COVID-19 Infection Prevention and Control Guidelines for South Africa

This guideline provides guidance towards the reduction and prevention of transmission in both patients and staff at community and healthcare facility level. It should be read in conjunction with the National Infection Prevention Control Strategic Framework and the Practical Manual for the Implementation of the National Infection Prevention Control Strategic Framework.

These guidelines are subject to change as the situation with COVID-19 develops in South Africa. The guidelines will be updated regularly based on WHO recommendations. The last update was on 21 May 2020.

EMGuidance confirms that it is not the owner of the information provided, nor does it intend to present it as such.

These are the amendments:

• Recommendations for the handling of clinical notes
• It is now recommended that all clinical staff wear surgical masks and increase hand hygiene when consulting all patients, irrespective of whether or not the patient is known or suspected to have COVID-19, or has respiratory symptoms
• Principals for PPE use have been updated in line with the universal masking policy.
• Guidance on the use of PPE during labour and breastfeeding has been added
• Bodies with expected leakage should be transferred in a body bag from a ward to the mortuary.
• The table on dilution of chlorine has been updated
• A section on healthcare risk waste and sewerage has been added
• Recommendation that body spraying of humans with chemicals or other products before entering a facility be avoided.
• Recommendations for the use of PPE by emergency medical services have been added and updated.  

Click here to access the guideline

Below you can find extracts of certain parts of the guidelines.

Clinical Notes:

• Always perform hand hygiene before and after touching the notes (persistence on cardboard and paper has been reported)
• Do not write in the clinical notes while wearing gloves
• Cover the clinical notes with a plastic folder which can be easily cleaned and disinfected with alcohol.

Use of PPE during labour and breastfeeding

The currently available evidence does not include the second stage of labour and delivery as an aerosol-generating event. In light of this, the recommended PPE for obstetric staff performing deliveries is as follows:

• Labour and deliveries of all women: PPE as indicated to reduce exposure risk to blood and bodily fluids i.e. surgical mask, gloves, apron/gown and goggles/visor.
• Caesarean section under general anaesthetic or with regional anaesthesia and a high probability of requiring intubation: PPE as indicated for aerosol-generating procedure (AGP), N95 respirator, gloves, apron/gown and goggles/visor. Limit the presence of non-essential staff in the operating theatre. Consider the use of larger screens to separate patient and operating team and the use of a clear box over the patients head to minimise aerosol spread during intubation and suctioning. 

In keeping with the universal masking recommendation, all women admitted to obstetric wards should wear a cloth mask or surgical mask, and all women in labour and those undergoing a caesarean section under regional anaesthesia, should wear a surgical mask. 

All obstetric staff should wear a surgical mask during all clinical care, and a cloth mask (non-medical mask) in non-clinical areas of the healthcare facility e.g. tea rooms, meeting rooms, cafeteria.

For post-natal care of the infant, COVID-19 infected mothers should wear surgical masks when feeding their baby for 14 days after their symptoms have resolved as mother to baby transmission via respiratory droplets can occur. They should perform hand hygiene before handling their baby and before expressing breastmilk. There is no evidence of viral presence in breastmilk and breastfeeding is strongly encouraged.

Environmental cleaning

Human coronaviruses can remain infectious on surfaces for up to 9 days. The SARS-CoV-2 virus has been detected after up to 72 hours in experimental conditions.Therefore, cleaning the environment is paramount and is covered in detail in the National IPC Manual (2020).

To summarise, each area of the healthcare facility must be cleaned at least twice daily, with a proper schedule, checklist and programme. In high risk areas (COVID-19 triage, isolation ward and ICU settings), the environment must be cleaned and disinfected at least 3-4 times per day and checked by the supervisor each time.

The cleaning can be validated using visual inspection and fluorescent markers and a record of cleaning must be kept.

Following thorough cleaning, surfaces are wiped (NOT SPRAYED) with disinfectants such as 1:1000 ppm chlorine or 70% alcohol, as recommended. Universal disinfectant wipes which combine cleaning and disinfection are impregnated with peracetic acid and or hydrogen peroxide and may be used but these are expensive. 

Hypochlorite must be used at the correct dilution of 1:1000ppm to ensure maximum efficacy.

Table 5. How to dilute to 0.1% (1:1000ppm)  (for COVID cleaning)

Environmental spraying of walls, floors, ceilings and passages in health care facilities with chlorine is not recommended. There is no evidence that transmission from these areas occurs.

Body spraying of humans with any chemical or product in any situation including entrances to healthcare facilities, is not warranted. The chemicals used may be toxic to the skin, eyes and respiratory tract and may aggravate the acquisition of SARS-CoV 2.