- Primary Aim: Prevent Coronavirus Entering the House.
- Secondary Aim: Minimize Household Risk/Spread.
- Tertiary Aim: Be prepared to care for a household member with COVID-19.
- Implementation of Precautions.
1. Primary Aim: Prevent Coronavirus Entering the House.
Rationale and Objectives
The only way to prevent coronavirus entry is for all household members to stay in the house, with no outside contact (not even deliveries). As there is likely to be some contact, the primary aim is thus to minimize/eliminate coronavirus entry. This may be achieved by
- cleaning and disinfection of household members (and their clothes and items) when they enter the house, and by
- cleaning and disinfection of all items that enter the house, and by
- restricting the entry of non-household members; in case they need to enter, by taking appropriate precautions.
Precautions Against Coronavirus Entry
- When leaving the house (exit/leave only if absolutely necessary),
- only wear clothes and footwear that may be washed, and
- only carry items that may be washed or disinfected on return.
- Do not carry a wallet/bag,
- remove keychain attachments and only carry essential keys in a ring.
- Carry a hand disinfectant in a small bottle, and clean money including small notes/change.
- Wear a mask, and eyeglasses/sunglasses. A cloth mask is good enough. A mask (and eyewear) will (i) prevent you touching your face (ii) protect others in case you have COVID-19, and (iii) somewhat protect you in case an infected person coughs or sneezes in your presence.
- When outside the house,
- stay 6 feet away from people if possible. Do not shake hands.
- Avoid touching unnecessary surfaces and your face.
- Do not eat outside food. Cooked food is ok, but packaging/utensils are contaminated.
- After leaving a building/other activity, use the hand disinfectant (if possible).
- When entering your car/vehicle, put away all carried items (in the trunk or on the adjacent seat floor), use the disinfectant on hands and car keys, and then close the door. Rub disinfectant on any surfaces like the steering wheel/switches that you may have touched while getting in.
- When entering the house,
- place all items on your person and items you may have brought, into appropriate containers for cleaning/disinfection (details below). Items that can be washed (e.g. keys, disinfectant bottle, small plastic items, eyewear) may be carried into the house.
- Remove mask. Cloth masks may be placed in bleach solution. All masks and money may be placed in a tray/box for sunlight/heat disinfection (details below).
- Avoid touching the house main door handle (disinfect later, in any case, from both inside and outside). Remove your footwear at/outside the door (wash with soap/disinfectant later) and change into washable footwear.
- Wash hands (follow standard technique for 20s) with soap and water, and then wash each item for 20s with soap, and place on a clean/disinfected surface. At the end, wash any parts of the sink where the items touched, rub the tap fixture with soap and wash with water, apply soap on hands, rinse the soap with water before placing back (if using a soap dispenser, wash it with soap and water). Wash/rinse hands, dry ideally with a disposable tissue, and ideally close the tap using the disposable tissue.
- Proceed immediately to the shower/bath area and remove all clothes and place them in a large bucket for disinfection later.
- Wash hands again.
- Take a shower (shampoo hair thoroughly) and get dressed.
- Disinfect contaminated clothes. Soak the outside clothes in the bucket in 0.05-0.1% bleach (clothes will get bleached in the long term) or in 0.1% dettol (clothes will smell of dettol even after the wash) for a few minutes, ideally hours, or soak in washing detergent for a few hours/overnight. Rinse to remove disinfectant (optional). These clothes may now be washed with other household clothes. An alternative to this pre-soaking is to wash contaminated clothes directly in a washing machine using a disinfectant fabric softener, at the highest heat setting. When used this way, contaminated clothes may be washed with other household clothes. Prevent contamination of the washing machine when putting contaminated clothes in. Disinfect the outside of the washing machine if there is any doubt.
- Disinfect door handles and other surfaces you may have touched while entering the house (use alcohol disinfectant/wipe or dettol or detergent. Details below).
- Wash and disinfect outside footwear with soap and/or bleach (details below). Disinfect other items brought from outside. Details below.
- When entering the house after a walk/jog or outdoor exercise or after a drive, where you did not touch anything and where there was no human contact (i.e. no one within 6 feet), strict entry precautions may not be necessary. Change footwear and wash/disinfect hands. Disinfect the door handle.
