1、Guidance on Donning and Removing P.ersonal P.rotective E~uipment (P.P.E).to manage COVID-19 Patients

Protocol for Donning PPE:
Put on special work clothes and work shoes --> Wash hands --> Put on disposable surgical cal)--> Put on medical protective mask (N95) --> Put on inner disposable nitrite/latex gloves --> Put on goggles and protective clothing (note: if wearing protective clothing without foot covers, please also put on separate waterproof boot covers), put on a disposable isolation gown (if required in the specific work zone) and face shield/powered air-purifying respirator(if required in tne specific work zone) --> flut on outer disposable latex gloves

Protocol for Removing PPE:

Wash hands and remove visible bodily fluids/blood contaminants on the outer surfaces at both hands --> Wash hands replace outer gloves with new gloves
--> Remove powered air-purifying respirator m self-priming filter-type full-face mask/mask (if used)
--> Wash hands
--> Remove disposable gowns along with outer gloves (if used)
--> Wash hands and put on outer gloves --> Enter Removal Area No. G)
--> Wash hands and remove protective clothing along with outer gloves (for gloves and protective clothing, turn inside out, while rolling them down) (note: if used, remove the waterproof boot covers with clothing)
--> Wash hands
--> Enter Removal Area No.1
--> Wash hands and remove goggles
--> Wash hands and remove mask
--> Wash hands and remove cap
--> Wash hands and remove innei disposable latex gloves
--> Wash hands and leave Removal Area No.2
--> Wasti hands, take a stiower, put on clean clothes and enter the clean area

2、Disinfection Procedures for COVID-19 Isolation Ward Area

2.1 Disinfection for Floor and Walls

• (1) Visible pollutants shall be completely removed before disinfection and handled in accordance with disposal procedures of blood and bodily fluid spills;
• (2) Disinfect the floor and walls with 1000 mg/L chlorine-containing disinfectant through floor mopping, spraying or wiping;
• (3) Make sure that disinfection is conducted for at least 30 minutes;
• (4) Carry out disinfection three times a day and repeat the procedure at any time when there

1. contamination.

2.2 Disinfection of Object Surfaces

• (1) Visible pollutants should be completely removed before disinfection and handled in

1. with disposal procedures of blood and bodily fluid spills;

• (2) Wipe the surfaces of objects with 1000 mg/L chlorine-containing disinfectant or wipes with effective chlorine; wait for 30 minutes and then rinse with clean water. Perform disinfec- tion procedure three times a day (repeat at any time when contamination is suspected);
• (3) Wipe cleaner regions first, then more contaminated regions: first wipe the object surfac- es that are not frequently touched, and then wipe the object surfaces that are frequently touched. (Once an object surface is wiped clean, replace the used wipe with a new one).

2.3 Air Disinfection

• (1) Plasma air sterilizers can be used and continuously run for air disinfection in an environment with

1. activity;

• (2) If there is no plasma air sterilizers, use ultraviolet lamps for 1 hour each time. Perform this operation three times a day.

2.4 Disposal of Fecal Matter and Sewage

• (1) Before being discharged into the municipal drainage system, fecal matter and sewage must be disinfected by treating with chlorine-containing disinfectant (for the initial treatment, the active chlorine must be more than 40 mg/L). Make sure the disinfection time is at least 1.5 hours;
• (2) The concentration of total residual chlorine in the disinfected sewage should reach 1O mg/L.

3、Disposal Procedures for Spills of COVID-19 Patient Blood/Fluids

3.1 For spills of a small volume(

• (1) Option 1: The spills should be covered with chlorine-containing disinfecting wipes (con- taining 5000 mg/L effective chlorine) and carefully removed, then the surfaces of the object should be wiped twice with chlorine-containing disinfecting wipes (containing 500 mg/L effective chlorine);
• (2) Option 2: Carefully remove the spills with disposable absorbent materials such as gauze, wipes, etc., which have been soaked in 5000 mg/L chlorine-containing disinfecting solution.

