TABLE OF CONTENTS
- INFLUENZA-LIKE ILLNESS (ILI) CASE AND OUTBREAK IDENTIFICATION
- CHECKLIST FOR IDENTIFYING COVID-19 SUSPECTS
- ILI/ SUSPECTED COVID-19 STRATEGIC CONTROL STEPS
- TABLE 12.1: ISOLATION ROOMS AND PPE
- MEDICAL HOLD
- CONTACT INVESTIGATION
- MONITORING PATIENTS WITH SUSPECTED OR CONFIRMED COVID-19
- FIGURE 12.1: ALGORITHM FOR EVALUATION AND TREATMENT OF SUSPECT COVID-19 CASES
- RESPONSE TO A COVID-19 OUTBREAK
- CRITERIA FOR RELEASE FROM ISOLATION CONFIRMED COVID-19 CASES
- FIGURE 12.2: ALGORITHM FOR RELEASE FROM ISOLATION CRITERIA FOR PATIENTS WITH COVID-19
- CRITERIA FOR RELEASE FROM ISOLATION CONFIRMED INFLUENZA CASES
- CLEANING SPACES WHERE SUSPECT AND CONFIRMED COVID-19 CASES SPENT TIME
INFLUENZA-LIKE ILLNESS (ILI) CASE AND OUTBREAK IDENTIFICATION
Patients should be triaged as soon as possible upon arrival to a facility (right after leaving the transportation bus) for symptom assessment and temperature check per current policy protocols prior to allowing patients to be within 6 feet of other persons. ILI screening in a physically removed area that is outdoor with canopy or indoor separated, is highly recommended. If a patient presents with ILI symptoms, place a surgical facemask on the patient and isolate them immediately until a health care provider can clinically assess and evaluate them. Non-symptomatic patients who are contacts of confirmed cases should be placed in quarantine according to CCHCS current policy.
Test patients per the Diagnostic Testing prioritization.
- All people who refuse testing should be given educational information in an accessible format and an opportunity to have their concerns expressed and questions answered. Patients should NOT face discipline or any punitive reprisals for refusal to test.
- People who refuse testing after showing symptoms should be treated as if they tested positive. They should be placed in medical isolation. See more details in the Isolation section.
See checklist below for active means to identify ILI already within an institution. For the control strategy for confirmed cases of influenza, see CCHCS Seasonal Influenza Infection Prevention and Control Guidance (CDCR networking is required for access).
CHECKLIST FOR IDENTIFYING COVID-19 SUSPECTS
- Examine laboratory testing results for positive COVID-19 and other communicable diseases requiring public health action.
- Examine COVID-19 tests ordered in the last 24 hours to identify patients with ILI.
- Examine treatment and triage area (TTA) logs for patients who had respiratory symptoms.
- Coordinate with Utilization Management (UM) nurse on patients who are out to medical with ILI/pneumonia.
- Review the daily movement sheet to identify patients that may have been sent out for HLOC due to ILI/respiratory symptoms.
- Attend daily Patient Care (PC) clinic huddles, as time permits, to identify any patients being seen that day with complaints of ILI symptoms.
- Establish a sustainable process by which Public Health and Infection Control staff are notified of patients that are put on precautions for ILI after hours.
ILI/ SUSPECTED COVID-19 STRATEGIC CONTROL STEPS
- Immediately mask patients when COVID-19 is suspected. Surgical or procedure masks are appropriate for patients. If there is a shortage of surgical/procedure masks, have the patients use a cloth face covering, tissue and/or bandana when coughing.
- Patients should be placed in an airborne infection isolation room (AIIR) as soon as possible (this can be ordered in the electronic health records system [EHRS]). If AIIR is not immediately available, the patient shall be placed in a private room with the door closed. Appropriate signage indicating precautions and required PPE to enter should be visible outside the patient’s room. A summary of isolation room type recommendations is below.
- Standard, contact, and airborne precautions plus eye protection should be implemented immediately (see Infection Control and Personal Protective Equipment section). HCWs should use a surgical/procedure mask, unless N95 respirators are in abundant supply.
- When possible, assign dedicated health care staff to provide care to suspected or confirmed cases.
- Ensure staff caring for confirmed cases or involved in intra-facility transporting of cases and inmate workers if they are to come within 6 feet of confirmed case patients, utilize appropriate PPE: Use procedure/surgical masks, (unless N95 respirator or PAPR are in abundant supply), gloves, gown, and face shield covering sides and front of face or goggles.
