Post Lockdown Lifting: Resumption of Hospital Services

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Salient features:

This article focuses on

  • Section A: hospital space
  • Universal precautions in Corona Times “The new normal” for Staff, patients and attendants 
  • Infection Prevention protocols including biomedical waste (BMW) management
  • Depiction of Visitor flow in a hospital system before and after triaging
  • Section B Hospital system – Resumption of Hospital services with department wise precautions 
  • Guidelines for General areas in a hospital including laboratory services
  • Guidelines for Special situations (aerosol generating and non- aerosol generating procedure)
  • Guidelines for Home health ,elderly care and teleconsultation
  • Measures to guide handling of dead patients
  • Action to be taken on detection of COVID -19 case in non-COVID health facility
  • Section C : Hospital supplies
  • Guidelines on rational use of PPE
  • Guidelines on Reuse of PPE 
  • Section D : Hospital Staff
  • Ensuring safety and protection of HCWs including mental health needs
  • Interim Operational Considerations for Public Health Management of Healthcare Workers Exposed to or Infected with COVID-19

DETAILED SUMMARY:

SECTION A: HOSPITAL SPACE

  • Key issue : Paramount importance in health care centers would be allocation of appropriate and adequate space to patients and to reduce transmission.

Universal precautions – Staff, patients and attendants (Corona Times– the new normal)

  •  Only one entry for patients:

– There should be a separate entry for staffs

 – Patients and visitors should be screened for symptoms of acute respiratory illness (e.g., fever, cough, difficulty in breathing) before entering healthcare facility. 

– Retina scan should be encouraged for staff attendance instead of Biometric and attendance registers

– Gate passes should be provided for any deliverable item/equipment received by the hospital

– Cleaning of the surface of the item/equipment should be ensured before they reach the end user.

– Personal Couriers/Parcels to be discouraged.

  1.  Ensure all patients, staff and others are thermal screened at all points of entry

– Screening and triage area should be set up before entry to main area of hospital.

– IR thermometers should be ensured at hospital entry.

– Printed checklists should be available for symptom questionnaire at hospital entry.

  1. Ensuring Testing of all suspects

– An area should be designated for fever clinic / care of COVID-19 patients

– Patients with COVID symptoms should be directed to Fever clinic.

– If dedicated flu clinic is not established, separate the patients with respiratory symptoms so that they are not waiting among other patients seeking care. Identify a separate, well-ventilated space that allows waiting patients and visitors to be separated.

  1. Ensure all patients, staff and others wear mask before entering the hospital. It is advisable to make masks and hand sanitizers available at the hospital entrance. 
  2.  All staff members and visitors should have Aarogya Setu app for Contact tracing. Self-reporting of symptoms and location for patients, staff and others should be encouraged.
  3.  Ensure social distancing

– Marking should be done in in all common areas including lifts. (keeping minimum 3 feet distance)

– Queue management rules should be followed.

– No overcrowding of places within the hospital

– Patients are recommended to take stairs or wait for the next lift.

  1. Visual alerts (signs, posters, digital) at all strategic places providing instruction on hand hygiene, respiratory hygiene, wearing mask and cough etiquette.
  2.  Disinfection and cleaning

– Proper disinfection of the concerned area should be carried out periodically.

– Sanitizing hand rub dispensers and hand wash with soap and water should be provided in prominent places.

– Regular check on stock of disinfectants, tissues, liquid soaps, thermal scanner, masks, gloves & PPE should be ensured and monitored.

– Public areas, toilets and high touch points should be cleaned and disinfected once in 2 hours using standard disinfectants. 

– Work space, corners, lifts, staircase handles, door knobs, chair handles, electrical switch points, wash rooms etc. should be cleaned and disinfected.

– All double doors should be kept open to prevent touching doors or knobs.

– Closed dustbins (pedal push type) are kept in all lunch areas and washrooms.

– Cleaning frequency to be increased at all public areas (example washrooms, waiting areas, cafeterias, etc.)

  1. Adequate supply of Personal protective equipment (PPE) and hand sanitizers should be ensured. Rational use policy of PPE should be in place.
  2. Follow strict treatment protocols

– Treat – According to the severity, hospitalize only those requiring in-house care.

– Isolation of COVID-19 cases should be ensured.

– Quarantine should be ensured for contacts and mild cases

– Consent from every patient whether IPD or OPD Annexure 1.