3.2 For spills of a large volume(> 1Oml) of blood and bodily fluids:

• (1) First, place signs to indicate the presence of a spill;
• (2) Perform disposal procedures according to Option 1 or 2 described below:
  (j) Option 1: Absorb the spilled fluids for 30 minutes with a clean absorbent towel (containing peroxyacetic acid that can absorb up to 1 L of liquid per towel) and then clean the contami- nated area after removing the pollutants.

al Option 2: Completely cover the spill with disinfectant powder or bleach powder contain- ing water-absorbing ingredients or completely cover it with disposable water-absorbing materials and then pour a sufficient amount of 10,000 mg/L chlorine-containing disinfectant onto the water-absorbing material (or cover with a dry towel which will be subjected to high-level disinfection). Leave for at least 30 minutes before carefully removing the spill.

• (3) Fecal matter, secretions, vomit, etc. from patients shall be collected into special contain- ers and disinfected for 2 hours by a 20,000 mg/L chlorine-containing disinfectant at a spill-to-disinfectant ratio of 1:2.
• (4) After removing the spills, disinfect the surfaces of the polluted environment or objects.
• (5) The containers that hold the contaminants can be soaked and disinfected with 5,000 mg/L active chlorine-containing disinfectant for 30 minutes and then cleaned.
• (6) The collected pollutants should be disposed of as medical waste.
• (7) The used items should be put into double-layer medical waste bags and disposed of as medical waste.

4、Disinfection of COVID-19 Related Reusable Medical Devices

4.1 Disinfection of powered air-purifying respirator

Note: The disinfection procedures for protective hood described above are only for reusable protec- tive hoods (excluding disposable protective hoods).

4.2 Cleaning and Disinfection Procedures for Digestive Endoscopy and Bronchofibro- scopy

• (1) Soak the endoscope and reusable valves in 0.23% peroxyacetic acid (confirm the concentration of the disinfectant before use to make sure it will be effective);
• (2) Connect the perfusion line of each channel of the endoscope, inject 0.23% pero- xyacetic acid liquid into the line with a 50 ml syringe until fully filled, and wait for 5 minutes;
• (3) Detach the perfusion line and wash each cavity and valve of the endoscope with a disposable special cleaning brush;
• (4) Put the valves into an ultrasonic oscillator containing enzyme to oscillate it. Connect the perfusion line of each channel with the endoscope. Inject 0.23% pero- xyacetic acid into the line with a 50 ml syringe and flush the line continuously for 5 minutes. Inject air to dry it for 1 minute;
• (5) Inject clean water into the line with a 50 m l syringe and flush the line continuously for 3 minutes. Inject air to dry it for 1 minute;
• (6) Perform a leakage test on the endoscope;
• (7) Put in an automatic endoscopic washing and disinfection machine. Set a high level of disinfection for treatment;
• (8) Send the devices to the disinfection supply center to undergo sterilization with ethylene oxide.

4.3 Pre-treatment of Other Reusable Medical Devices

• (1) If there are no visible pollutants, soak the device in 1ooo mg/l chlorine-containing disinfectant for at least 30 minutes;
• (2) If there are any visible pollutants, soak the device in 5000 mg/l chlorine-containing disinfectant for at least 30 minutes;
• (3) After drying, pack and fully enclose the devices and send them to the disinfection supply center.

5、Disinfection Procedures for Infectious Fabrics of Suspected or Confirmed Patients

5.1 Infectious fabrics

• (1) Clothes, bed sheets, bed covers and pillowcases used by patients;
• (2) Ward area bed curtains;
• (3) Floor towels used for environmental cleaning.

5.2 Collection methods

• (1) First, pack the fabrics into a disposable water-soluble plastic bag and seal the bag with matching cable ties;
• (2) Then, pack this bag into another plastic bag, seal the bag with cable ties in a gooseneck fashion;
• (3) Finally, pack the plastic bag into a yellow fabric bag and seal the bag with cable ties;
• (4) Attach a special infection label and the department name. Send the bag to the laundry room.

5.3 Storage and washing

• (1) Infectious fabrics should be separated from other infectious fabrics (non-COVID-19) and washed in a dedicated washing machine;
• (2) Wash and disinfect these fabrics with chlorine-containing disinfectant at 90 °c for at least 30 minutes.

5.4 Disinfection of transport tools

• (1) Special transport tools should be used specifically for transporting infectious fabrics;
• (2) The tools shall be disinfected immediately each time after being used for transporting infectious fabrics;
• (3) The transport tools should be wiped with chlorine-containing disinfectant (with 1000 mg/L active chlorine). Leave disinfectant for 30 minutes before wiping the tools clean with clean water.