- Limit movement of designated staff between different parts of the institution to decrease the risk of staff spreading COVID-19 to other parts of the facility. To assist staff, traffic patterns may need to be changed or guided with demarcations.
- Patients shall only be transported for emergent medically necessary procedures or transfers, and shall wear a surgical or procedure mask during transport. During vehicle transport, custody or HCW will use an N-95 mask for symptomatic patients. Limit number of staff that have contact with suspected and/or confirmed cases.
- Assess and treat as appropriate soon-to-be released patients with suspected COVID-19 and make direct linkages to community resources to ensure proper isolation and access to medical care. Notify LHD of patients to be released who have suspect or confirmed cases and are still isolated.
- IMPORTANT: Suspect cases, patients from facilities with large outbreaks, and COVID-19 case patients should not be released without the coordination of CDCR discharge planning and LHD guidance. See the Inmates Releasing from Institutions During COVID-19 section.
- Once COVID-19 has been ruled out clinically and by testing, airborne precautions can be stopped. Follow the CCHCS Influenza Guidance document for general ILI and influenza management (CDCR networking is required for access).
Promptly separate patients who are sick with fever or lower respiratory symptoms from well-patients. Patients with these symptoms should be isolated until they are no longer infectious and have been cleared by the health care provider. provider (see Release from Isolation). Also, promptly isolate asymptomatic but test-confirmed cases.
- NOTE: For Patients with COVID-19 symptoms that refuse testing: People who refuse testing after showing symptoms should be treated as if they tested positive. They should be placed in medical isolation in celled housing. They should NOT be placed in cohorts (double-celled or in dorm housing) with other people who are symptomatic, pending a test result, or confirmed positive following testing.
Medical isolation conditions should be as similar to regular housing as possible.
- The preference is for isolation in a negative pressure room; second choice would be isolation in private room with a solid, closed door.
- As a last resort, when a negative pressure room or a private single room is not available, groups of symptomatic patients can be cohorted in a separate area or facility away from well-patients. Possible areas to cohort patients could be an unused gym or section of a gym or chapel. When it is necessary to cohort patients in a section of a room or area with the general population of well-patients (e.g., dorm section) there should be at least 6 feet (3.6 feet minimum for severe space shortages) between symptomatic patients and the well patient population. However, symptomatic patients with ILI and no diagnosis should maintain social distancing between each isolated individual if at all possible. Tape can be placed on the floor to mark the isolation section with a second line of tape 6 feet away to mark the well-patient section which can provide a visual sign and alert well-employees and patients to remain outside of the isolation section unless they are wearing appropriate PPE.
In order of preference, individuals under medical isolation should be housed:
- Separately, in single cells with solid walls (i.e., not bars) and solid doors that close fully
- Separately, in single cells with solid walls but without solid doors
- As a cohort, in a large, well-ventilated cell with solid walls and a solid door that closes fully. Employ social distancing strategies.
- As a cohort, in a large, well-ventilated cell with solid walls but without a solid door. Employ social distancing strategies.
- As a cohort, in single cells without solid walls or solid doors (i.e., cells enclosed entirely with bars), preferably with an empty cell between occupied cells. (Although individuals are in single cells in this scenario, the airflow between cells essentially makes it a cohort arrangement in the context of COVID-19.)
- As a cohort, in multi-person cells without solid walls or solid doors (i.e., cells enclosed entirely with bars), preferably with an empty cell between occupied cells. Employ social distancing strategies. Use tape to mark off safe distances between patients.
- Safely transfer individual(s) to another facility with available medical isolation capacity in one of the above arrangements.
NOTE – Transfer should be avoided due to the potential to introduce infection to another facility; proceed only if no other options are available.
- If the ideal choice does not exist in a facility, use the next best alternative.
Provide individuals under medical isolation with tissues and, if permissible, a lined no-touch trash receptacle. Instruct them to:
- Cover their mouth and nose with a tissue when they cough or sneeze.
- Dispose of used tissues immediately in the lined trash receptacle.
- Wash hands immediately with soap and water for at least 20 seconds. If soap and water are not available, clean hands with an alcohol-based hand sanitizer that contains at least 60% alcohol (where security concerns permit). Ensure that hand washing supplies are continually restocked.
- Patients with ILI of unknown etiology should be isolated alone. If they cannot be isolated alone, they should be isolated with other sick patients from the same housing unit or other sick ILI patients of unknown etiology. When cohorting ILI patients, if at all possible, separate patients 6 feet from each other, with 3.6 feet minimum if space is limited.
