Triage

KING KHALED EYE SPECIALIST HOSPITAL Policy and Procedure No. A08-084

Issue Date: 11 February 2020 Revised: 18 March 2021 Page 1 of 12

1.0 Title: Infection Prevention and Control Policy for Suspected and Confirmed Coronavirus Disease 19 (COVID-19)

2.0 Applies to:

All staff of King Khaled Eye Specialist Hospital (KKESH).

3.0 Purposes:

3.1 To provide guidance on managing Coronavirus Disease 19 (COVID-19) based on the latest guidelines from the Ministry of Health (MOH).

3.2 To provide guidance on Infection Prevention and Control (IPC) practices to be implemented when managing suspected and confirmed Coronavirus Disease 19 (COVID-19) cases.

3.3 Standardized the clinical management of COVID-19 patients.

4.0 Policy:

4.1 All KKESH staff should follow Infection Prevention and Control Policy and Procedures for Suspected and Confirmed Coronavirus Disease 19 (COVID-19.

4.2 Standard Precautions and Transmission-based Precautions when applicable, as outlined in Policy and Procedure No. A08-010 titled “Guidelines for Isolation and Barrier Precautions” will be used for patient care.

4.3 Ministry of Health’s Coronavirus Disease (COVID-19) Guidelines for Healthcare Professionals is available in the Infection Prevention and Control Manual.

4.4 KKESH leadership should be accountable for monitoring the adherence of KKESH staff to the policy.

5.0 Definition

5.1 Health Care Worker defined as all staff in the health care facility involved in the provision of care for a COVID-19 infected patient, including those who have been present in the same area as the patient, as well as those who may not have provided direct care to the patient, but who have had contact with the patient’s body fluids, potentially contaminated items or environmental surfaces. This includes health care professionals, allied health workers, auxiliary health workers (e.g. cleaning and laundry personnel, x-ray physicians and technicians, clerks, phlebotomists, respiratory therapist, nutritionists, social workers, physical therapists, lab personnel, cleaners, admission/reception clerks, patient transporters, catering staff etc.).

5.2 Patient- a person receiving or registered to received medical treatment.

5.3 Suspected Coronavirus Disease 19 (COVID-19) Case is defined as:

5.3.1 Patient with acute respiratory illness (sudden onset of at least one of the following: fever (measured or by history), cough, or shortness of breath).

5.3.2 Patient with sudden onset of at least one of the following: headache, sore throat, rhinorrhea, nausea or diarrhea AND in the 14 days prior to symptom onset, met at least one of the following criteria:

5.3.2.1 Had contact with a confirmed COVID-19 case

KING KHALED EYE SPECIALIST HOSPITAL Policy and Procedure No. A08-084

Issue Date: 11 February 2020 Revised: 18 March 2021 Page 2 of 12

5.3.2.2 Working in or attended a healthcare facility where patients with confirmed COVID-19 were admitted.

5.3.2.3 Any admitted adult patient with unexplained severe acute respiratory infection (SARI), either Community Acquired Pneumonia (CAP) or Hospital Acquired Pneumonia (HAP).

5.3.3 Contact is defined as anyone with any of the following exposures:

5.3.4 Being within 2 meter of a confirmed COVID-19 case for >15 minutes;

5.3.5 Direct physical contact with a confirmed COVID-19 case;

5.3.6 Providing direct care for a confirmed COVID-19 patient without using proper personal protective equipment (PPE);

5.3.7 Living in the household with a confirmed COVID-19 case;

5.3.8 Sharing a room, meal, or other space with a confirmed COVID-19 case;

5.3.9 Sitting within 2 rows (in any direction) of a confirmed COVID-19 case for >15 minutes and any crew in direct contact with the case in a public or shared transportation.

5.4 Confirmed Coronavirus Disease 19 (COVID-19) case is defined as a person who meets the suspected case definition with laboratory confirmation of COVID-19 infection.

6.0 Procedure:

6.1 VISUAL TRIAGE:

6.1.1 Visual triage should be used for early identification of all patients with Acute Respiratory Illness (ARI) in the entrances of Emergency Room, Hospital Main Entrance, Screening Clinic, Employee Health, Saleh AlRajhi Center, OR for excimer laser patients, Pre- Hospitalization, West Building and in Basement A Ramp (cafeteria).

