Corona Virus Situation in Sri Lanka

18/05/2020

We are endeavoring to meet our customers every requirement, whilst negotiating a reasonable quote for the services that we provide.

19/04/2020

Common Prevention Tips

Help stop the spread of COVID-19

Listen for instructions from your local government about staying home.

Keep a safe distance from others.

Clean hands often and disinfect frequently touched surfaces at home.

Don't touch your eyes, nose or mouth.

Cover coughs and sneezes with your elbow or tissue.

19/04/2020

www.hpb.health.gov.lk

Official LIVE updates and the latest news from the Sri Lankan Government

11/04/2020

Guideline for the Home quarantine / Quarantine in non-health care settings


“Home quarantining” refers to keeping visibly healthy, possible high-risk contacts separately
at non-health care settings. High risk contacts include individuals returning to Sri Lanka from
countries where local transmission has been established for coronavirus infection, and
those who had maintained close contact with a suspected or diagnosed case of COVID- 19.
Such high risk contacts must be home quarantined for 14 days to prevent community
transmission.


Following measures are expected to be followed under this concept:

1. Consider to allocate a separate room with adequate ventilation at home if possible
and household members should stay in another room or to be separated from the
returnee.

2. Maintain at least one meter distance from family members.

3. Preferably, household members should use a separate bathroom. But, if sharing the
same bathroom, cleaning of taps, doorknobs and utensils with soap and water are a
requirement.
4. Need to minimize visitors to home and returnee should not face any visitors.

5. Frequent hand washing with soap and water for at least 20 seconds at a time and
maintain alcohol based hand hygiene in instances where hand washing facilities are
inadequate
6. Avoid touching eyes, nose and mouth with unwashed hands.

7. Home quarantined person is expected to monitor body temperature using a
thermometer twice a day. If gets fever , cough, difficulty in breathing, sore throat,
body aches and pain, including flue like symptoms, immediately inform MOH / PHI of
the area immediately.

8. The disposable face masks and gloves after use should be properly discarded without reuse, preferably in a closed container

9. Assign separate dishes, drinking glasses, cups, eating utensils, towels, bedding, and other items for the quarantined person.
10. Used utensils, bed linen and clothes should wash with soap and water


Self-monitoring with active public health supervision

1. MOH is the responsible officer for field supervision and follow up of home quarantined persons.
2. MOH assigns Public Health Inspector (PHI) for monitoring of quarantined persons.

3. PHI also will check their health status daily by visiting, by a telephone inquiry, SMS throughout the quarantine 14 days’ period.

4. In case of a person with signs and symptoms, PHI should immediately inform the MOH and the Regional Epidemiologist.

5. Transportation of suspected patient is arranged through “1990 on-call ambulance (Suwaseriya) service” to the nearest government hospital or to the designated hospitals

6. Regional Director of Health Services (RDHS) and Provincial Director of Health Services
(PDHS) support in administrative activities and Provincial / District Consultant
Community Physicians (CCP) and Regional Epidemiologist are providing technical
support.

Epidemiology Unit Ministry of Health & Indigenous Medical Services 231, De Saram Place, Colombo 10, Sri Lanka Tele: (+94 11) 2695112, 2681548, 4740490, 4740491, 4740492 Fax: (+94 11) 2696583 E-mail: [email protected], [email protected] Web: www.epid.gov.lk

Interim guidance for Sri Lankan flights to and from China Instructions to be given to all passengers boarding from China
The following instructions should be given to passengers by the flight crew:

1. Inform the flight crew if a passenger is suffering from any symptom of an acute respiratory infection (e.g. fever, cough, runny nose, sore throat, breathing difficulties).

2. Clean hands properly with soap and water or alcohol-based hand rub, especially after using the washroom.

3. Avoid touching mouth, eyes, and nose as much as possible.

4. Discard face masks in to the yellow bag provided after use.

5. Fill the Health Declaration Form that will be given to passengers on the flight clearly and completely and make sure to hand over to health staff/immigration staff at the airport

6. Monitor their health status after arriving in Sri Lanka for a period of 14 days. Instruct them to watch for the development of any of the following symptoms of an acute respiratory infection (e.g. fever, cough, runny nose, sore throat, breathing difficulties) and seek immediate medical care if they develop any of these symptoms.

