11. Mar, 2020

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PRACTICAL ADVICE ON INFECTION CONTROL

INTRODUCTION

I spent 38 years working in the NHS Ambulance Service most of it as a member of an ambulance crew or as an operational manager.

That's 38 years of trying my best to follow Infection Control Procedures to avoid taking infections home to my young family.

That's 38 years of protecting ME from the PATIENTS and.....

38 years of protecting the PATIENTS from ME.

Am I an expert? NO, but I do have practical experience in this field.

MINDSET

It is very difficult to convey all that is needed to be practiced and observed in the space available, but time now seems paramount as the covid-19 coronavirus continues to spread. We cannot rely on Politicians to protect us, not when a Health Minister herself has just been diagnosed with the disease. Nor when they continue to allow flights from heavily infected areas to continue to land in the UK. Nor when the passengers are told, if anything at all, to go home and self-isolate. Yeah right, like they're going to do that aren't they? And even if they did, they have already been infecting people for a whole week before their symptoms showed. That's why the Governments current strategy will fail.

No, we have to face facts. The only people we can trust are ourselves. So how do we do it?

Below I have listed items I would recommend purchasing, and that means buy them NOW before they're all gone. We need to look at this calamity as a war, not just a war against the virus itself, but against something just as dangerous - our fellow citizens. These people I have collectively named 'Wayne and Waynetta Slob', it's not meant to be a class thing, though I suppose it would be true to say that those  on low income will be less likely to be able to afford to buy items which could protect themselves - and us. No, these are the people who through ignorance, selfishness, thoughtlessness or just plain old fashioned stupidity pose a risk to us all, and every time you step out your front door you'll be surrounded by them.

What makes things more complicated for us all is that individuals can have contracted, and be infectious, for up to seven days before showing the symptoms of infection. That means that even the most conscientious among us will have unwittingly been infecting others for a whole week before self isolating.

So I want you to think of everybody out there as Wayne & Waynetta Slob, who threaten your wellbeing maybe without even realising it.

In order for you to have the best chance to avoid catching this virus I want you imagine that your hands have been placed palms-down on to wet sticky red paint, and it will remain wet and sticky the whole time you're out of the house. Now imagine that's the infected matter. Once you have that image in your head then it becomes much easier to understand how it can spread with what you touch, what needs to be avoided, and what needs to be cleaned as you transfer the sticky red paint from one thing to another.

Now imagine every time others exhale you see a bright red mist - that's their potentially infected droplets. The velocity it leaves their body will be greatly increased by coughing or sneezing. Hence the need to keep your distance.

Also, think of contaminated items as the virus's equivelant of Heathrow Airport. It's not where they want to be, but they'll use it to get to their intended destination, in this case your eyes, nose, mouth and ultimately your lungs.

But above all DON'T BE AFRAID - be resilient.

LINKS TO INFECTION CONTROL PRODUCTS

ISOPROYL RUBBING ALCOHOL

https://www.amazon.co.uk/gp/product/B007ECG29U/ref=ppx_yo_dt_b_asin_title_o03_s00?ie=UTF8&psc=1

I bought three of these to bring away with us. Isoproyl Rubbing Alcohol is better known as Surgical Spirit in the UK

CLINELL UNIVERSAL DISINFECTANT WIPES

These are used throughout the NHS. We are carrying a couple of packs with us. The wipes are plastic based so don't dispose of them down toilets.

https://www.amazon.co.uk/gp/product/B00BKX0RSQ/ref=ppx_yo_dt_b_asin_title_o04_s00?ie=UTF8&psc=1

DIGITAL MEDICAL THERMOMETER

https://www.amazon.co.uk/gp/product/B000LZ0Y82/ref=ppx_yo_dt_b_asin_title_o06_s00?ie=UTF8&psc=1

Useful to have but by no means essential - you'll know when you're getting hot!

MEDICAL FACE MASKS

https://www.amazon.co.uk/gp/product/B009PPMVGC/ref=ppx_yo_dt_b_asin_title_o01_s00?ie=UTF8&psc=1

I do not recommend paper face masks. They are designed to be used in hospitals and worn for short periods of time such as a nurse putting one on to go in to a room to carry out a procedure on a patients before leaving the room and disposing of it. Once these masks become damp from exhaled air they are worthless as the virus can then pass through it. Wearing these in public just makes people feel safer. Though in fairness it must be recognised that should a person wearing one suddenly cough our sneeze, the projection of their infected droplets will be contained. Though they would then need to change the mask immeadiately.