- If pets exit the house, there may be coronavirus on their skin/fur. Wash with appropriate shampoo on return. Otherwise, dogs and cats do not spread the disease.
- Disinfection of all items brought into the house.
Receive all items in a large plastic box or on a tray; place the box/tray on the ground or another surface; wash hands, and decide which of the following methods is appropriate for disinfection of the item/s received:
- Expose items to sunlight/UV rays for a few (2-4) hours. All dry items and clothes may be disinfected this way. Place on trays or in clear plastic boxes, or hang from a clothesline. Flip the items after 2 hours to expose all surfaces to direct sunlight. Wash hands after flipping. Disinfection with a UV light/bulb is not currently recommended.
- Wash with copious amounts of water. This is appropriate for most vegetables and fruit. For items like loose onions and garlic which may go bad with washing followed by storage, consider these items infected, and store them separately; wash hands after storage.
Wash these items thoroughly immediately before peeling/use.
- Wash with soap/detergent and water. Suitable for sealed plastic bags or other packages like milk cartons which may be sprayed with detergent, rubbed if possible, and washed with water. Place in sunlight for drying or use a clean disposable tissue to dry. Wash hands.
- Chemical Disinfection: alcohol or bleach or dettol or other disinfectant/wipe. Appropriate use of any of these agents will kill coronavirus. Items must stay wet with the disinfectant for appropriate time (follow manufacturer instructions). Ten seconds are generally enough for 70% alcohol based surface disinfectants/wipes, and 1-2 minutes for 0.1% bleach or 0.1% dettol (chloroxylenol). Once disinfected, bleach and dettol may be washed off with water. Dettol may be wiped dry with a disposable wipe/tissue, or left to dry on the surface. Do not use bleach or dettol in fine mist spray when dispensing from a spray bottle, as you may inhale the agents. Ideally wear a mask when using either of these agents. Always wash hands after using bleach, ideally wear gloves. More information on surface disinfection below.
- Store items for 2 weeks. Place in an isolated room, wash hands, tag item/s with the date received. Coronavirus will probably be killed on most dry surfaces in 3 days (paper, cardboard, metals, and possibly on plastic and fabrics i.e. clothes, upholstery, though there are reports of 9 days or longer survival on some surfaces.
- Use heat/oven. Money and other heat stable items (newspaper, bills) may be disinfected in a kitchen oven. Maintain a temperature over 60 deg. C (140F) for 10-15 minutes. Best to maintain temperature around 100 C. Money generally withstands moist and dry heat well (do not take my word for it; try small bills first. Alternatively, send me the money for complete disinfection).
After received items have been disinfected/stored, wash the receiving box/tray with detergent and/or disinfectant. Wash hands.
- Entry of non-household members.
Consider complete restriction of entry to outsiders, including part-time servants working inside and outside the house (e.g. gardner). This is the only way.
Should entry be necessary:
- Follow precautions for household members entry.
- All outsiders should be considered infected, and should wear a mask, wash hands on entry, should avoid touching unnecessary surfaces, and should be kept away from commonly used areas and from household members.
- Items used by the outsider e.g. cups, plates should be collected in a sink (wash hands after collection) or immersed in the bucket of bleach, and cleaned and disinfected all together. Wash with soap and water and disinfect with bleach/dettol for 1-2 minutes.
- Clean and disinfect all the floors and the commonly touched surfaces in rooms/areas the outsider used, ideally 3 hours after departure of the outsider (Coronavirus may stay in the air for 3 hours).
2. Secondary Aim: Minimize Household Risk/Spread.
In case coronavirus has entered the house, minimize risk of infection, and/or minimize the number of viruses that infect a household member.
Rationale and Objectives
Despite our best efforts, the virus may enter the house on the
- clothes, hair, skin, mask, shoes, money, or keys of a household member who went outside, or via
- delivered packages/items, or via
- entry of a non-household member.
- It is possible for a household member to be infected with the virus and not show symptoms for 1-2 weeks. During the first week of infection, the infected person sheds a large number of viruses (1000 times more than the flu virus), and this is the most infective period of COVID-19, during which the patient may feel normal, and infect others unknowingly.