Instructions to flight crew

1. All crew members should be made aware of infection control measures and techniques

2. Keep several fixed alcohol hand rubs in different cabins and in washrooms

3. Display clear hand washing instructions at washrooms.

4. Keep an adequate amount of basic Personnel Protective Equipment on board to be used when required E.g. Surgical masks and gloves

Take spill management kit with each flight. This includes commercially available bleach solution, absorbent material (wadding), tongs, dustpans, yellow bags

5. Instruct passengers to inform if they have symptoms of an acute respiratory infection (e.g. fever, cough, running nose, sore throat, breathing difficulties)

6. Provide surgical masks for passengers with respiratory symptoms

7. Clean hands properly with soap and water or alcohol based-hand rub frequently

8. Avoid touching mouth, eyes and nose as much as possible.

9. Headsets given to passengers should be disinfected with 70% alcohol after use.

10. Tell all passengers to fill the Health Declaration form on board and make sure the passengers hand them over to the Airport Health Office/Immigration officers

11. Any crew member who develop respiratory symptoms within 14 days of travel after arriving in Sri Lanka, should promptly seek care at a government hospital and should disclose their travel history to the healthcare provider


Actions to be taken if there is a sick passenger on the flight

1. If possible, designate one crew member to interact with the sick passenger.

2. The crew member/s dealing with the sick passenger should wear the recommended Personnel Protective Equipment (surgical mask/N95 mask, coverall, goggle, gloves). Keep ten packs of recommended Personal Protective Equipment (surgical mask/N95 masks, coverall, goggle, gloves) on board.

3. Give a disposable surgical mask to the sick passenger (can be worn for 4 hours, but need to change more frequently if soaked). Face masks are not recommended for sick passengers complaining of nausea and vomiting as this could result in choking.

4. Separate the sick passenger from other travelers by 6 feet (two rows in front and rear) or move adjacent passengers without compromising flight safety or exposing additional passengers to the sick passenger.

5. If unable to separate the passengers from the sick passenger, give surgical masks to passengers seated on either side of the sick passenger.

6. Keep interactions with the sick passengers as brief as possible.

7. If possible, cover the seats of sick passenger/s with a polythene/mackintosh (in case if the passenger vomits, it is easier to dispose)

8. Keep an alcohol-based hand rub near the sick passenger/s and encourage them to use it after coughing and sneezing, after removing the mask etc.

9. Give tissues to be used adequately

10. Provide a disposable bag (polythene bag) to collect vomits

11. Provide a yellow plastic bag/bio hazard bag for disposal of used tissues, air sickness bag(s), or other contaminated items used by sick passengers.

12. All bags containing any body fluid (such as diarrhea, vomits, respiratory secretions or blood) should be tightly closed as they are infectious. Keep them securely and separately in a closed container during a long flight.

13. Dispose the used masks/coveralls/gloves in to a closed bin for incineration

14. All yellow bags must be handed over to the designated officers for incineration after landing.

15. The pilot should inform the Medical Officer of Sri Lankan airlines and Medical Officer of Airport Health Office to get further guidance.

16. Report to the airport health office upon arrival in Sri Lanka



Targeted cleanup of the-flight carrying sick passenger/s after landing

1. Employees should wear PPE (fluid resistant gown, apron, heavy duty gloves, goggles, surgical mask) before cleaning or disinfecting any area.

2. For hard (nonporous) surfaces such as tray tables, TV monitors, seat arms, windows, and walls: clean the surfaces using tongs with 0.1% hypochlorite and finally wipe with normal water (if any visible contamination, clean with 1% hypochlorite. Metal surfaces can be corroded by hypochlorite. Hence, can be decontaminated with 70% alcohol).

3. Dispose the absorbent material in yellow bags.

4. Treat all body fluids (such as diarrhoea, vomitus, respiratory secretions or blood) as infectious material. These should be disinfected with 1% hypochlorite solution with adequate precautions.

5. For soft (porous) surfaces such as carpeted floor or seat cushions: remove as much of the contaminant as possible, cover the area with an absorbent substance, and contain the area as much as possible. Remove the absorbent substance and any remaining material, and then clean and disinfect the area with products approved by the company.