 

LATEX FREE EXAMINATION GLOVES

https://www.amazon.co.uk/gp/product/B06XPFFNL7/ref=ppx_yo_dt_b_asin_title_o06_s00?ie=UTF8&psc=1

When I first joined the Ambulance Service back in 1976 the wearing of rubber gloves was unheard of, you wouldn't believe what we had to put our hands in to but we were protected by a strict code of infection control including thorough hand washing. However thankfully times move on and in the current climate these gloves are in my view essential. They come in different sizes, if in doubt buy them too big, better that way than too small. As a guide my hand size is seven and I take a 'large' size. As a guide, a man's glove size is the size of his Willie measured in inches and divided by two (yeah - I wish!)

AUTOSMART G101 CLEANER

https://www.amazon.co.uk/Autosmart-Multi-Purpose-Cleaner-Official/dp/B07QQ4X6MJ/ref=sr_1_2?crid=ADXKBDOGDSRX&keywords=g101+multi+purpose+cleaner&qid=1583680900&sprefix=g101%2Caps%2C264&sr=8-2

Between 2003 & 2008, in my final role as a career within the Ambulance Service, I was tasked with doing all of the legwork, research and writing of Standard Operating Procedures (SOP's) to introduce a 'Quality Assured' system of ambulance cleaning and equipment preparation. G101 is one of the cleaning products we used. I asked the rep if G101 killed MRSA and he said he didn't know, but they worked with a team of chemists in the Midlands and he'd put the question to them. About two weeks later he came back to inform me that the chemists had grown MRSA cultures in the lab and G101 killed it effectively at what was then its current dilution rate of one-to-forty (it looks as if it's now one-to-thirty). To be fair we often used it neat, but when I regularly took swabs to check the systems effectiveness not a thing had survived on any of the ambulance interior surfaces (not surprisingly the main areas of contamination were hand and grab rails, the side handles on the stretcher trolleys, cupboard handles and the floors - remember that the next time you see a brat kid stood or sat in the main section of a supermarket trolley being pushed by Wayne or Waynetta).

This is what I would be buying if I were back in the UK right now. In fact I now regret not having bought a five-litre container to bring with us. I would recommend having one spray container of neat G101 for stubborn jobs and one spray bottle with a one-to-twenty solution in it.

Search 'G101' on Amazon UK and you will find there are cheaper versions of the product than the one we used.

I would describe this product as a slightly corrosive detergent, so wear gloves and a face mask or cover your nose and mouth whilst spraying it in a fine mist.

MILTON STERILISING SOLUTION

https://www.amazon.co.uk/Milton-Disinfecting-Liquid-5-Litres/dp/B015Y1QYEK/ref=sr_1_3?crid=29R5VPP1DYRZ9&keywords=milton+solution&qid=1583681281&sprefix=milton+solution%2Caps%2C246&sr=8-3

This is a very mild bleach solution, suitable for overnight soaking of baby bottles etc, but not strong enough to do any real harm which probably explains why teats soaked in them turn a much lighter colour over time. A good general purpose cleaner and if I didn't have G101 I'd be using this as a general purpose cleaner. I would also use it to soak my home made face masks in overnight.

Wilco's produce a much cheaper version of 'Milton' - Sterilising Fluid.

WILKINSON'S (Wilco's) WIPES

https://www.wilko.com/en-uk/home/household/cleaning-products/c/405?q=%3Arelevance%3Atype%3AWipes

This link will take you to a page on Wilco's website showing various brands of sanitising wipes - take your pick. Really useful to have with you when in a public place, in the office for wiping phones, computer keyboards etc and as a general wipe around the house.

ALCOHOL SOAP (SANITISER)

https://www.amazon.co.uk/s?k=alcohol+soap+hand+wash&crid=21L7VXMPZQHHS&sprefix=alcohol+soap%2Caps%2C286&ref=nb_sb_ss_i_3_12

Really good stuff to have available when in public places. Don't run off with the idea it's the answer to all your problems - it isn't. Firstly it needs to be used on clean hands, otherwise the dirt will act as a barrier between your skin and the soap. As managers we used to tell the Paramedics they should only use the soap for up to about eight times before washing their hands with traditional soap and water.

FACE MASKS

https://www.amazon.co.uk/Pack-Surgical-Performance-Breathing-Protection/dp/B084WX4Z1J/ref=sr_1_28?crid=137P42PUADTSF&keywords=face+masks+medical+virus&qid=1583684285&sprefix=face+masks%2Caps%2C254&sr=8-28

Yesterday these were available - today they are not. I have a horrible feeling that as these products come back in to stock the price will go up dramatically. See my suggestion for home made masks.