6.1.2 Designated areas will be attended by trained staff to have a high level of clinical suspicion of COVID-19

6.1.3 HCWs should maintain social distance by staying at least one meter away, whenever possible, from anyone, including anyone that is with the patient (e.g., companion or caregiver). When physical distance is NOT feasible and yet NO direct contact with patients, use mask and eye protection (face shield or goggles)

6.1.4 All HCWs should adhere to Standard Precautions, which includes hand hygiene, selection of PPE based risk assessment, respiratory hygiene, cleaning and disinfection.

6.1.5 Staff performing triage must be aware of the COVID-19 Case definitions described above in section 5.3 and the precautionary measures to be applied.

6.1.6 All patients with clinical symptoms will be assessed using the predefined scoring of Visual Triage Checklist (see Appendix A).

6.1.7 A score of ≥4 separate patients at high risk for COVID-19 from others or direct patient to respiratory clinic if emergency eye cases and to be seen by the Ophthalmologist. Offer mask and ask to perform hand hygiene. Apply droplet and contact precautions. Limit the number of accompanying family members in the respiratory clinic for (no one less than 18 years old unless a patient or a parent) then patient will be given a referral letter.

KING KHALED EYE SPECIALIST HOSPITAL Policy and Procedure No. A08-084

Issue Date: 11 February 2020 Revised: 18 March 2021 Page 3 of 12

6.1.8 If patient for admission or for emergency surgery apply contact and droplet precautions.

6.1.9 Patient who are stable and not emergency eye cases will be given a referral letter from CMO / MD and will be sent to a general hospital/Coronavirus Disease19 (COVID-19) facility at Prince Mohammed bin Abdul-Aziz Hospital for evaluation.

6.1.10 Patient in respiratory distress or unstable patient should be placed in Airborne Infection Isolation Room (AIIR) in ER at the back of VIP clinic for MD assessment. MD will coordinate with MOH (#937) for diagnosing the case and transferring of patient to a COVID-19 facility at Prince Mohammed bin Abdul-Aziz Hospital.

6.1.11 Coronavirus Disease 19 algorithm see Appendix B.

6.1.12 Post visual alerts at the entrances and in all patient care areas (English and Arabic) about respiratory hygiene and cough etiquette and social distancing. This includes how to cover nose and mouth when coughing or sneezing and disposal of contaminated items in trash cans.

6.2 ADMISSION PROCESS AND PATIENT PLACEMENT:

6.2.1 RT-PCR guidelines for patient and sitter admitted in our facility is based on the decision of the COVID 19 committee.

6.2.2 Patient with suspected or confirmed COVID-19 should not be admitted in KKESH unless emergency cases.

6.2.2.1 Patient will be admitted to 5th floor A wing.

6.2.2.2 Patient will be discharged as soon as possible after emergency eye intervention and follow up will be given through ER Respiratory clinic.

6.2.3 Patient and sitter waiting for RT-PCR result will be admitted to 5th floor B wing.

6.2.4 Inpatient areas, patients with suspected Coronavirus Disease 19 (COVID-19) infection who are stable, mask will be offered, transfer patients in adequately ventilated single rooms and will be assessed by medical Doctor and will be discharged from the hospital by the medical doctor and ophthalmologist with medical report and will be advised to go to general hospital / Coronavirus Disease 19 (COVID-19) facility for evaluation.

6.2.4.1 If patient requires emergency eye intervention, patient will be tested for COVID -19 infection (RT-PCR) without delaying the treatment.

6.2.5 Patients in respiratory distress admitted in inpatient department with suspected or confirmed Coronavirus Disease 19(COVID-19) infection should be placed in Airborne Infection Isolation Rooms 347and 502 for MD assessment. MD will coordinate with MOH (#937) for diagnosing the case and transferring of patient to a COVID-19 facility to Prince Mohammed bin Abdul-Aziz Hospital. RT-PCR for COVID-19 infection will be taken depends on medical doctor recommendations.

6.2.6 It is preferred and strongly recommended not to cohort suspected COVID-19 patients because it carries a risk of transmission of infection between patients if one of them will be confirmed.