Guidance for cabin crew while in China

1. Travel as a group in private transport provided by the air carrier when traveling between the Airport and hotel

2. Minimize contact with ground personnel and time in public areas while moving between the aircraft and the private transport.

- Do not use public transportation, including when traveling between the airport and hotel.

3. Minimize going out into the general population, and use social distancing (maintain a distance of approximately 6 feet, if possible) whenever out in public. Avoid crowds,
stores, sporting or mass entertainment events, and other situations likely to attract large numbers of people.

4. Wash your hands often with soap and water for at least 20 seconds or use a 70% alcohol based hand sanitizer.

5. Avoid touching mouth, eyes, and nose as much as possible

6. Self-monitor your health condition

- Immediately report any fever, cough, runny nose or difficulty breathing to relevant authorities

11/04/2020

Novel Corona virus (2019-nCoV) - Situation Report – 2020.01.28

Global Situation
 2798 confirmed cases with 80 deaths

Local Situation
 One (1) confirmed patient
 An outbreak of pneumonia of unknown reason was first reported on 31st December 2019 from Wuhan City in Hubei Province of China.  On 7th Jan 2020, it was diagnosed as “Novel Corona Virus”  As of January 27, 2020 the Novel Corona virus has been reported from 11 countries with 2798 confirmed cases and 80 deaths.  The incubation period is reported as 2-10 days  Initially, the disease was reported to be spread from animal to human but now the human to human transmission has been observed.  First confirmed case of Corona virus infected person was reported from Sri Lanka on 27th January 2020. The patient was a Chinese national who came to Sri Lanka as a tourist 2 weeks ago.  Currently, the patient is admitted to the National Institute of Infectious Diseases (NIID).  So far 5 other suspected individuals are at NIID under surveillance. Out of them, 2 are Sri Lankan.  12 hospitals around the country have been identified as the treatment centers for the suspected persons. (NIID, TH Ragama, DGH Gampaha, DGH Negombo, National Hospital Kandy, TH Karapitiya, TH Anuradhapura, TH Jaffna, TH Kurunegala, PGH Rathnapura, TH Batticoloa, PGH Badulla)  Returning Sri Lankan students who were in China are advised to stay in their homes with minimal contacts with others for a period of 2 weeks from the day of arrival to Sri Lanka. In the event of the development of symptoms, inform the area PHI / MOH office and seek treatment at the closest above identified-hospitals.  At present there is no official Health Ministry directive to wear face masks by the general public including school children.  In the event of wearing face masks, the colored side should be faced outside.

Follow up one

My Ref : EPID/400/2019/nCoV 29th January 2020

Provincial Directors of Health Services, Regional Directors of Health Services,

Follow up of Sri Lankan Students/Nationals and other Foreign Nationals returning from high risk areas for ongoing Corona Virus Transmission

It is essential to follow up the Sri Lankan student returnees / nationals other foreign nationals returning from high risk areas for ongoing Corona Virus Transmission (eg- China) for a period of 14 days from the time of their arrival in Sri Lanka. It is essential to get the Regional Epidemiologist (RE), area Medical Officer of Health (MOH) and the area Public Health Inspector (PHI) to visit the students personally to assess the situation and get information.

The Epidemiology unit will regularly provide a list of the Sri Lankan students/nationals and Chinese nationals returning to the country through the Regional Epidemiologist to the respective Medical Officers of Health.

It is needed to get the PHI of the area to visit the house regularly up till 14 days. For the follow up activities the annexed follow up sheet should be used.

The following points should be adhered to by the health staff during the visit to the house.

 It is essential to follow up the student for 14 days. (approximate incubation period). Health staff are essentially duty bound to cooperate without any excuse.

 MOH should know the total number of returnees in the area and update the Epidemiology unit/ RDHS office or any other necessary institution when required.

 At the time of the PHI`s visit to the house it is recommended to do it in a diplomatic and organized way which will cause no fear or social phobia to the occupants.

 There is no need to wear a face mask by the PHI when visiting returnees as there is no indication to do so.

 In case of a student developing sore throat, cough and fever (symptoms of new Corona virus) the PHI, MOH , RE should be informed immediately. (to advise the student regarding ways to communicate to PHI, MOH and RE)

 To give proper health education to the student/person and make available as a facilitator person.

