A systematic review on disinfection, airborne precautions and biomedical waste management for prevention of infection by SARS-CoV-2: Current evidences and adoptable practices in healthcare settings

Abstract

The emergence and spread of the novel corona virus SARS-CoV-2 causing pneumonia and severe respiratory tract infections has put the whole world in grave situation. The pandemicity is because the virus is highly contagious with very high transmissibility and spread from person to person by infected respiratory droplets and contacts. As no specific drug or vaccine against SARS-CoV-2 are available in the market, so preventive measures that break the chain of transmission are the mainstay to prevent COVID-19 infections. The present systematic review article highlights the current updates on preventive measures in the context of disinfection practices, droplet precautions, airborne precautions and biomedical waste management based on various research articles, national guidelines by Indian Council of Medical Research (ICMR) and Central Pollution Control Board, Government of India and international guidelines by WHO, CDC. Search was conducted in Medline, Embase and Google Scholar with articles published in English language from 1st January 2020 to 20th July 2020 and were taken for reviewing. A systematic review protocol was developed based on PRISMA checklist and the PRISMA statement and was conducted to synthesise adoptable best practices based on current evidences. Three disinfectants have become most important to combat this novel corona virus, which are 70-85% ethanol, 0.1% sodium hypochlorite for routine environmental disinfection and 0.5% sodium hypochlorite for large spillage management and >0.5% hydrogen peroxide with a minimal contact time of 1 minute for all three disinfectants. Fogging of unoccupied rooms and testing laboratories can be done by 2% hydrogen peroxide solution. UV radiation at 240-260 nm have wide applications in routine terminal disinfection of unoccupied rooms and biosafety cabinets and also used for decontamination of N95 masks for reuse. Based on available evidences from WHO and ICMR it is suggested to take respiratory droplets and contact precautions in every health care settings taking care of suspected or confirmed COVID-19 cases, and airborne precautions are recommended when aerosol generating procedures are performed. According to CDC droplets and contact precautions are essential in routine health care settings and airborne precautions are essential when aerosol generating procedures are performed and are also recommended when taking care of suspected or confirmed COVID-19 cases depending on resource availability. Whether airborne precaution is essential for all settings is debatable and is still unclear based on available evidences. Proper handling of biomedical waste, segregation at source and disposal as per classification along with proper disposal of PPE after doffing can help in preventing the disease in community and among health care providers. Evidence on the modes of transmission of COVID-19 from dead bodies to individuals is yet to be established. Steps to be followed are based on Government Guidelines. However scholarly article depicting desirable and undesirable effects of dead body handling strategy is lacking.