6.2.7 In cases of severe shortage of single rooms, it is possible to cohort suspected COVID- 19 patients together with strict adherence to the following standards:

KING KHALED EYE SPECIALIST HOSPITAL Policy and Procedure No. A08-084

Issue Date: 11 February 2020 Revised: 18 March 2021 Page 4 of 12

6.2.8 One patient only should be admitted in each multi bed room, then another patient will be put to bed far from the first patient’s bed, and so on until the need to admit patients in all the beds of the room.

6.2.9 There must be a physical separation between the patients’ beds (single use curtains – mobile or fixed partitions) and in the event of unavailability the distance between the bed and the other, distance should not be less than two (2) meters.

6.2.10 It is strictly forbidden to implement aerosol-generating procedures (AGPs) such as respiratory suctioning and nasopharyngeal swabbing in these cohort rooms, the patient should be directed to a negative pressure room or single room with portable HEPA filter if negative pressure room is not available.

6.2.11 If the mobile HEPA filter devices are available, a device can be placed between each of two beds.

6.2.12 Cohort Healthcare Workers to exclusively care for cases to reduce the risk of spreading transmission due to inadvertent infection control breaches.

6.2.13 Never share the patient care equipment between patients, use either single use disposable equipment or dedicated equipment (e.g. stethoscopes, blood pressure cuffs and thermometers). If equipment needs to be shared among patients, clean and disinfect between each patient use (e.g. ethyl alcohol 70%).

6.2.14 Strict adherence by health care workers to infection control practices, hand hygiene between patients, new gloves between patients, wearing new set of personal protective equipment if the worn set become visibly soiled.

6.2.15 Patients should be asked to wear surgical mask throughout their hospitalization period (except during eating or sleeping), they are required not to move in the rooms between beds and corridors.

6.2.16 Limit the number of HCWs, family members and visitors in contact with a patient with suspected or confirmed COVID-19 infection.

6.2.17 Refrain from touching eyes, nose or mouth with potentially contaminated hands.

6.2.18 All Healthcare workers, visitors and companion entering the room of patient suspected/confirmed COVID-19 should fill in the log in sheet (see Appendix E for healthcare workers, see Appendix C for Companion and visitors).

6.3 PERSONAL PROTECTIVE EQUIPMENT (PPE):

6.3.1 Recommended PPE for Healthcare workers for suspected/confirmed COVID-19 patient according to the type of activity (see Appendix D).

6.3.2 PPE should be worn by HCWs upon entry into the patient’s room or care areas in the following order:

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

6.3.2.2 Surgical mask (or N95 when airborne precautions are applied)

6.3.2.3 Eye protection (goggles or face shield)

6.3.2.4 Gloves

KING KHALED EYE SPECIALIST HOSPITAL Policy and Procedure No. A08-084

Issue Date: 11 February 2020 Revised: 18 March 2021 Page 5 of 12

6.3.3 For patients on airborne precautions, any person entering the patient's room should wear a fit-tested N95 mask instead of a surgical mask. Those who failed the fit-testing (e.g. those with beards), they can use the Air Purifying Respirator (PAPR).

6.3.4 Re-use of N95 mask during outbreak and N95 fit test and seal check are outlined in P&P A08-067 titled “Handling, Fit Testing and Fit Checking Guidelines”.

6.3.5 Upon exit from the patient’s room or care area, PPEs should be removed and discarded in a yellow bag. Except for N95 masks, remove PPE at the doorway or in the anteroom. Remove N95 mask after leaving the patient’s room and close the door.

6.3.6 Remove PPE in the following sequence:

6.3.6.1 Gloves

6.3.6.2 Goggles or face shield

6.3.6.3 Gown

6.3.6.4 Mask or respirator

6.3.7 The following should also be noted:

6.3.7.1 The outside of the gloves, masks, goggles and face shield are contaminated.

6.3.7.2 Never wear a surgical mask under the N95 mask as this prevents proper fitting and sealing of the N95 mask thus decreasing its efficacy.

6.3.7.3 For female staff who wear veils, the N95 mask should always be placed directly on the face behind the veil and not over the veil. In this instance, face-shield should also be used along with the mask to protect the veil from droplet sprays.

6.3.7.4 Whenever possible, use either disposable equipment or dedicated equipment (e.g. stethoscopes, blood pressure cuffs and thermometers).