1. Wearing masks is a social responsibility of the individual returned from high risk country to minimize transmission (as there is a possibility of asymptomatic transmission).

2. It is not essential for the family members/co-workers to wear masks.

3. If there is provisions the person should stay in a separate room.

4. Avoid public places as much as possible. e.g:- festive celebrations, parties, temples, churches, markets and all other places of public gatherings.

5. To be away from high risk groups such as old people, young children, and immune compromised persons (chronic disease as lung, heart, metabolic, renal, liver or neurological disease) as much as possible as they come under the vulnerable group.

6. To have personal hygiene and cough netiquettes as advised per circular No. DDG(PHS)I/DO2/12-9/2019/10 Interim summary Guidelines for Clinical management of patients with novel corona virus (2019-nCoV).

 All MOOH should inform the Epidemiology unit regarding each student by the end of 14 days of follow up after arrival using the attached format.

All other foreign nationals returning from high risk areas( e.g – China) also need to be regularly followed up by the Public Health Inspector of the area based on the information provided by the Epidemiology unit to assess the health status and provide information specified above.

If your MOH area has projects with significant number of foreign nationals who have come from high risk areas within last 14 days need to be followed up during the approximate incubation period using the same instructions.

Please bring the contents of this letter to all REE and MOOH of the area and ensure adherence to correct procedures will be followed.

Greatly appreciate your kind early attention in this regard during the country emergency situation.



…………………………………… Dr.Sudath Samaraweera Chief Epidemiologist Epidemiology Unit



FOLLOW UP SHEET

Details of Sri Lankan Students/Nationals and Other Foreign Nationals Returning from High Risk Areas for ongoing Corona Virus Transmission

[To be filled by the area PHI under the guidance of MOH]

A. Student details 1. RDHS area: MOH area:

2. Name:

3. Age:

4. S*x:

5. Address:

6. Date of arrival to Sri Lanka:

7. Name of city resided in China: Province:

8. Known contact history with a suspected case: Yes/No

Place of contact: Date of contact:

B. Health status follows up details Review details Date Signs/Symptoms (Fever/sore throat/cough)
Remarks: detail identified during the visit & referrals if any
MOH Signature
Date of onset-Day 1

Day 2 Day 3 Day 4 Day 5 Day6 Day7 Day8 Day9 Day10 Day11 Day12 Day13 Day14

*Copies of filled form should be sent after 14 days to RE and Epidemiology Unit. * If positive case is found, need to inform Epidemiology Unit immediately Telephone: 2695112, FAX No: 2696583, E-mail: chepid @ sltnet.lk

Follow up two

Advice's for Sri Lankan Students/Nationals and other foreign nationals returning from high risk area of on-going Corona virus transmission

 Corona virus disease (2019-nCoV) is an acute respiratory tract infection.  It is spread through respiratory secretions (sputum, respiratory droplets) and contaminated fomites (objects or materials which are likely to carry infective agents such as clothes , utensils and furniture)  Symptoms of Corona virus disease are fever, runny nose, sore throat, cough and difficulty in breathing.  Some people are at high risk of developing complications. [elderly people and people with chronic diseases (lung, heart, metabolic, renal, liver or neurological diseases]  Symptoms develop from 2 days to 10 days after entry of virus into the human body.  Persons infected with virus but yet are asymptomatic (not showing any symptoms) can spread the disease for a few days prior to appearance of symptoms.

In view of possible importation of Corona virus disease (2019-nCoV into the country), it is essential to adhere to the following practices for a period of 14 days from the time of arrival in Sri Lanka.

If you do not have symptoms at the time of arrival:  Avoid public places as much as possible (festive celebrations, parties, temples, churches, markets and all other places of public gatherings).  Wear a face mask (it is a social responsibility of the individual to minimize transmission of infection to other people).  Keep away from high risk groups as much as possible  Stay in a separate room if there are provisions available  Practise frequent hand washing with soap and water or suitable alcohol-based hand rub  Do not share utensils with family members or other people  Keep windows open to provide good ventilation to rooms  Follow good hygienic practices  Cover your nose and mouth when coughing/sneezing with paper tissue/or cloth and proper disposal  It is not indicated for family members or co-workers to wear surgical face masks

If you develop symptoms within 14 days of arrival in Sri Lanka:  Wear a surgical face mask to prevent spread of disease to others.  Inform area Public Health Inspector (PHI), Medical officer of Health (MOH) or Regional Epidemiologist (RE).  Go to the nearest recommended government hospital immediately for assessment of the health situation and further management.  It is advised to wear a surgical face masks by family members or co-workers as there is high risk of getting the disease from a symptomatic patient.