TRAVIS PERKINS FACE MASK

https://www.travisperkins.co.uk/respirators-and-dust-masks/4trade-cup-respirator-with-valve-mask/p/551611

This is where I bought my cloth face masks from, though not this exact mask, as that  is no longer available. My intention, should I need to use our cloth masks is to soak them in a Milton solution overnight, rinse them well, allow to dry naturaly, then use them again (we have about 10 onboard), or back home I'd probably give the exterior surface a light spray with G101 and allow them to dry in natural light.

ANTI VIRUS HAT & FACE PROTECTION

https://www.amazon.co.uk/ZAVAREA-Protective-Fishermans-Anti-Saliva-Transparent/dp/B084SB6JVC/ref=sr_1_61?crid=137P42PUADTSF&dchild=1&keywords=face+masks+medical+virus&qid=1583684569&sprefix=face+masks%2Caps%2C254&sr=8-61

I found these online a couple of days ago and I like them - a lot. They fulfil two needs - to cover the head (ever noticed how dirty your hair is when you wash it after a day in the city?), and provides protection to the mouth and nose - go buy these quickly before they run out. You may not need to wear them until things get pretty serious.

DISPOSABLE SHOE COVERS

https://www.amazon.co.uk/gp/product/B079SGHXMT/ref=ppx_yo_dt_b_asin_title_o01_s00?ie=UTF8&psc=1

We happen to have two packs of these onboard with the intension of using them on our shoes should we pull up at a particularly oily fuel pump. That way the motorhome carpet doesn't get contaminated. The added bonus now is that they can be used to cover the head should the risk increase.

SNAP HOOKS OR CARIBINERS

https://www.amazon.co.uk/Am-Tech-Snap-Hook-Set-Pieces/dp/B0030EBCHS/ref=sr_1_10?crid=3B88G0MEW3PDW&keywords=carabiners+and+clip+hooks&qid=1583759792&sprefix=caribiners%2Caps%2C300&sr=8-10

To reduce contamination of your hands and personal items it is important to have easy access to your alcohol soap. This can be achieved as follows:

  1. Take one bottle of alcohol soap and unscrew  its lid.

  2. Tie a short length of nylon string tightly around the top of the bottle.

  3. Burn the end of the nylon string with a lighter to stop it fraying.

  4. Replace the screw top tightly.

  5. Tie the other end of the nylon string to a snap hook or caribiners and burn that end with a lighter also Distance between the bottle and the clip need only be about two inches.

  6. Clip to your belt and dispense soap without removing it from the belt.

TOUCHSCREEN PENS

https://www.amazon.co.uk/gp/product/B00EZ08MAQ/ref=ppx_yo_dt_b_asin_title_o04_s00?ie=UTF8&psc=1

https://www.amazon.co.uk/gp/product/B071VG7C61/ref=ppx_yo_dt_b_asin_title_o05_s00?ie=UTF8&psc=1

The Chef carries the smaller one in her bag for using on ATM keypads as well as shop card readers. After using on the screens just dab a tiny amount of sanitizer on to the palm of your hand and clean the tip of the pen in it. If such pens are not available use the end of a biro pen. Whatever you use clean it immediately afterwards.

 

So as well as items from the list above you may also need to buy:

A ball of nylon string

A good length of elastic or cotton tape ( for the DIY masks)

A small roll of thin plastic (usually green coloured) covered steel wire from the gardening section of a store or a Garden centre (to use a short length within the DIY masks which will bend and allow the mask to fit around the nose. If you can find something better to do the just use it)

Re-sealable clear plastic bags - very important. These are the clear bags which can be sealed at the top by pressing the two edges together along the top (various uses including carrying one in the Infection Control Kit in which wet contaminated tissues can be isolated until disposal).

Dettol disinfectant (to wipe sufaces neat or dilute down and use use as a spray). 'Savers' sell a much cheaper alternative - 'Antiseptic Disinfectant', it's less that a pound a bottle and it's what we use.

 

CHEAPER ALTERNATIVES TO ABOVE

Don't underestimate the effectiveness of plain soap or detergent and water, a nail brush and sunshine (ultraviolet light).

Bars of hard soap are a very efficient way to buy soap. Remember to buy plastic soap dishes to go with them.