More than half the population is estimated to eventually become infected, thus there is a high chance that sooner or later one of the household members will become infected. Strict adherence to these precautions may prevent spread of disease in the household, or limit the number of viruses that initially infect a household member. With fewer numbers, the progress of the infection may be slower, possibly giving more time for the immune system to respond.
The risk of infection is reduced by:
- Cleaning and disinfection of the commonly used areas and surfaces of the house.
- Washing hands frequently, and before eating, on entering the house, on exiting the bathroom.
- Avoiding unnecessarily touching the face unless hands are clean.
- If there is more than one family in a household, or if there are servants, minimizing contact between subunits of the household may be considered.
Precautions against Household Spread
- Remove all clutter from the commonly used areas in the house. Only daily use items should be placed on tables, shelves and counters.
- Remove carpets/rugs/mats from all daily use areas (bedroom, bathroom, lounge, dining area, kitchen), as floors will need to be disinfected daily.
- Consider removing decoration items, photographs, trophies etc. to facilitate cleaning of tables, counters and surfaces.
- Prepare 2 or 3 disinfectants for cleaning and disinfection on a daily basis, and fill into spray bottles:
- liquid soap/detergent. Great for cleaning as well as disinfection. Dissolved particles of soap and detergent destroy coronavirus. The action is enhanced by rubbing/scrubbing. Liquid soap may be used for cleaning and disinfection of commonly touched and non-commonly touched surfaces, floors, plastic items and bags, bathrooms, hands etc. The surface needs to stay wet and be rubbed, thus takes longer than using disinfectants. All visible contamination on surfaces should be removed with soap, before using other disinfectants.
- 0.1% Dettol (chloroxylenol) or other surface disinfectant non-toxic to human skin e.g. 70% alcohol spray or wipes. These items may be used for disinfection of surfaces touched frequently by human hands, and for disinfection of packages and plastics. Dettol is useful for bathroom disinfection after cleaning, safe on stainless steel, and is non-toxic to human skin (used for cleaning wounds in higher concentration). Is an alternative to soap as well as bleach. It may be left to dry on commonly touched surfaces.
- 0.1% Bleach. Larger quantities of bleach (5-10 lit) may be prepared in a bucket daily, which may be used for filling spray bottles, immersion of items for disinfection (1-2 min), disinfection of bathroom after cleaning, of floors, of garbage, and used later/end of the day for soaking of clothes/masks. Household bleach is around 5%, which may be diluted to 0.1% for coronavirus killing (follow instructions on label). Once diluted, it loses efficiency after 24 hours, thus prepare fresh daily. Wear a mask and gloves when using (ideally). Avoid use on stainless steel and commonly touched surfaces. Has multiple other applications, details below.
Do not mix disinfectants. They work better alone.
- Prepare one (or more) basket for contaminated waste by lining a waste basket with a large garbage bag, so the bag may be folded over the rim and cover the outside of the basket. These baskets will be used for disposal of tissues used for cleaning/disinfection, and for discarding contaminated packaging of received items. When full, spray the waste material inside the basket with bleach, before sealing the garbage bag for disposal. Spray outside of the bag with bleach and leave to dry before disposal.
- Outside the main door of the house (or immediately inside the main door), there should be 1-2 large (clear) plastic boxes/buckets (and/or trays) to receive all items from outside the house. Other items needed at the entrance when receiving items:
- all 3 sprays (soap, bleach, dettol/wipes),
- disposable tissues,
- contaminated waste basket,
- bucket of bleach for immersion of items (optional),
- washable footwear (optional).
- Make a list of commonly touched surfaces in frequently used areas (e.g. kitchen door handle, doorknobs, tabletops, light switches, bathroom fixtures, faucet, sink, toilets, phones, keyboard, tablets) and disinfect multiple times a day.
- Use a disinfectant wipe, or a wet disposable tissue soaked in liquid detergent/soap or disinfectant (dettol). The soap or dettol may be sprayed onto the surface and then spread using a tissue, or sprayed onto the tissue so that it is soaking wet and then applied to the surface. The surface needs to stay wet for a minute. The used tissue should be discarded in the contaminated waste basket. Do not spray any liquid directly onto electronic/electric devices.
- Other surfaces (counters, tables) and floors should be cleaned/disinfected daily.