Epidemiology Unit Ministry of Health & Indigenous Medical Services

11/04/2020

PRESS RELEASE

On 31st December 2019, Chinese health authorities have alerted the World Health Organization about several cases of pneumonia in Wuhan City of Hubei Province due to a virus previously unknown. One week later, on 7th January 2020, it was confirmed that the causative organism for the illness is a corona virus and this was named as “2019-nCoV” (novel corona virus). Corona viruses are a large family of viruses transmitted between animals and people. They can cause illness ranging from common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS).
An increased number of cases infected with 2019-nCoV are reporting from the Hubei Province, number of other provinces and cities in China and also several other countries. As of 25th January 2020, the World Health Organization has reported 1,370 confirmed novel corona virus cases of which 1,297 cases are from China (Including Taipei, Macau and Hong Kong). Out of 23 cases reported from other countries 21 had a travel history to Wuhan City. Forty-one deaths have been reported, all of them are from China.

One Sri Lankan returned from Wuhan city was admitted to the National Institute of Infectious Diseases, Angoda on 24th January 2020 with symptoms and signs of respiratory illness. Another two Chinese nationals from Wuhan and visiting Sri Lanka were admitted on 25th January with similar illness. All three are females and were having very mild illness at the time of admission. Their state of health is improving. They are investigating for novel corona virus and confirmatory test results will be available within next two days.

The 2019-nCoV can be transmitted from one individual to another. Since there is the possibility to introduce the disease in to Sri Lanka, similar to reporting of cases in countries other than China, necessary precautions have already been implemented at ports of entries. They are:
• Travelers arriving the country are advised on board to report to the health desk at the Bandaranaike International Airport if they are having symptoms suggestive of the disease (high fever, cough, cold and difficulty in breathing). • The health desk at the airport is in operative round the clock • Thermal scanners are installed in the airport to identify travelers having running temperature. • If any person presents with signs and symptoms of suggestive of respiratory illness will be screened at the airport health desk to determine any possibility of novel corona virus infection. • If there is any such possibility, appropriate measures will be taken for admission and further investigation and treatment.
General public are advised to adhere to standard health measures needed for the prevention and control of respiratory infections. They are:

• Avoid crowded places. • Frequently clean hands with soap and water or alcohol based hand rubs.
• When coughing and sneezing cover mouth and nose with flexed elbow or tissues. Discard tissues safely and wash hands immediately after. • Avoid close contact with anyone who is having fever and cough. • If you have fever and cough, and had traveled to a city from where novel corona virus cases are reported, seek prompt medical advice and share your travel history with the health care provider.


Dr. Sudath Samaraweera Chief Epidemiologist Epidemiology Unit Ministry of Health and Indigenous Medical Services. 26 January 2020

11/04/2020

Bio Safety Guide Lines

1. General Guidelines for working with potentially infectious materials

• Laboratory workers should wear appropriate personal protective equipment (PPE) which includes disposable gloves, laboratory coat/gown, eye protection and a respirator (N95 or similar) when handling potentially infectious specimens.
• Any procedure with the potential to generate fine-particulate aerosols (e.g., vortexing or sonication of specimens in an open tube) should be performed in a Class II Bio Safety Cabinet (BSC).
• Appropriate physical containment devices (e.g., centrifuge safety buckets; sealed rotors) should be used for centrifugation. The rotors and buckets should be loaded and unloaded in a BSC.
• Perform any procedures outside a BSC in a manner that minimizes the risk of exposure to an inadvertent sample release

2. Bio safety risk assessment for clinical/lab procedures for 2019-nCoV

Table 1 - Bio safety risk assessment for clinical/lab procedures for 2019-nCoV
Procedure What could go wrong or hazard? Overall risk Sample collection • Aerosol exposure during sample processing • Eye splash during sample processing • Infectious culture material spill • High • Medium • Medium/High Sample reception • Leaking sample • High • • RT-PCR • Aerosol exposure during NA extraction • Medium
5
3. Bio safety risk mitigation for clinical procedures for 2019nCoV