- Patients with confirmed COVID-19 or influenza can safely be isolated in a cohort with other patients who have the same confirmed diagnosis.
- Correctional facilities should review their medical isolation policies, identify potential areas for isolation, and anticipate how to provide isolation when cases exceed the number of isolation rooms available. (See subsection in Primary Prevention on this topic)
- If possible, the isolation area should have a bathroom available for the exclusive use of the identified confirmed positive cases. When there is no separate bathroom available, patients that are symptomatic and asymptomatic with a positive test, should wear a surgical or procedure mask when outside the isolation room or area, and the bathroom should be sanitized frequently (ideally 3 to 4 times daily).
- A sign should be placed on the door or wall of an isolation area to alert employees and patients. All persons entering the isolation room or areas need to follow the required transmission-based precautions.
- When possible, assign dedicated health care staff to provide care to suspected or confirmed cases.
- If a patient with ILI or confirmed COVID-19 or influenza must be moved out of isolation, ensure a surgical or procedure mask is worn during transport. Staff shall wear an appropriate respirator (or surgical mask in times of shortage) during vehicular transport of these patients.
- Facilities should also ensure that plans are in place to communicate information about suspect and confirmed influenza cases who are transferred to other departments (e.g., radiology, laboratory) or another prison or county jail. Ensure communication and a plan before transfer. (Refer to Inmates Releasing From Institutions During COVID-19 section)
To the greatest extent possible, individuals who are under medical isolation should be provided access to the same necessities and privileges that would otherwise normally be available.
- Patients under medical isolation for suspected or confirmed COVID-19 should continue to have access to the following activities (see below). However, facilities must ensure staffing, and the ability to adhere to all recommended infection control precautions (see Infection Control Precautions and PPE Scenarios) and physical distancing guidelines when implementing these daily activities:
- Showering/bathing must be permitted at least every other day, or more often if possible (per CCR 15, § 1226)
- Spending time outside of isolation, including yard and day room time
- Phone calls and access to personal property
- When feasible, accessing the canteen
- Strategies to minimize unnecessary movements outside of isolation include conducting surveillance rounds and providing meals and medications at the cell/room door should be instituted.
- Patients with confirmed COVID-19 who are isolated as a cohort may participate as a group for yard time, day room time, while dining, and in medication and canteen lines, as long as they are masked and adhering to physical distancing from well persons.
- Providing access to the above necessities and time outside of isolation to the extent that is feasible and safe is important for reducing disincentives for symptomatic patients to seek medical attention.
When a patient with a suspected case of COVID-19 is identified:
- The patient should be isolated and placed on a medical hold.
- All patients housed in the same unit, and any other identified close contacts, should be placed on a medical hold as part of quarantine measures.
- If the contact with the case that occurred likely posed a high risk of transmission (see Close Contact table below), consideration can be given to a preliminary contact investigation as if it was a confirmed case, time and resources permitting
- Separate and isolate any symptomatic contacts.
- Initiate surveillance measures detailed in the monitoring section.
Any persons identified through the contact investigation to have symptoms or test positive for COVID-19, should be immediately isolated and masked and reported to the headquarters PHB: CDCRCCHCSPublicHealthBranch@cdcr.ca.gov.
If COVID-19 case is confirmed, initiate a contact investigation.
Contact investigation for suspected COVID-19 cases should not be initiated while Influenza and COVID-19 test results are pending, except in consultation with the PHB (e.g., highly suspicious suspect case or multiple suspect cases with known contact to a confirmed case).
A contact investigation should be conducted for all confirmed cases of COVID-19.
- Determine the dates during the case-patient’s infectious period during which other patients and staff may have been exposed (from 2 days [48 hours] prior to the date of symptom onset to the date the patient was isolated).
- Interview the case-patient to identify all close contacts based on exposure (within 6 feet for ≥10 minutes) during the infectious period, without the use of PPE:
- Identify all activities and locations where exposure may have occurred (e.g., classrooms, group activities, social activities, work, dining hall, day room, church, clinic visits, yard, medication line, and commissary line).
- Determine the case-patient’s movement history, including cell/bed assignments and transfers to and from other institutions or outside facilities.