- Use a damp disposable tissue to clean surfaces, wet with liquid detergent/soap or disinfectant (dettol). The used tissue should be discarded in the contaminated waste basket.
- For floors use a floor/surface disinfectant (follow manufacturer instructions) or bleach or liquid detergent/soap. Spread agent over all the floor (spray will miss small areas). Floor must stay wet with the selected agent for at least 1-2 minutes for disinfection to work. Efficiency of liquid detergent at killing coronavirus on the floor and other surfaces is enhanced by rubbing/mopping/wiping. Ideally all surfaces should be cleaned before applying disinfectant.
- Bathrooms may be disinfected by detergent and/or bleach or other disinfectant. Ideally wash first with detergent, followed by bleach or dettol. Surfaces should stay wet with the selected agent for the recommended time (as above).
- All household members entering the house (from the main door or kitchen/back door, lawn etc) should wash their hands with soap and water.
- If there are subunits of the household (more than one family), each member of the subunit should wash hands when entering or leaving their domain. Consider the use of masks when members leave their respective domain.
- Hands should be washed frequently, before meals, before leaving the toilet, and ideally before touching the face. Hand disinfectants may be used instead of handwashing when hands are basically clean, though it may be best to save hand disinfectants for use outside the house, or when you are inside and have coronavirus anxiety 🙂
3. Tertiary Aim: Be prepared to care for a household member with COVID-19.
- In case a household member gets COVID-19, or if a household member needs to go into isolation, prepare one or two rooms in the house with adequate ventilation (exhaust fans) and easily cleanable surfaces with no clutter.
- If a member of the household shows any features of COVID-19 e.g. cough, fever, throat pain, difficulty breathing, the member should wear a mask and be isolated from the rest of the household. Other household members should be quarantined. Seek medical advice.
- All the above precautions against household spread will be critical if there is a household member in isolation, or with COVID-19.
- In addition to the above precautions, N-95 masks, eye goggles and gown may ideally be worn if the isolation room needs to be entered.
- Ideally the person in isolation should disinfect the room and the bathroom. If the bathroom is shared, complete disinfection of the bathroom using protective gear will be required, before use of the bathroom by another member. Adequate disinfection and disposal of the items used for cleaning and disinfection of the bathroom (ironically) is necessary, alongwith disinfection of the clothes worn by the cleaner, and disinfection of the cleaner (take a shower).
4. Implementation of Precautions
- Decide on the extent to which you want to implement these precautions, and procure supplies.
- When initiating precautions in a large household, consider daily meetings with all members present. Introduce one aim a day. Change is difficult to accept.
- On day 1 discuss what they know about the disease, spread, and prevention. Clear ambiguities. Bust myths. Introduce primary aim. Review handwashing technique, and discuss guidelines for leaving and entering the house and for receiving items.
- On day 2 review day 1 measures, and discuss the rationale for minimizing household risk. Ask them to remove clutter, rugs etc. and make their rooms/areas ready for inspection the next day.
- On day 3, review previous measures, and demonstrate the use of disinfection and cleaning products (spray bottles, disposable tissues, basket for contaminated waste), take a round of their rooms/areas. Recommend changes to facilitate cleaning and disinfection. Identify commonly touched areas. Demonstrate where and how to use each color coded spray bottle. Ask members to make a note of all commonly touched surfaces.
- On day 4 review previous measures, and discuss tertiary aim, and how to recognize signs of the disease and what immediate measures to take in case a member shows features of COVID-19. Discuss other issues like entry of outsiders; receiving, disinfection and storage/handling of items. Hand over all the items needed for infection control and ask them to inform you whenever there is an issue. One member of each subunit of the household (if applicable) may be made responsible for daily precautions in their domain.
- Over the next few days, supervise exit and entry of household members. Order household items online for delivery, and monitor reception and disinfection of the items, and their safe storage. Observe members during their daily cleaning and disinfection of the house, especially after the exit of an outsider. Solve issues; motivate members.
- Have a follow up meeting/s where all measures and protocols may be reviewed. Give feedback and thank household members for their cooperation, and for doing their bit. Motivate them to continue their efforts.
- If possible, stay positive and somehow deal with panic and despair.