Table 2 - Bio safety risk mitigation for clinical procedures for 2019-nCoV
Procedure Risk mitigation Residual risk • Sample collection • Standard PPE + Respirator • GMPP • Validated waste management • Low Procedure Risk mitigation Residual risk
• Sample reception
• RT-PCR for 2019-nCoV
•
• Work in BSC
• Standard PPE + Respirator
• GMPP
• Validated waste management
• Low

• BSC – Bio safety cabinet Class 11
• PPE – Personal Protective Equipment
• GMPP – Good Microbiological Practices and Procedure

4. Recommended Personal Protective Equipment (PPE)

• N95 mask / Respirators (NIOSH-certified N95). • Eye/facial protection (i.e. goggles or a face shield) • A clean, non-sterile, long-sleeved fluid-resistant gown with tight cuffs. If gowns are not fluid resistant, a waterproof apron should be used for procedures where it is expected that fluid might pe*****te the gown • Apron (when performing additional procedures) • Gloves
6

5. Sequence for donning personal protective equipment (PPE)

1. Gown • Fully cover torso from neck to knees, arms to end of wrists, and wrap around the back • Fasten in back of neck and waist

2. Mask or respirator • Secure ties or elastic bands at middle of head and neck • Fit flexible band to nose bridge • Fit snug to face and below chin • Always check the seal/fitness after wearing N95 mask. Be aware that the presence of facial hair (e.g. beard) may prevent a proper respirator fit for the wearer.

• Check for any leakages- Cup both hands over the respirator and inhale and exhale sharply to check for any leaks around the nose. If any leaks are found readjust the nose piece and repeat the leak test.

3. Goggles or face shield • Place over face and eyes and adjust to fit

4. Gloves • Extend to cover wrist of isolation gown
Figure 1 - Sequence for donning personal protective equipment
7
6. Safe doffing of personal protective equipment (PPE)

1. Gloves • Outside of gloves are contaminated If your hands get contaminated during glove removal, immediately wash your hands or use an alcohol-based hand sanitizer • Using a gloved hand, grasp the palm area of the other gloved hand and peel off first glove • Hold removed glove in gloved hand Slide fingers of un gloved hand under remaining glove at wrist and peel off second glove over first glove • Discard gloves in a yellow bag

2. Goggles or face shield • Outside of goggles or face shield are contaminated. If your hands get contaminated during goggle or face shield removal, immediately wash your hands or use an alcohol-based hand sanitizer • Remove goggles or face shield from the back by lifting head band and without touching the front of the goggles or face shield If the item is reusable, place in designated receptacle for reprocessing. Otherwise, discard in a yellow bag.
Figure 2 - Safe doffing of personal protective equipment (PPE)
8
3. Gown • Gown front and sleeves are contaminated. If your hands get contaminated during gown removal, immediately wash your hands or use an alcohol-based hand sanitizer • Unfasten gown ties, taking care that sleeves don’t contact your body when reaching for ties • Pull gown away from neck and shoulders, touching inside of gown only • Turn gown inside out Fold or roll into a bundle and discard in a yellow bag

4. Mask or respirator
• Front of mask/respirator is contaminated DO NOT TOUCH. If your hands get contaminated during mask/respirator removal, immediately wash your hands or use an alcohol-based hand sanitizer • Grasp bottom ties or elastics of the mask/respirator, then the ones at the top, and remove without touching the front • Discard in a yellow bag

7. The currently available diagnostic method in Sri Lanka
Real-time Reverse Transcription (RT)-PCR assay to detect 2019-nCoV RNA.
Virus isolation in cell culture and initial characterization of viral agents recovered in cultures of 2019-nCoV specimens are NOT recommended at this time, except at a BSL3 facility.




9
8. Specimens for diagnosing 2019-nCoV

• Respiratory materials including nasopharyngeal or oropharyngeal swabs in Viral Transport Medium (VTM).
• Use a sterile, leak-proof, screw-cap container with VTM for sputum.
• Endotracheal aspirate or bronchoalveolar lavage in patients with more severe respiratory disease. Send in VTM.
• Tissue from biopsies or autopsy including those from the lungs in VTM

All specimens should be triple packaged

NB: Collection of the samples should be done with CAUTION and all samples regarded as potentially infectious with regard to strict adherence to Infection Prevention and Control guidelines.