6.3.7.5 If hands become contaminated during PPE removal, stop and perform hand hygiene, and then proceed with PPE removal.

6.4 TRANSMISSION PRECAUTIONS:

6.4.1 For patients with suspected/confirmed infection of Coronavirus Disease 19 (COVID- 19), Contact and Droplet precautions are recommended in addition with Standard precautions.

6.4.2 Airborne precautions is recommended for suspected/confirmed Coronavirus Disease19 (COVID-19) requiring aerosol-generating procedures (AGP).

6.5 AEROSOL-GENERATING PROCEDURES:

6.5.1 Aerosol generating procedures have been associated with increased risk of transmission of coronaviruses (SARS-CoV and MERS-CoV) such as nasopharyngeal swabbing, tracheal intubation, non-invasive ventilation, tracheotomy, cardiopulmonary resuscitation, manual ventilation before intubation and bronchoscopy.

KING KHALED EYE SPECIALIST HOSPITAL Policy and Procedure No. A08-084

Issue Date: 11 February 2020 Revised: 18 March 2021 Page 6 of 12

6.5.1.1 Additional precautions should be observed when performing aerosol- generating procedures, which may be associated with an increased risk of infection transmission.

6.5.1.2 Perform procedures in negative pressure rooms with at least 12 air changes per hour (ACH) and controlled direction of air flow when using mechanical ventilation or other aerosol-generating procedures.

6.5.1.3 During the procedure, room doors should be kept closed except when entering or leaving the room, and entry and exit should be minimized. Maintain negative pressure by opening only one door at a time.

6.5.1.4 Limit the number of persons present in the room to the absolute minimum required for the patient’s care and support.

6.5.1.5 Wear a fit tested particulate respirator or PAPR (Powered Air Purifying Respirator): Always perform the seal-check when putting on a disposable particulate respirator. Wear eye protection. Wear a clean, non-sterile, long- sleeved gown and gloves. Wear an impermeable apron for some procedures with expected high fluid volumes that might penetrate the gown.

6.5.1.6 For nasopharyngeal swabbing, in case of non-availability of respirators (n95 or PAPR) the HCW can use surgical mask and face shield during the process.

6.5.1.7 HCW that all available types of respirators are not fit or with facial hair (beard) should be excluded from aerosol-generating procedures or use PAPR (Powered Air-Purifying Respirator).

6.5.1.8 In case of unavailability of negative pressure room, nasopharyngeal swab could be taken in well ventilated single room with portable HEPA filter.

6.5.1.9 Perform hand hygiene before and after contact with the patient and his / her surroundings and after PPE removal.

6.6 SURGICAL INTERVENTIONS

6.6.1 Risk of transmission of COVID-19 infection during surgery and anesthesia from suspected or confirmed COVID-19 is due to prolonged close contact with the patient and aerosol generating procedures practiced with the patient.

6.6.2 Only emergency or medically necessary surgical intervention is allowed for suspected or confirmed COVID-19 cases and this should be by a discussion between infection control department and treating department.

6.6.3 Minimize the amount of equipment, supplies and personnel in the room to the most needed.

6.6.4 When the patient become inside the room Minimize traffic into and out of the room; only open the door if necessary and the theatre door should be closed with warning sign hanged outside the door to alarm other OR staff with “no entry without4 permission”.

6.6.5 Dedicate a trained HCW to be the “runner” station him/her outside the OR in case additional drugs or equipment are needed.

KING KHALED EYE SPECIALIST HOSPITAL Policy and Procedure No. A08-084

Issue Date: 11 February 2020 Revised: 18 March 2021 Page 7 of 12

6.6.6 Positive pressure should be maintained during the procedure > 20 ACH per hour, never switch the pressure in the OR to neutral or negative as it is not recommended and disrupt pressure balance.

6.6.7 All the attending staff should wear fit tested respirator masks or PAPR (for bearded staff) throughout the procedure.

6.6.8 Place portable HEPA filters near the head of the patient and the patient’s breathing zone, Turn on during intubation and extubation. The HEPA filter should be switched off during the surgical procedure.