- Identify close contacts associated with each activity and movement
Within 6 feet and prolonged (generally ≥10 minutes) contact with a confirmed case of COVID-19 during the infectious period, without the use of PPE
Examples (ranked in order of descending risk):
- Cellmate of a patient with confirmed COVID-19
- Residing in the same dormitory pod or small housing unit (up to 8 beds) as the confirmed case
- Occupying adjacent beds in a large dormitory or ward with the confirmed case
- Inmate worker/volunteer caring for a patient with confirmed COVID-19 without PPE
- Being directly coughed or sneezed upon (even though may be transient encounter)
- Close contact during activities (e.g., in classrooms, groups, social activities, work, church, clinic visits, medication line, and commissary line) with the patient with confirmed COVID-19
- Linkage to a high risk group defined by public health during an outbreak (e.g., an affected dorm, housing unit, or yard)
- Resident transferring from a facility with sustained COVID-19 transmission in the last 14 days
- Sharing common spaces (e.g., yard, shower, dining hall, day room)
- Use the COVID-19 Contact Investigation Tool (Appendix 6) and the Index Case-Patient Interview Checklist (Appendix 7) and to guide and document the interview and identification of the case-patient’s close contacts.
- All symptomatic patients with a known exposure to a confirmed case should be placed in quarantine. If an asymptomatic patient is offered testing while in quarantine and refuses, they will continue in quarantine. They should not be placed in cohorts with people who are symptomatic, pending a test result, or confirmed positive following testing.
- Determine the last date of exposure for each of the contacts for the purpose of placing them in quarantine for a full incubation period (14 days). If a contact is subsequently exposed to another confirmed COVID-19 case, the quarantine period should be extended for another 14 days after the last exposure.
- Initiate and submit a contacts line list to the Public Health Branch (PHB) in the COVID-19 SharePoint: https://cdcr.sharepoint.com/sites/cchcs_ms_phos (see Reporting section – CDCR networking is required for access).
- Use the COVID-19 SharePoint contacts line list to track the date of last exposure, date the quarantine began, and the end date for quarantine.
- Asymptomatic contacts should be monitored for symptoms two times daily, unless severe staffing or resource issues necessitate once daily.
- Any contact who develops symptoms consistent with COVID-19 should be immediately isolated (see Isolation).
Institutional leadership is responsible for notifying the OEHW and RTWC of the possibility of employees exposed to COVID-19.
MONITORING PATIENTS WITH SUSPECTED OR CONFIRMED COVID-19
- Patients with suspected or confirmed (symptomatic and asymptomatic) COVID-19 require a minimum of twice daily nursing assessments. However, strong consideration should be given to an increased frequency of assessments beyond twice a day because COVID-19 patients tend to decline precipitously (and after improvement) and silent hypoxemia (patient not experiencing undue dyspnea, but blood oxygenation is declining) may contribute to this. Nursing assessments will include, but are not limited to:
- Temperature monitoring
- Pulse oximeter monitoring
- Blood pressure checks
- Respiratory rate and heart rate
- Monitor patients for complications of COVID-19 infection, including respiratory distress and sepsis:
- Fever and chills
- Low body temperature
- Rapid pulse
- Rapid breathing
- Labored breathing
- Low blood pressure
- Low oxygen saturation (highest association with the development of pneumonia)
- Persistent pain or pressure in the chest
- Bluish lips or face
- Altered mental status or confusion, inability to arouse
Patients with abnormal findings should be immediately referred to a provider for further evaluation.
- Keep in mind the risk factors for severe illness: older age and those with medical conditions described in the High Risk Conditions section of the document.
- Patients at high risk of progression, rapid deterioration, and death should be assessed by a nurse and monitored for complications as described above, with consideration of increasing frequency beyond twice daily while in isolation.
- Please refer to the Lifeline QM COVID-19 Risk Registry to identify patients with medical conditions that place them at high risk for severe COVID-19 disease
- Patients tend to deteriorate rapidly and may occur after a day of feeling better. Studies show patients tend to decline and need hospital admission around the 8th day after exposure.
- Patients with laboratory-confirmed COVID-19 who do not present with symptoms (e.g., tested as asymptomatic contacts at higher risk due to close contact with a symptomatic confirmed case) require isolation and twice daily nursing assessment including:
- Temperature monitoring
- Development of symptoms (e.g., chills, subjective fever, shaking chills, fatigue, malaise, sore throat, myalgia or arthralgia, gastrointestinal [GI] symptoms including loss of appetite, upper respiratory infection [URI] symptoms, and loss of sense of smell or taste)
- Pulse oximeter monitoring, only if symptoms develop
- Please refer to the Quality Management (QM) COVID-19 Monitoring Registry (CDCR networking is required for access) which tracks patients with either confirmed or suspected of COVID-19. The COVID-19 Monitoring Registry helps health care staff stay apprised of COVID-19 testing results and ensure that rounding is occurring as required across shifts, as well flags certain symptoms, such as fever.