9. Infection prevention measures during sample collection for 2019-nCoV diagnosis

• Ensure that Health Care workers (HCWs) who collect specimens follow the standard and additional precautions and use the recommended PPE
• Perform procedures in an adequately ventilated room:
• Limit the number of persons present in the room to the minimum required for the sample collection
• Wear recommended PPE
• Follow the steps of donning and doffing PPE
• Perform hand hygiene before and after contact with the patient and his or her surroundings and after PPE removal.

10
10. Specifics for the transport of samples to the laboratory

• Ensure that personnel who transport specimens are trained in safe handling practices and spill decontamination procedures.
• Follow the requirements in the national or international regulations for the transport of dangerous goods (infectious substances) as applicable.
• Deliver all specimens by hand whenever possible. State the full name, age, travel history, clinical symptoms and the type of specimen of the suspected case clearly on the accompanying request form.
• Send all samples on ice (4°C). • Notify the laboratory as soon as possible that the specimen is being transported.
• PPE is not necessary for people who transport specimens in the triple package.

11. Packing and Shipping
Basic triple packaging system: The system consists of three layers as follows. 1. Primary receptacle- This should be a watertight, leak-proof receptacle containing the specimen and properly labeled. The receptacle should be wrapped in enough absorbent material to absorb all fluid in case of breakage. For disposal purposes please choose a suitable plastic container as a primary receptacle. 2. Secondary receptacle- This should be a durable, watertight, leak-proof receptacle to enclose and protect the primary receptacle(s). Several wrapped primary receptacles for the same laboratory test may be placed in one secondary receptacle. Enough additional absorbent material must be used to cushion multiple primary receptacles. 3. Outer package - This is the container in which the secondary receptacle is placed. This is the outer most package that protects it and its contents from outside influences such as physical damage and water while in transit.


11


Figure 3 - Basic triple packaging system



Figure 4 – Packaging and Labeling of Infectious Substances


12
• Size of the triple package – As this is opened inside a biosafety cabinet (BSC) this should be small enough to be accommodated in a BSC. • The specimen container should be properly labelled. • Specimen data forms, letters and other types of information that identify or describe the patient, specimen and the receiver should be taped to the outside of the secondary receptacle. • All tests should have a duly signed separate request form/s. • Packaging, shipping, and transport of specimens from confirmed or suspected cases of 2019-nCoV infection must follow the current edition of the International Air Transport Association (IATA) Dangerous Goods
• Follow shipping regulations for UN 3373 Biological Substance, Category B when sending potential 2019-nCoV specimens.
• Novel coronavirus specimens should follow the UN Model Regulations, and any other applicable regulations depending on the mode of transport being used.
• More information may be found in the WHO Guidance on regulations for the Transport of Infectious Substances 2019-2020 (Applicable as from 1 January 2019).
• A summary on transport of infectious substances can also be found in Toolbox 4 of the Managing epidemics handbook.

12. Specimen transport to Medical Research Institute, Colombo

Hospital staff should strictly adhere to the following instructions for specimen transport to Medical Research Institute for the confirmation of virus or any other special bacterial or fungal diagnosis in suspected patients with 2019-nCoV.

• Inform the Director / Head of Laboratory before sending the specimens. • Label the specimens with appropriate tests required and patient details. • Separate the tests according to specialized fields such as virology, bacteriology and mycology etc. • All specimens should be triple packaged.
13
• Depending on the test requested packaging should be done separately to distribute to different laboratories. • All tests should have a duly signed separate request form/s. • A notation should be made in the request form to identify the specimen as bio hazardous. If available, bio hazardous labeling is ideal. • The counter or any laboratory at the Medical Research Institute unable to sort out samples in the triple package. Therefore, if different laboratory tests are needed, different sets of triple packaged specimens should be sent to MRI to distribute to the appropriate laboratory. Once the triple package is removed by the laboratory staff all irrelevant specimens will be discarded. MRI will not be responsible for lost samples. • Transport of samples should be according to Category B transportation regulations. • Specimens should be hand delivered to the counter at the Medical Research Institute directly from the hospital by trained personnel.