MAKE YOUR OWN FACE MASKS

Use a COTTON sheet, ideally a white one (buy a cheapie from somewhere like Wilkinson's (Wilco's) or go hunting in your airing cupboard).

Use sheets of A4 paper or newspaper as templates to mark out the oblongish shapes, as there will be different size needs for different members of the family.

Cut out the pieces of mask and place about 3 layers on top of each other, this will make it multi-layer (experiment with the number of layers prior to sewing them together).

To provide a means of shaping the mask around the nose sew in between the layers one piece of something like the green plastic covered thin steel wire you find in garden centres right at the top of the mask. Failing that maybe use those large paper clips about three inches long hich can be straightened out for use. If you can think of something else that will do the job better - go for it.

Sew the layers together.

Sew elastic strips to the top and bottom of the masks, the length being dependant on the size of the user and whether or not they are to be worn with two straps over the head or two over the ears.

To save money it is envisaged that these masks could be used a number of times, and as the elastic won't like boiling water or an overnight soak in a solution of 'Milton' consider using lengths of white cotton tape cut to length so that they can be tied behind the head in a bow.

Make about five for each member of the family ( one to wear, two to take as replacements and two back at home still drying)

Mark each mask with the initial or name of the person it was made for.

Soak cotton masks overnight in Milton solution or detergent, rinse thoroughly under running water, then allow to dry naturally outside in sunshine and fresh air. Alternately place them in to a container with a lid. Bring the water to the boil and then turn off the heat and allow to cool. Rinse well and dry naturaly

SANITISING SOAP

Make your own using Surgical Spirit and ordinary hand soap at a ratio of seven parts spirit to three parts soap. Decant this it to small containers.

or:

Carry a small plastic bottle with ordinary liquid hand soap in it and an all-plastic nail brush. This will ensure you will always have the means to clean your hands. Wipe your hands dry with a paper tissue or let them dry naturally.

TOILET PAPER

Why people are rushing out to buy and hoard toilet paper I do not know, after all this virus doesn't give you the trots.

Years ago when times were hard folk would use newspaper and I suggest you make preparations now to drop back to this should the need arise.

Start saving your old newspaper now (The Sun & Daily Mirror are made for it!).

If the newspapers have to be used cut the pages in to four. Make a small pile of them then make a hole in one corner through which you thread some string. This will keep it all together and provide a means to hang it somewhere should you wish.

Those who are morbidly obese may wish to use half pages of the Daily Telegraph - they should be big enough to cover the job.

This could earn you a 'Blue Peter' badge.

(I do not recommend putting the newspaper down the toilet as it could cause a blockage. Use a small bin like the skanky Greeks then dispose of in the dustbin).

 

HANDKERCHIEFS OR PAPER TISSUES?

I tend to disagree with the official advice of using disposable paper tissues. It is being suggested that you quite simply pull out a paper tissue, have a lovely old cough or sneeze in to it and then dispose of it. Well I'm afraid reality is not that simple. Let's look at it step by step.

PAPER TISSUES

You carry tissues with you - but where do you keep them?

If they're in a nice little pack then how quickly can you get one out to use?

To save time, do you just stick a couple in your pocket just in case?

When you need it in a hurry, will you need to pull it out, then unfold it before it's ready?

Where are you going to keep the tissue until you can find a bin? Chances are there won't be one right next to you.

Do a dummy run. Put your tissues in the normal place you keep them on your person. Then get a friend to shout something like 'SNEEZE' when you're not quite expecting it. See how quickly you can get your tissue out and use it for its intended purpose.

If you can pull it off then well done - audition as a gunslinger in a Hollywood Western.

If you weren't quick enough then you could have contaminated everybody within a six-foot radius. If you were quick enough then you now have a wet tissue and a damp hand loaded with 'Sticky Wet Paint'.

Carry a re-sealable clear plastic bag with you so that you can put each used paper tissue in it for disposal at the first available bin, though only tip the bag out, don't throw it away as you may still need it, plus it can be decontaminated, dried and used again. Remove the 'Sticky Wet Paint' immediately with sanitiser.

COTTON HANDKERCHIEF

My preferred option. I feel at a loss if I don't have a clean handkerchief in my pocket each and every day. I do understand that some will say that they are not as hygienic as disposable tissues, and in normal circumstances I would agree. But we're entering unusual circumstances, and I bet you could pull a cotton hankie from your pocket and use it far quicker and easier than you could a paper tissue. And that's the point.

Clean hands with sanitiser after each use.

Carry more than one hankie if you need to.

There will be some contamination but it will be less and the hankies can be taken home for a soak in 'Milton'.

