-2), spread from person-to-person happens most frequently via respiratory droplets among close contacts (1).
  • Transmission via contact with contaminated surfaces is also plausible, since SARS-CoV-2 may remain viable for hours to days on surfaces made from a variety of materials (2). However there is no evidence that clothing (unless grossly soiled) or hair poses any significant risk of transmission of SARS-CoV-2 (3). 
  • Currently, there are no existing guidelines on physician decontamination prior to leaving the workplace.
  • Given the high potential for exposure to SARS-CoV-2 among healthcare workers, the following precautions may be sensible (4). They are not intended to replace appropriate use of PPE, hand hygiene, or barriers in clinical settings (5).

II.   GENERAL PRACTICES (4,6)

Prepare for work

  • Consider wearing scrubs every day. Wash white coats daily, when worn.  
  • Avoid wearing jewelry, a tie, a watch, or other non-essential accessories.
  • Prepare clean clothing and shoes to change into after work.
  • Remove non-essential items in your car. Keep disinfecting wipes in the car to wipe down interior surfaces.

Before leaving work

  • If possible, shower and change into clean clothes and shoes before leaving the workplace.
  • Put soiled clothes and shoes into a bag and wash daily. Wash or safely discard used clothing bags.
  • Practice appropriate hand hygiene after removing work clothing and before touching clean clothing.

When you arrive home

  • If you were unable to change clothes and/or shower before leaving your workplace, change in an isolated location (e.g. garage, mudroom, laundry room) and shower as soon as possible after returning home.
  • Do not wear shoes from work into your home. Decrease the chance of contamination via footwear by using shoe covers at work, wearing non-porous footwear that can be more easily decontaminated, or wearing dedicated footwear that do not leave the workplace.

III.   RECOMMENDED CLEANING AND DISINFECTANT PROCEDURES

Hard (non-porous) surfaces (1)

  • If surfaces are dirty, clean with detergent or soap and water prior to disinfection.
  • Apply a hospital-grade disinfectant to frequently touched surfaces or objects (see below for a list of disinfectants appropriate for use against SARS-CoV-2).

Soft (porous) surfaces

  • In order to minimize the possibility of dispersing virus through the air, do not shake dirty laundry (1,7).
  • If the items can be laundered, launder items with regular laundry detergent and hot water (60-90°C) (7).
  • Clean and disinfect laundry hampers according to guidance above for hard or soft surfaces (1).
  • Wash hands immediately after handling soiled laundry.

Electronics (1)

  • Consider use of wipeable or disposable covers for electronics.
  • Use an alcohol-based wipe or spray containing at least 70% alcohol to disinfect touch screens.
  • Dry surfaces thoroughly to avoid pooling of liquid.
  • Comply with the manufacturer’s instructions for cleaning and disinfecting electronics.

IV.   DISINFECTANTS APPROPRIATE FOR USE AGAINST SARS-CoV-2

  • Below is a list of common disinfectants known to be effective against SARS-CoV-2 (8). Most janitorial product outlets carry all of these products.
  • Pre-made solutions (no dilution needed) or ready-to-use wipes can be used.
  • Please visit Health Canada for a comprehensive list of commercially available disinfectant products approved for use against SARS-CoV-2 (9).

 

Agent and concentration Uses
1.   1:100 dilution Chlorine bleach

(10 ml bleach to 990ml water)

Disinfecting surfaces and medical equipment. Allow surfaces to air dry naturally.
2.   1:50 dilution Chlorine bleach

(20 ml bleach to 980ml water)

Disinfecting surfaces contaminated with bodily fluids and waste, after cleaning with soap and water first. Allow surfaces to air dry naturally.
3.   Accelerated Hydrogen Peroxide 0.5% Cleaning and disinfecting surfaces and medical equipment.
4.   Isopropyl alcohol solutions containing at least 70% alcohol Disinfecting surfaces and medical equipment. Allow surfaces to air dry naturally.
5.   Quaternary Ammonium Compounds (QUATs) Cleaning and disinfecting surfaces.

V.   IMPORTANT NOTES REGARDING DISINFECTANT PRODUCTS (8,9)

  • Ensure that the disinfectant product has a Drug Identification Number (DIN) on its label.
  • Read and follow manufacturer’s instructions for safe use of cleaning and disinfection products (e.g. wearing gloves, good ventilation, dilution, contact time, etc.)
  • Check the expiry date of products before use.

Questions? Comments? Does this need to be updated? Do you have valuable points to add ? Please email ask.reakt@ubc.ca.

References

  1. CDC. Interim Recommendations for US Community Facilities with Suspected/Confirmed Coronavirus Disease 2019 [Internet]. Centers for Disease Control and Prevention. 2020 [cited 2020 Apr 12]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/community/organizations/cleaning-disinfection.html
  2. Chin AWH, Chu JTS, Perera MRA, Hui KPY, Yen H-L, Chan MCW, et al. Stability of SARS-CoV-2 in different environmental conditions. The Lancet Microbe [Internet]. 2020 Apr [cited 2020 Apr 12]; Available from: https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(20)30003-3/fulltext
  3. Reducing Disease Transmission to the Emergency Physician’s Family For Immediate Release [Internet]. [cited 2020 Apr 12]. Available from: https://caep.ca/wp-content/uploads/2020/03/Reducing-disease-transmission-to-the-emergency-physician-hjo-clean-v-march-29PP.pdf
  4. Adams JG, Walls RM. Supporting the Health Care Workforce During the COVID-19 Global Epidemic. JAMA [Internet]. 2020 Mar 12 [cited 2020 Apr 12]; Available from: https://jamanetwork.com/journals/jama/fullarticle/2763136
  5. COVID-19 – Guidance for the Health Sector – Ministry Programs – Health Care Professionals – MOHLTC [Internet]. Gov.on.ca. 2020 [cited 2020 Apr 12]. Available from: http://www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/2019_guidance.aspx
  6. FPM Editors. How to leave coronavirus behind when you come home [Internet]. Aafp.org. 2020 [cited 2020 Apr 12]. Available from: https://www.aafp.org/journals/fpm/blogs/inpractice/entry/covid19_home.html
  7. Public Health Agency of Canada. Cleaning and disinfecting public spaces (COVID-19) – Canada.ca [Internet]. Canada.ca. 2020 [cited 2020 Apr 12]. Available from: https://www.canada.ca/en/public-health/services/publications/diseases-conditions/cleaning-disinfecting-public-spaces.html
  8. Environmental Cleaning and Disinfectants for Physicians’ Offices [Internet]. Available from: http://www.bccdc.ca/Health-Professionals-Site/Documents/COVID-19_MOH_BCCDC_EnvironmentalCleaning.pdf
  9. Health Canada. COVID-19: List of hard-surface disinfectants authorized for use against coronavirus – Canada.ca [Internet]. Canada.ca. 2020 [cited 2020 Apr 12]. Available from: https://www.canada.ca/en/health-canada/services/drugs-health-products/disinfectants/covid-19/list.html

Disclaimer

The above is intended to serve as a rapidly-created, accessible source of information curated by medical students and healthcare professionals. It is for educational purposes only and is not a complete reference resource. It is not professional medical advice, and is not a substitute for the discretion, judgment, and duties of healthcare professionals. You are solely responsible for evaluating the information above.