– COVID patients should be seggregated from the patients needing routine care.

– Tele/Video Consultations, Online trainings, Video Counselling etc. should be promoted for routine patients. 

Infection Prevention protocols including BMW management– All areas of hospital 

General areas in hospital:

  • General clinical areas- Floors

Procedure: 

  • Surface dust should be sweeped with dust mop or damp mop. Gathered dust should be removed using a hearth brush and shovel
  • Sweep tools should be cleaned or replaced after use.
  • Cleaning solution should be prepared with detergent and warm water.
  • A three-bucket technique ( one with plain water, one with detergent solutiona nd one with sodium hypochlorite (1%) ) should be used for mopping the floors.
  • If the solution gets dirty in between moppin, it should be changed.
  • Mopping should be done twice a day
  • Mopping should be started at the far corner of the room and work towards the door.
  • Ceiling and walls

Procedure :

  • Damp dusting with long handled tool for the walls and ceiling done with very little moisture just enough to collect dust.
  • Damp dusting should be done in straight lines that overlap one another.
  • Change the mop head/cover when soiled.
  • The mop should be cleaned with hot water and detergent solution and then disinfected with sodium hypochlorite and then kept for drying upside down.
  • Doors and door knobs:

Procedure: 

  • The doors should be washed with a brush, using detergent and water once a week.
  • Door knobs and other frequently touched surfaces should be cleaned daily
  • Isolation room:

Procedure 

  • Liaise with the infection control team for details of any special requirements. 
  • Safety uniform should be worn
  • Chemicals and disinfectants should be used.
  • If the bed screen and shower screen have to be changed, refer to cleaning in isolation rooms.
  • Wait for 15 mts prior to entering room, post patient discharge. Keep the room vacant post terminal cleaning for 30mts before allotment.
  • All clinical areas/laboratories/wherever spill care is required:

Procedure: 

  • Non-sterile gloves should be worn
  • For large spills, cover with absorbent paper/ rag pieces.
  • Use a pair of gloves and forceps to carefully retrieve pieces of broken glasses or sharps.
  • Cover the spill with 1% sodium hypochlorite for 10-20 minutes contact time.
  • Clean up spill and discard into infectious waste bin and the area should be mopped with soap and hot water.
  • Stethoscope:

Procedure: 

  • Should be cleaned with detergent and water.
  • It should be wiped with an alcohol based rub/spirit swab before each patient contact.
  • BP cuffs and covers

Procedure: 

  • Cuffs should be wiped with alcohol based disinfectant and regular laundering is recommended for the cover.
  • Thermometer :

Procedure: 

  • It should be stored inverted in a dry individual holder.
  • Clean with detergent and tepid water and wipe with alcohol rub in between patient use.
  • One thermometer should be used for one patient.
  • Injection and dressing trolley:

Procedure :

  • Should be cleaned daily with detergent and water
  • After each use, wipe with disinfectant.
  •  Refrigerators 

Procedure :

  • The fridge should be emptied and things should be stored appropriately
  • Defrost, decontaminate and clean with detergent.
  • Dry it properly and replace things.
  • Weekly cleaning is recommended.

In- patient rooms

  • General cleaning:

Procedure: 

  • The floors should be scrubbed with hot water and detergent and allowed to dry.
  • Cleaning should be done twice a day
  • Mopping should be done with 1% sodium hypochlorite.
  • Lockers, tables, cupboard, wardrobes, benches, shelves and cots

Procedure: 

  • Damp dusting should be done with warm water and detergent
  • Railings :

Procedure :

  • Damp dusting should be done with warm water and detergent followed by disinfection with hypochlorite.
  • Mirrors and glass

Procedure: 

  • Wipe mirror and surroundings with warm water and a small quantity of detergent using a damp cloth followed by dry lint-free cloth, buff mirror and glass to a clean dry finish.
  • Sluice room

Procedure :

  • Sinks should be cleaned with powder cleaner. 
  • Powder cleaner should not be used on dry sink.
  • After removing spillage and any stains, flush away with running water. Wipe down the surface of the sink.
  • Pantry furniture 

Procedure :

  • Damp dusting should be done.
  • Telephone: 

Procedure: 

  • Damp dusting should be done with warm water and detergent
  • The ear and mouthpiece should be dried properly
  • Desks 