6.6.9 Extubate and allow the patient to recover in the Theatre Room.

6.6.10 When the patient is ready for discharge from OR, the route to the isolation room should be cleared by security.

6.6.11 Attending OR staff should remove all PPE inside the theatre except the respirator or surgical mask removed outside then hand hygiene is a must.

6.6.12 Terminal cleaning and disinfection of the operating theater outlined in Policy and Procedure A08-016 “Terminal Cleaning”.

6.7 RADIOLOGY DEPARTMENT:

6.7.1 If portable machine is not available or cases requested for static machines and/or advance imaging/procedure, (e.g. CT scan, MRI etc.) the attending Physician should discuss the case with the radiology consultant and infection control department before sending the patient for imaging.

6.7.2 Use designated portable X-ray equipment and/or other important diagnostic equipment.

6.7.3 The patient should be directly taken into the modality room without delay and should not be waiting in general waiting areas of the department.

6.7.4 The modality scan area should be clear of patients and/or unnecessary staff.

6.7.5 Items/equipment that are not needed in the examination should be cleared.

6.7.6 Radiology staff should don the necessary PPE when dealing with the patient and doff them after the process finished.

6.8 PATIENT TRANSPORT INSIDE HOSPITAL:

6.8.1 Security should clear the route.

6.8.2 Avoid the movement and transport of patients out of the room or area unless medically necessary.

6.8.3 Patients should wear a surgical mask during movement to contain secretions. If patient on nasal cannula facemask should be fixed over the cannula.

6.8.4 Use pre-determined transport routes to minimize exposure to staff, other patients and visitors.

6.8.5 Notify the receiving area of necessary precautions as soon as possible before patient’s arrival.

KING KHALED EYE SPECIALIST HOSPITAL Policy and Procedure No. A08-084

Issue Date: 11 February 2020 Revised: 18 March 2021 Page 8 of 12

6.8.6 Transporting team should wear surgical mask, clean gloves, and goggles or face shield isolation gowns and perform hand hygiene afterwards.

6.8.7 Limit the number of HCWs, family members and visitors in contact with a patient with suspected COVID-19 infection.

6.8.8 Refrain from touching eye, nose or mouth with potentially contaminated hands.

6.8.9 Staff should disinfect the patient’s bed/ wheelchair using MOH approved disinfectant after used.

6.8.10 Dispose Personal Protective Equipment (PPE) in a yellow bag properly after patient contact.

6.9 COLLECTION AND HANDLING OF LABORATORY SPECIMEN

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

6.9.2 HCWs who collect or transport clinical specimens should rigorously to Standard Precautions to minimize the possibility of exposure to pathogens.

6.9.3 Ensure that HCWs who collect specimens use appropriate PPE (see Appendix D).

6.9.4 The respiratory specimen should be collected under Airborne Precautions and aerosol generating procedure guidelines. Personnel should wear a particulate certified N95 respirator.

6.9.5 Samples to be collected in upper respiratory tract :

6.9.5.1 Sample collections in adults; whenever feasible, nasopharyngeal swab should be the first choice when collecting the samples. If nasopharyngeal swab not feasible oropharyngeal swab can be used.

6.9.5.2 Sample collection in children less than 12 years old; Oropharyngeal swab should be considered. If not feasible nasopharyngeal swab can be used.

6.9.6 Ensure that all personnel who transport specimens are trained in safe handling practices and spill decontamination procedures.

6.9.7 Place specimens for transport in leak-proof specimen bags (secondary container) that have a separate sealable pocket for the specimen (i.e. a plastic biohazard specimen bag), with the patient’s name label on the specimen container (primary container), and a clearly written laboratory request form.

6.9.8 Ensure that health-care facility laboratories adhere to appropriate biosafety practices and transport requirements according to the type of organism being handled.

6.9.8.1 Deliver all specimens by hand whenever possible.

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

6.9.8.3 HESN Printed lab requisitions must be sent with samples to Riyadh Regional laboratory via courier, SMSA, at the following number (8006149999), and result values must be updated on HESN on their corresponding time.

KING KHALED EYE SPECIALIST HOSPITAL Policy and Procedure No. A08-084

Issue Date: 11 February 2020 Revised: 18 March 2021 Page 9 of 12

6.10 MANAGEMENT OF HEALTHCARE WORKERS EXPOSED TO CORONA VIRUS DISEASE 19 (COVID-19):

6.10.1 Risk category will be identify according to the available “Management of Healthcare workers exposed to COVID-19’ MOH updated guidelines.

