STAYING SAFE IN TIMES OF COVID-19

Dr. Adithya Bharadwaj spells out the standard protocols to be followed by doctors, hospital staff and patients in clinics and hospitals in the wake of the life-threatening pandemic.

The world today is grappling with Covid-19, an unprecedented corona virus disease that is raging across continents, sowing structural havoc and affecting millions wherever it has struck, crippling health care systems and destroying economies. Basically, Covid-19 is a respiratory illness caused by a novel corona virus, presently called SARS-CoV-2.

The first case in India was reported from Thrissur in Kerala on 30th January 2020. The patient was studying in Wuhan University in China and had recently returned to India.

The number has now shot up to nearly 3 lakhs and is rising by the hour. Although a large number of clinical trials are under way, a curative treatment strategy and a definitive preventive vaccine remain elusive to date. As of now, personal hygiene, respiratory etiquette and social distancing have remained the most widely accepted strategies for controlling and mitigating this highly contagious virus.

The major control measures adopted have been the imposition of a total lockdown on human activities, to try and prevent people socialising and interacting by introducing social distancing norms such as working from homes, closure of educational institutions, cinema halls, malls, etc. This strategy has the potential to delay the disease spreading and reducing the number of those affected by the epidemic, thereby providing the health care systems time to respond and innovate, helping to eventually to control the disease from spreading further.

Need to rethink strategies

Now that we are in the phase of unlocking or easing the lockdown measures, we need to rethink our strategies and focus on how health care professionals can operate unhindered. They are the frontline soldiers fighting this pandemic and have their limitations as they have been encountering a plethora of problems, and run the high risk of exposure and contagion. We have seen a large percentage of health care workers being afflicted, and there have even been a number of deaths from among them worldwide.

There is also enough evidence to suggest that asymptomatic people can also transmit SARS-CoV-2 to close contacts, especially health care workers. Hence, it is prudent to consider every person visiting a health care facility as a potential carrier of this virus. This mandates health care providers taking appropriate precautions to protect themselves, their staff, as well as those unsuspecting patients visiting their clinics or hospitals. It is hence advisable that every health care practitioner acquires a detailed knowledge of all procedures to be followed in a clinic or hospital for safety and protection against this highly contagious virus.

Measures to be taken in out-patient clinics

  • For most minor ailments, prefer teleconsultation to direct contact. In fact, encourage this practice among all patients, especially those at high risk like the elderly, those afflicted with chronic lung diseases, hypertension, diabetes, kidney disease, cardiovascular diseases, etc. Patients should be discouraged from undertaking routine visits for simple follow-up. Cut down all online automated appointments. Appointments should be encouraged only through telephonic contact, and every patient should come to the OPD only with prior appointment. While giving an appointment, the medical officer or qualified trained staff concerned, should enquire about a patient’s history of travel (in the recent past), of contact with any Covid-19 suspect patient, the presence of any kind of influenza-like illnesses or fever, cough, cold, throat pain, abdominal pain, diarrhea, breathlessness, or loss of smell and taste. If any of these is confirmed, then that patient should immediately be redirected to the nearest government-approved Covid-19 centre for diagnosis and testing. The name, contact number and address of these patients should be noted and the respective health authorities informed as per the guidelines. Patients should be encouraged to send soft copies of their medical reports and all related documents through email or WhatsApp to prevent health care professionals having to touch them.
  • At the entrance of every entry point, adequately trained staff should be deployed. They should check the temperature of all individuals passing through, keeping the statutory 2-3 feet distance, and ensure that everyone entering the premises wears a facemask. There should be an administered standard screening questionnaire to the record symptoms and travel history of the patient who should be accompanied by just one attendant. Both the patients and those attending to them must wear masks throughout their stay at the health care centre. An alcohol-based sanitizer must be placed at the point of entry for those who enter the clinic to sanitize their hands. To prevent contamination of door handles, if possible a staff should be deputed at the entrance to open the doors for those entering and exiting. Also, such high-touch areas should be sanitized and disinfected frequently. At the Reception area all windows and doors must be kept open; also, ensure maximum cross ventilation. It is important to strictly monitor the entrance and other areas to ensure hand hygiene, respiratory hygiene and cough etiquette of both patients and health care workers. In clinics and hospitals, social distancing must be maintained at all times. Two people must stay at a distance of a minimum 2-3 feet. Patients should be allowed to sit only on cleanable hard surfaces with places distinctly demarcated in the Reception area as well as in the Parking area. If the waiting area is small, allow only 1 or 2 patients at a time. Other patients must be instructed to wait in their cars or in the Parking area outside the clinic. Once a patient leaves the hospital/clinic, the place should be immediately disinfected with 1% sodium hypochlorite. All the staff members should ideally wear three-layered surgical masks, or N95 masks. They should wear gloves and aprons, and should minimize physical contact with the patients.
  • When a patient is finally allowed entry into the Consultation room, the patient and the doctor should maintain at least 6-feet distance between them. Recording the history – of travel or exposure to Covid-19 – of the patient should be done meticulously. Examination should be brief and to the point, and osculation should only be done if essential, thereby shortening the examination period to less than 5 minutes. The stethoscope should be cleaned after every use. If the patient was made to sit on a footstool, it should be cleaned thoroughly after he/she leaves. The surface of the table should be cleaned regularly with disinfectant. It is advisable not to touch the files or documents brought by the patients. As much as possible, patients must be encouraged to send soft copies of previous reports and prescriptions. It is also advisable to maintain electronic medical records with the facility for transferring prescriptions directly to the pharmacy. Consultation fee should be collected via electronic transfer. If cash is being collected at the Reception or by the Accounts Department, it should be kept in a separate plastic bag, and should be handled only after 3-4 days. The staff should clean their hands with sanitizer after every transaction.

    Dos and don’ts for pharmacists

    Pharmacists should wear triple-layered surgical masks or N95 masks. The no-touch principle should be encouraged while dispensing medicines, which should be placed in proper bags, labelled and with clear instructions written on them. These medicine bags should be kept on the counter or the dispensing window with glass partition for patients to pick up. Payment, again, should be preferred to be done via electronic transfer. In the Lab, only one patient (wearing a mask) should be allowed at a time. The staff should wear N95 masks or three-layered surgical masks, face shields, gloves and aprons, and should strictly adhere to social distancing and hygiene norms while collecting blood. The reports should be send via email or WhatsApp. Charges should be collected via electronic transfer. The most important and often overlooked point is about disinfection and disposal of bio-medical waste. High-touch surfaces like wall tiles, reception seating areas, footstools, tables, door knobs and handles, stair rails, door frame, bed frame, etc., should be cleaned with sodium hypochlorite solution (1%) for 30 minutes at least 3 times a day. Standard guidelines should be followed in disposing bio-medical waste, and all used disposable materials should be collected in a plastic bag and disposed accordingly.

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