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.
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.
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.
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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