13. Specifics for bio safety practices in the laboratory

• Ensure that health laboratories adhere to appropriate bio safety practices.
• Any testing on clinical specimens from suspected or confirmed patient should be performed in appropriately equipped laboratories by staff trained in the relevant technical and safety procedures.
• It is recommended that all manipulations in laboratory settings of samples originating from suspected or confirmed cases of 2019-nCoV can be conducted according to WHO/CDC recommendations
• National guideline on the laboratory bio safety should be followed in all circumstances.
• Also, for general information on laboratory bio safety guidelines, refer WHO Laboratory Bio safety Manual, 3rd edition (8) and 4th Edition.

14
A. The following activities may be performed in BSL-2 facilities using standard BSL-2 work practices:

• Pathological examination and processing of formalin-fixed or otherwise inactivated tissues
• Molecular analysis of extracted nucleic acid preparations
• Electron microscopic studies with glutaraldehyde-fixed grids
• Routine examination of bacterial and mycotic cultures
• Routine staining and microscopic analysis of fixed smears
• Final packaging of specimens for transport to diagnostic laboratories for additional testing. Specimens should already be in a sealed, decontaminated primary container.
• Inactivated specimens (e.g., specimens in nucleic acid extraction buffer)


B. The following activities involving manipulation of potentially infected specimens should be performed as above and, in a Class II, BSC:

• Aliquoting and/or diluting specimens
• Inoculating bacterial or mycological culture media
• Performing diagnostic tests that do not involve propagation of viral agents in vitro or in vivo
• Nucleic acid extraction procedures involving potentially infected specimens
• Preparation and chemical- or heat-fixing of smears for microscopic analysis




15
14. Clinical Laboratory Testing

Clinical laboratories performing routine haematology, urinalysis, and clinical chemistry studies, and microbiology laboratories performing diagnostic tests on serum, blood, or urine specimens can be done in BSL2 laboratory wearing recommended PPE. All staff should follow standard laboratory practices, including Standard Precautions, when handling potential 2019-nCoV specimens.
PCR/Serology/Clinical chemistry/Hematology:
• Personnel protection: Gloves, Long-sleeved gown, Eye protection, Respiratory protection (N95 type) • Primary containment: Biological safety cabinet type Class 11 A2 when processing specimens • Secondary containment: BSL2 laboratory • Staff training: Good microbiological practices and procedures and demonstrated competence


15. Decontamination and disposal of waste

• After specimens are processed, decontaminate work surfaces with 0.1% hypochlorite Contact time is at least 10 minutes. Alcohol (e.g. isopropyl 70%, ethyl alcohol 60%) can be used to wipe down surfaces where the use of bleach is not suitable, e.g. metal.
• Equipment should be disinfected according to manufactures instructions with appropriate disinfectants. 70% alcohol can also be used for equipment surfaces.
• For spillages use 1% hypochlorite. Contact time is at least 10 minutes.
• All disposable waste should be autoclaved and incinerated. If incinerator is available within the premises waste could be directly sent for incineration.
16

Figure 5 - Decontamination and disposal of waste



17
16. References

• https://www.who.int/csr/sars/biosafety2003_04_25/en/. and other guidance • https://www.cdc.gov/coronavirus/2019-ncov/lab/lab-biosafety-guidelines.html •https://www.who.int/docs/default-source/coronaviruse/20200114-interim-laboratoryguidance-version.pdf • https://www.nea.gov.sg/our-services/public-cleanliness/environmental-cleaningguidelines/guidelines-for-environmental-cleaning-and-disinfection • https://www.who.int/publications-detail/infection-prevention-and-control-during-health-carewhen-novel-coronavirus-(ncov)-infection-is-suspected-20200125 • https://www.who.int/csr/disease/coronavirus_infections/Biosafety_InterimRecommendations_ NovelCoronavirus20 12_31Oct12.pdf?ua=1

• Interim Laboratory Biosafety Guidelines for Handling and Processing Specimens Associated with 2019 Novel Coronavirus (2019-nCoV) February 2, 2020

SARS specimens should be handled according to appropriate biosafety practices in order to avoid laboratory-related infections and spread of disease to close contacts. As the primary route of infection is thought to be via droplets, extreme caution must be exercised to eliminate the unguarded product...