RESPONSE TO A COVID-19 OUTBREAK
When one or more laboratory confirmed cases of COVID-19 have been reported, surveillance should be conducted throughout the institution to identify close contacts. The institutional PHN and NCPR will confer and implement the investigation. A standardized approach to stop COVID-19 transmission is necessary by identifying people who have been exposed to a laboratory confirmed COVID-19 case.
Containment: Stopping transmission will require halting movement of exposed patients. The goal is to keep patients who are ill or who have been exposed to someone who is ill from mingling with patients from other areas of the prison, from food handling and duties in healthcare settings. Close as many affected buildings/units as needed to confine the outbreak. Remind patients not to share eating utensils, food or drinks. Stop large group meetings such as religious meetings and social events. Patients who are housed in the same affected building/unit may have pill line or yard time together.
Communication within the Institution: Establish a central command center to include CME, PHN, CNE, Director of Nurses (DON), ICN, Warden and key custody staff. Call for an Exposure Control meeting with the Warden, CME, Facilities Captains, Department Heads and Employee Union Representatives to inform them of outbreak, symptoms of disease, number of patients affected and infection control measures.
Reporting and Notification: As soon as outbreak is suspected, contact your Statewide Public Health Nurse Consultant by telephone or email within 24 hours. Initiate and submit a contacts line list to the PHB in the COVID-19 SharePoint: https://cdcr.sharepoint.com/sites/cchcs_ms_phos (CDCR networking is required for access). Report outbreak by telephone to the Local Health Department as soon as possible to assist with contact investigation, if needed. If your facility is considering halting all movement in and out of your institution, please consult with the PHB warmline at (916) 691-9901.
Tracking: For the duration of the outbreak, collect patient information systematically to ensure consistency in the data collection process. Assign back up staff for days off, to be responsible for tracking cases and reporting.
CRITERIA FOR RELEASE FROM ISOLATION CONFIRMED COVID-19 CASES
- For individuals with asymptomatic or symptomatic laboratory confirmed COVID-19 under isolation, considerations to discontinue Transmission-Based Precautions include clinical AND testing criteria. Clinical criteria should be met first, then test the patient for COVID-19 related virus by RT-PCR. See Algorithm.
- CLINICAL CRITERIA::
- At least 5 days after resolution of fever without use of antipyretic medication (if applicable) AND
- At least 10 days**(minimum) from after the date of the initial positive test AND
- Improvement in illness signs and symptoms
AND once clinical criteria above are met:
- TESTING CRITERIA: One negative RT-PCR
- If the test is negative, release the patient from isolation with a face covering
- If the test is still positive or equivocal, consult the CME, consider re-testing OR use clinical criteria
- In cases where there is severe shortage of testing materials/swabs, then the clinical criteria alone may be used:
- At least 5 days after resolution of fever without use of antipyretic medication (if applicable) AND
- At least 14 days**(minimum) from after the date of the initial positive test AND
- Improvement in illness signs and symptoms
**CMEs may choose to lengthen the criteria time for symptom resolution to 14 days or beyond at their discretion.
- Given studies showing highly variable prolonged viral shedding after resolution of symptoms, all patients should wear a face covering and continue social distancing after release from isolation. The timeframe for this has not been specified by the CDC. At this time, CCHCS is recommending a minimum of 2 weeks. If a facility-wide order for social distancing and universal face coverings are in place, continue for 2 weeks from release or as long as the universal order persists, whichever is longer.
- IMPORTANT: Consider the potential for harassment of patients released from isolation into the general population, especially if wearing masks but the general population is not using them. Work with custody leadership to mitigate stigma-related risk as much as possible before release.
- Resolution of cough, is not necessary for release, however people with residual cough should wear a face covering once released, until completely without cough.
Check for updates: https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-hospitalized-patients.html
CRITERIA FOR RELEASE FROM ISOLATION CONFIRMED INFLUENZA CASES
Remain in isolation for 7 days from symptom onset and 24 hours after resolution of fever and respiratory symptoms.