6.10.2 Return to work of Healthcare Workers Infected with COVID-19:

6.10.2.1 Refer to Employee Health protocol.

6.10.2.2 Always wear mask.

6.10.2.3 Self-monitor for symptoms and seek re-evaluation from Employee Health if respiratory symptoms recur or worsen.

6.11 MANAGEMENT OF PATIENTS EXPOSED TO A COVID-19 CASE:

6.11.1 Patients sharing the same room with a confirmed case of COVID-19 for at least 15 minutes:

6.11.1.1 Patients should be followed up daily for symptoms for 14 days after exposure if patient still admitted.

6.11.1.2 Testing (Nasopharyngeal swabs or deep respiratory sample if intubated) for COVID-19 is required (preferably 24 hours or more after the exposure).

6.11.1.3 If negative on initial testing, exposed patients should be re tested with RT-PCR if they develop symptoms suggestive of COVID-19 within the follow up period.

6.11.1.4 Patients discharged during the follow up period will be reported to the Public Health Department to continue monitoring for symptoms.

6.12 OUTBREAK MANAGEMENT

6.12.1 Protocol for Epidemiological Investigation of a Suspected Epidemic is outlined in Policy and Procedure A08-050.

6.13 PATIENT TRANSPORTATION / AMBULANCE PRECAUTION

6.13.1 Transport of infectious/contagious patient outlined in P&P A08-065 titled “Infection Control Guidelines for Transport of Patients with Infectious/Contagious Disease”.

6.13.2 Where possible, ambulance staff should carry out initial assessment keeping a distance of at least 2 meters from the patient.

6.13.3 Ambulances with isolated driver and patient sections providing independent ventilation to each area is preferred. To assure driver isolation from the patient section, keep connecting doors and windows closed before bringing the patient into the ambulance.

6.13.4 Ambulance staff providing care for or accompanying suspected or confirmed COVID-19 patients in the patient section of the ambulance should adhere to standard and transmission-based precautions including required PPE (see Appendix D).

KING KHALED EYE SPECIALIST HOSPITAL Policy and Procedure No. A08-084

Issue Date: 11 February 2020 Revised: 18 March 2021 Page 10 of 12

6.13.5 Recommended PPE for ambulance drivers (see Appendix D).

6.13.6 Minimize the number of people involved in the transportation, when possible, use an ambulance that has a separate driver and patient compartment with closed door/ window between these compartments.

6.13.7 To use the ventilation in ambulances lacking a physically isolated driver section, open the outside air vents in the driver section should be opened and the rear exhaust ventilation fans turned on to the highest setting. This generates a negative pressure gradient in the patient area.

6.13.8 Place a surgical mask on the patient (if tolerated) and have the patient cover the mouth / nose with a tissue when coughing. Non-rebreather facemask may be used to provide oxygen support during transportation.

6.13.9 Coordinate with the receiving facility to receive the patient at the ambulance door and limit the need for EMS personnel entering the Emergency Department.

6.13.10 PPE will be removed on return to KKESH and will be disposed of in yellow bags.

6.13.11 Clean and disinfect the ambulance and reusable patient-care equipment using an MOH approved hospital disinfectant by the staff who assisted the patient during transport. Personnel performing the cleaning should wear proper PPE (see Appendix D).

6.13.12 Ambulance use outlined in Policy and Procedure M02-049 titled “Transfer and Transportation of Patient and Employees”

6.14 MANAGING BODIES OF DECEASED COVID-19 PATIENTS

6.14.1 Morgue’s staff should be informed about infectious status of the deceased.

6.14.2 Isolation precautions should be continued to the deceased COVID-19 patient, those handling the body at this point should use PPE (surgical mask, clean gloves, isolation gown.

6.14.3 Prevents relatives from direct surface contact with the body such as touching or kissing it is acceptable to open the body bag for the family viewing wearing PPE.