To wash them place the hankies in a pan with a lid. Add water and then bring it to the boil. Once the water has reached that temperature, turn off he heat and allow to cool. Remove the hankies and then launder in the usual way.

If I've failed to convince you of the merits of using cotton handkerchiefs then at least consider carrying sheets of thicker, larger kitchen towel individually folded up in your left pocket so that you can pull one out at a time and use with your right hand.

MAKE A 'MILTON' STERILISING SOLUTION

 Bottles of plain ordinary bleach should still be plentiful. The supermarket own brands are the cheapest. You don't need anything fancy.

In a pint of cold water add about 6-8 drops of bleach then stir (do some research on the amount to add, but that would be my first best guess). Use an eye dropper which should be vailable from chemists. This solution will be single use due to it being weak. 

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20-12-20

UPDATE:

Following research done by Cambridge University who tested items commonly found around the house to use as effective filters I have now created more effective masks which can be used during the current increase in the infection rate.

The masks are made by Tilley, who are famous for their hats. the masks is double layers creating a pouch in to which a filetr can be added.

The research found that Hepa filters as used in 'Henry' vacuum cleaners were very effective. Buy the bags and cut them to size and shape to slide in to the mask. It's a little harder to breath through but feels more effective. To avoid replacing the filter after each use, air them in the sunshine or sanitise them with a small UV light available through Amazon UK.

FACE MASK:

 https://www.surfdome.com/Tilley-100%25-Cotton-2-Pack-Face-Mask/sd50198589.htm

(Lakeland Ltd are also now selling this type of mask, and i'm sure there are others)

HENRY FILTERS:

ttps://www.amazon.co.uk/Henry-NVM-1CH-907076-HepaFlo-Vacuum/dp/B079NKN5TG/ref=sr_1_15?crid=27EWOARWHQ177&dchild=1&keywords=hepa%2Bfilter%2Bbags%2Bfor%2Bvacuum%2Bcleaner&qid=1608456452&sprefix=hepa%2Bfilter%2Bbags%2Caps%2C180&sr=8-15&th=1

When out in public I also now carry a hand sanitiser on a retractable cord which is clipped to my belt or coat pocket

SANITISER:

https://www.amazon.co.uk/gp/product/B004VNWHKS/ref=ppx_yo_dt_b_asin_title_o01_s00?ie=UTF8&psc=1

RETRACTABLE BELT CLIP:

https://www.amazon.co.uk/gp/product/B07FLSNTXQ/ref=ppx_yo_dt_b_asin_title_o08_s00?ie=UTF8&psc=1

On the other side of my belt I carry a gizmo for opening doors and pressing keys. It is also attached to a retractable belt clip, a stronger one this time. By using these I am reducing still further the risk of my touching infected surfaces.

DOOR OPENING TOOL:

https://www.amazon.co.uk/gp/product/B08BXJ843P/ref=ppx_yo_dt_b_asin_title_o01_s00?ie=UTF8&psc=1

RETRACTABLE KEY CHAIN:

https://www.amazon.co.uk/gp/product/B07CL3TM3K/ref=ppx_yo_dt_b_asin_title_o07_s00?ie=UTF8&psc=1

PORTABLE UV LAMP

I've built a cupboard in the garage at home, lined it with cooking foil and put a Uv lamp in it. This can be used to discinfect clothing, food shopping, face masks etc should we wish. The lamp is powerful enough to decontaminate a room, so a cupboard is no trouble.

For the motorhome I've just bought a small rechargable UV lamp and I'm impressed with it. You can smell the ozone witin a minute of it being turned on. This will travel with us to use as and when we feel it is appropriate

 

https://www.amazon.co.uk/gp/product/B08HM29DVQ/ref=ppx_yo_dt_b_asin_title_o00_s00?ie=UTF8&psc=1

 

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MAKE UP AN INFECTION CONTROL KIT

I would suggest you wear a bum bag in to which you place:

  • A small pack of sanitising wipes (wet wipes), or decant some from a large pack carried in a re-sealable plastic bag to keep them moist.

  • An all-plastic nail brush, don't use one with a wooden handle.

  • Alcohol soap, or if not available then ordinary liquid soap used with the nail brush.

  • Two packs of disposable tissues

  • Face masks, up to five.

  • Two re-sealable plastic bags, one to place used paper tissues in and one for used face masks.

  • A re-sealable bag with some latex free rubber gloves in.

  • + Anything else you would feel happier having with you - it's your kit after all.