CLEANING SPACES WHERE SUSPECT AND CONFIRMED COVID-19 CASES SPENT TIME
(See CDC page on this topic)
- Thoroughly clean and disinfect all areas where the confirmed or suspected COVID-19 case patients spent any time. Note – these protocols apply to suspected cases as well as confirmed cases, to ensure adequate disinfection in the event that the suspected case does, in fact, have COVID-19. Refer to the Definitions section for the distinction between confirmed and suspected cases.
- Close off areas used by the infected individual. If possible, open outside doors and windows to increase air circulation in the area. Wait as long as practical, up to 24 hours under the poorest air exchange conditions (consult CDC Guidelines for Environmental Infection Control in Health-Care Facilities for wait time based on different ventilation conditions), before beginning to clean and disinfect, to minimize potential for exposure to respiratory droplets.
- Clean and disinfect all areas (e.g., cells, bathrooms, and common areas) used by the infected individual, focusing especially on frequently touched surfaces.
Cleaning after aerosol generating procedures: Consult the CDC for updates: https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-faq.html
After discharge, terminal cleaning may be performed by EVS personnel. They should delay entry into the room until a sufficient time has elapsed for enough air changes to remove potentially infectious particles. We do not yet know how long SARS-CoV-2 remains infectious in the air. Regardless, EVS personnel should refrain from entering the vacated room until sufficient time has elapsed for enough air changes to remove potentially infectious particles (more information on clearance rates under differing ventilation conditions is available). After this time has elapsed, EVS personnel may enter the room and should wear a gown and gloves when performing terminal cleaning. A surgical mask (if not already wearing for source control) and eye protection should be added if splashes or sprays during cleaning and disinfection activities are anticipated or otherwise required based on the selected cleaning products. Shoe covers are not recommended at this time for personnel caring for patients with COVID-19.
- Hard (non-porous) surface cleaning and disinfection
- If surfaces are dirty, they should be cleaned using a detergent or soap and water prior to disinfection.
- For disinfection, most common EPA-registered household disinfectants should be effective. Choose cleaning products based on security requirements within the facility.
- Consult a list of products that are EPA-approved for use against the virus that causes COVID-19. Follow the manufacturer’s instructions for all cleaning and disinfection products (e.g., concentration, application method and contact time, etc.).
- Diluted household bleach solutions can be used if appropriate for the surface. Follow the manufacturer’s instructions for application and proper ventilation, and check to ensure the product is not past its expiration date. Never mix household bleach with ammonia or any other cleanser. Unexpired household bleach will be effective against coronaviruses when properly diluted. Prepare a bleach solution by mixing:
- – 5 tablespoons (1/3 cup) bleach per gallon of water or
- – 4 teaspoons bleach per quart of water
- Soft (porous) surface cleaning and disinfection
- For soft (porous) surfaces such as carpeted floors and rugs, remove visible contamination if present and clean with appropriate cleaners indicated for use on these surfaces. After cleaning:
- Electronics cleaning and disinfection
- For electronics such as tablets, touch screens, keyboards, and remote controls, remove visible contamination if present.
- Follow the manufacturer’s instructions for all cleaning and disinfection products.
- Consider use of wipeable covers for electronics.
- If no manufacturer guidance is available, consider the use of alcohol-based wipes or spray containing at least 70% alcohol to disinfect touch screens. Dry surfaces thoroughly to avoid pooling of liquids.
Additional information on cleaning and disinfection of communal facilities such can be found on CDC’s website.
- Ensure that staff and incarcerated/detained persons performing cleaning wear recommended PPE. (See PPE CHART)
- Food service items. Cases under medical isolation should throw disposable food service items in the trash in their medical isolation room. Non-disposable food service items should be handled with gloves and washed with hot water or in a dishwasher. Individuals handling used food service items should clean their hands after removing gloves.
- Laundry from COVID-19 cases can be washed with other individuals’ laundry.
- Individuals handling laundry from COVID-19 cases should wear disposable gloves, discard after each use, and clean their hands after.
- Do not shake dirty laundry. This will minimize the possibility of dispersing virus through the air.
- Launder items as appropriate in accordance with the manufacturer’s instructions. If possible, launder items using the warmest appropriate water setting for the items and dry items completely.
- Clean and disinfect clothes hampers according to guidance above for surfaces. If permissible, consider using a bag liner that is either disposable or can be laundered.
- Consult cleaning recommendations to ensure that transport vehicles are thoroughly cleaned after carrying a confirmed or suspected COVID-19 case.