I. COVID-19 Outbreak: Rights, Roles and Responsibilities of healthcare professionals (considering occupational safety and health)

1. Provide information, instruction, and training on occupational safety and health.
2. Provide training on usage, putting on, taking off and disposal of personal protective equipment (PPE).
3. Provide adequate PPE supplies (masks, gloves, goggles, gowns, hand sanitizer, liquid soap) in sufficient quantity to those caring for suspected/confirmed COVID-19 patients.
4. Provide appropriate security measures as needed for personal safety.
5. Provide a blame-free environment in which health workers can report on incidents, such as exposures to body fluids, or cases of violence, and adopt measures for immediate follow up, including support to victims
6. Advise on self-assessment, symptom reporting, and staying home when ill.
7. Provide access to mental health and counseling resources.
8. Follow established occupational safety and health procedures.
9. Avoid exposing others to health and safety risks, and participate in employer-provided occupational safety and health training
10. Use standard operating procedures (SOPs) to assess, triage, and treat patients.
11. Treat patients with respect, compassion and dignity.
12. Maintain patient confidentiality.
13. Swiftly follow established public health reporting procedures of suspected and confirmed cases.
14. Provide or reinforce accurate public health information.

II. Infection prevention and control during healthcare when novel coronavirus (nCoV) infection is suspected

1. Ensure triage, early recognition, and source control (isolating patients with suspected COVID-19)
2. Apply standard precautions for all patients
3. Implement empiric additional precautions (droplet, contact and, whenever applicable, airborne) for suspected cases of COVID-19
4. Implement administrative controls
5. Implement environmental and engineering controls

III. Rational use of personal protective equipment (PPE)

1. PPE should be used based on the risk of exposure (e.g. type of activity) and the transmission dynamics of the pathogen (e.g. contact, droplet or aerosol).
2. Following PPE should be used: gowns, gloves, medical mask, and eye protection (goggles, preferably face shield). Aprons should also be used if gowns are not fluid resistant.
3. Respirators (e.g. N95, FFP2 or equivalent standard) should be used for an extended time.However, using one respirator for longer than 4 hours can lead to discomfort and should be avoided.

IV. Infection prevention and control for healthcare professionals caring for patients with suspected or confirmed 2019-nCoV

A. How can you clean soiled bedding, towels and linens from patients

All individuals dealing with soiled bedding, towels and clothes from patients with COVID-19 should:

1. Wear appropriate personal protective equipment, which includes heavy duty gloves, mask, eye protection (face shield/goggles), long-sleeved gown, apron (if gown is not fluid resistant), boots or closed shoes before touching any soiled linen.
2. Never carry soiled linen against body; place soiled linen in a clearly labelled, leak-proof container (e.g. bag, bucket).
3. If there is any solid excrement on the linen, such as feces or vomit, scrape it off carefully with a flat, firm object and put it in the commode or designated toilet/latrine before putting linen in the designated container. If the latrine is not in the same room as the patient, place soiled excrement in covered bucket to dispose of in the toilet or latrine.
4. Wash and disinfect linen: Washing by machine with warm water (60-90°C) and laundry detergent is recommended for cleaning and disinfection of linens. If machine washing is not possible, linen can be soaked in hot water and soap in a large drum, using a stick to stir, avoiding splashing. If hot water not available, soak linen in 0.05% chlorine for approximately 30 minutes.  Finally, rinse with clean water and let linen dry fully in the sunlight.

B. What personal protective equipment (PPE) should be used by healthcare professionals performing nasopharyngeal (NP) or oropharyngeal (OP) swabs on patients

1. Health care workers collecting NP and OP swab specimens from suspected or confirmed COVID-19 patients should be well-trained on the procedure and should wear a clean, sterile, long-sleeve gown, a medical mask, eye protection (i.e., googles or face shield), and gloves. Procedure should be conducted in a separate/isolation room, and during NP specimen collection, professionals should request the patients to cover their mouth with a medical mask or tissue.

C. What are the disinfectants recommended for environmental cleaning in healthcare facilities or homes housing patients with suspected or confirmed 2019-nCoV infection?

1. Environmental cleaning in healthcare facilities or homes housing patients with suspected or confirmed 2019-nCoV infection should use disinfectants that are active against enveloped viruses, such as 2019-nCoV and other coronaviruses. There are many disinfectants, including commonly used hospital disinfectants, that are active against enveloped viruses. Currently WHO recommendations include the use of:
   1. 70% Ethyl alcohol to disinfect reusable dedicated equipment (e.g., thermometers) between uses.
   2. Sodium hypochlorite at 0.5% (equivalent 5000ppm) for disinfection of frequently touched surfaces in homes or healthcare facilities.