6.14.4 Limit the number of morgue’s personnel dealing with the dead body to the minimum number required.

6.14.5 Managing deceased body in KKESH is outlined in Policy and Procedure N08-032 titled “Death at KKESH”.

6.15 LAUNDRY:

6.15.1 Linen management for Coronavirus Disease 19 (COVID-19) patient’s, outlined in Policy and Procedure A08-063 titled “Infection Prevention and Control Guidelines for Laundry Department (section 5.3 Linen Management).

6.16 ENVIRONMENTAL CLEANING AND DISINFECTION:

6.16.1 Only designated, well-trained Housekeeping Personnel will be assigned for cleaning and disinfecting of Coronavirus Disease 19 (COVID-19) patient rooms / units.

KING KHALED EYE SPECIALIST HOSPITAL Policy and Procedure No. A08-084

Issue Date: 11 February 2020 Revised: 18 March 2021 Page 11 of 12

6.16.2 Nurses are responsible for cleaning and disinfecting patient-care medical equipment (e.g. IV pumps, ventilators, monitors, etc.).

6.16.3 A checklist will be provided to guide the Housekeeping Staff in cleaning the room (A08-016 Appendix A&B).

6.16.4 Housekeeping personnel should wear PPE. Housekeeping Staff are trained by the Infection Control about COVID-19 infection, the importance of hand hygiene and the proper use of PPE (see Appendix D).

6.16.5 Keep cleaning supplies outside the patient’s room (e.g. in an anteroom or storage area). Use MOH-approved disinfectant.

6.16.6 Clean and disinfect Coronavirus Disease 19 (COVID-19) patients' rooms at least daily and more often when visible soiling / contamination occurs. Pay special attention to frequently touched surfaces in addition to floors and other horizontal surfaces.

6.16.7 After an aerosol-generating procedure (e.g. suctioning, intubation), clean and disinfect horizontal surfaces around the patient. Clean and disinfect as soon as possible after the procedure.

6.16.8 Clean and disinfect spills of blood and body fluids by trained staff using the kit.

6.16.9 Cleaning and disinfection after Coronavirus Disease 19 (COVID-19) patient discharge or transfer must follow standard procedures for terminal cleaning of an isolation room. (Policy and Procedure A08-016 Terminal Cleaning).

6.17 MEDICAL WASTE:

6.17.1 Housekeeping Staff must wear disposable gloves and perform hand hygiene after removal of gloves when handling waste.

6.17.2 Collection and disposal of Coronavirus Disease 19 (COVID-19) contaminated medical waste is outlined in Policy and Procedure S03-007 titled “Environmental Service Department Waste Disposal” (section 5.2 Hazardous Healthcare Waste).

7.0 References:

7.1 Guidelines for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, updated July 2019

7.2 Saudi Center for Disease Prevention and Control, Coronavirus Disease 19 (COVID-19) Infection Guidelines V2.0 October 2020

7.3 Saudi Center for Disease Prevention and Control Guidance for Proper Selection and Use of PPE in Healthcare Setting, March 2020

8.0 Organizing / Reviewing Departments:

8.1 Infection Prevention and Control Unit 8.2 Emergency Room Department 8.3 Nursing Services 8.4 Internal Medicine and Employee Health Department 8.5 Quality Management 8.6 Chief Medical Officer

KING KHALED EYE SPECIALIST HOSPITAL Policy and Procedure No. A08-084

Issue Date: 11 February 2020 Revised: 18 March 2021 Page 12 of 12

Prepared by: ______________________________________ 18 March 2021 Rhona Mae Hipe, RN, Coordinator Date Infection Prevention and Control Unit

Recommended by: ______________________________________ 18 March 2021 Elvira V. Mabato, RN, Acting Supervisor Date Infection Prevention and Control Unit

Recommended by: ___________________________________ 21 March 2021 Mohammed AlAmry, MD, Chairman Date Emergency Room Department

Recommended by: __________________________________ 21 March 2021 Emily Bratcher, Acting Chief Nursing Officer Date Nursing Services

Recommended by: _____________________________________ 22 March 2021 Rachid Zeitounie, MD, Chair, Internal Medicine Date Internal Medicine and Employee Health Department

Recommended by: ______________________________________ 22 March 2021 Mohammed Fathy Shaban, MD, Director Date Quality Management Department

Approved by: ____________________________________ 24 March 2021

Saleh AlMesfer, MD, Chief Medical Officer Date Chair, Infection Prevention and Control Committee