Procedure :

  • Top, sides and handles should be wiped with a damp cloth. Wooden desks should be cleaned with furniture polish and buffed to clear glows.
  • Chairs 

Procedure :

  • Chairs should be wiped with water and detergent. Any masks under the seat should be removed.
  •  Furniture and fittings

Procedure: 

  • All the furniture and fittings should be damp dusted using water and detergent.
  1. Bed tables, bedside lockers

Procedure :

  • Bed table should be wiped with water and detergent and then completed after it drys.
  • The marks from the front of draws and sides should be wiped and washed to remove any sticky marks
  •  Light switches and over-bed lights

Procedures :

  • Light switches should be cleaned of dust, spots and finger marks.
  • Over bed lights should be damp dusted and cleaned with water and detergent.
  1.  Curtains 

Procedure:

  • Curtains should be cleaned with water and soap
  •  White clothes 

Procedure:

  • Should be washed under running water and soaked in 1% sodium hypochlorite for 20 minutes
  • Mattress and pillow covers

Procedure: 

  • Mattress and pillow covers should be covered with reusable mattress cover.
  • Should be changed for each patient and when soiled should be sent to laundry
  •  Mattress or pillow  with rexin covers

Procedure: 

  • Should be cleaned with 1% sodium hypochlorite before use for next patient.
  • Dry it in bright sunlight for 1-2 days before next patient.
  1.  Water jars

Procedure: 

  • For drinking boiled water is recommended
  • Water jars should be scrubbed / cleaned with soap and water and boiled water before filled with water.

Cleaning of toilets 

  • Toilet pot/ commode:

Procedure:

  • Inside of the toilet pot should be scrubbed with 1% sodium hypochlorite solution and recommended agents and a long angular brush.
  • Outside should be cleaned with a nylon scrubber.
  • Lid 

Procedure: 

  • Wet and scrub with soap powder and nylon scrubber inside and outside.
  • Toilet floor 

Procedure: 

  • The floor should be scrubbed with soap powder and washed with water.
  • 1% sodium hypochlorite should be used.
  • Tap: 

Procedure: 

  • Should be scrubbed with soap powder and nylon scrubber.
  • Shower area/ taps and fittings

Procedure: 

  • Floors should be thoroughly scrubbed with warm water and detergent.
  • Taps and fittings should be wiped with damp cloth and detergent.
  • Care should be taken to clean the underside of taps.
  • Taps should be dried after cleaning.
  • Soap dispensers: 

Procedures:

  • Daily dusting should be done.
  • Should be cleaned weekly with detergent and water and dried.

SECTION B: HOSPITAL SYSTEM

  • Guidelines for General areas in a hospital: 
  • Transparent shield of any material to shield against droplets from coughs and offer barrier COVID protection should be used.
  • Online registration should be encouraged. 
  • Digital payment modes should be encouraged.
  • If cash has to be collected, ensure staff practices hand hygiene for 20 seconds after every transaction. 

Ambulance:

  • Ambulance staff (technicians as well as drivers) should be trained and oriented about symptoms and use of PPE.
  • Patient and attendant should be provided with face mask. 
  • Only one caregiver should be allowed to accompany the patient.
  • Ambulance and equipment should be thoroughly cleaned and disinfected using 1% Sodium Hypochlorite solution.
  • Hydrogen Peroxide fumigation after wiping with Sodium Hypochlorite solution. 
  • Reusable patient-care equipment should be disinfected before use on another patient with alcohol based rub. 
  • Keeping the ambulance open for 20 minutes in sunlight is also effective.

Laboratory: 

  • A kiosk should be set up to collect swabs from suspected cases within flu clinic or a designated area closer to OPD as well as emergency department
  • For specimen collection:  N95 or higher-level respirator (or facemask if a respirator is not available), eye protection, gloves, and a gown should be used.
  • There should be minimum number of staff at reception counter
  • For specimen handlers: follow Standard Precautions; laboratory coats or gowns, gloves, and eye protection.
  • Staff trained in safe collection and transport of specimen, safe disposal of biomedical waste and in handling spills. Ÿ Spills of small volume of blood/body fluids (<10 ml) are cleaned with chlorine containing (5000mg/L) disinfecting wipes, while for large volume spills, higher concentrations of chlorine containing disinfectant (10,000 mg/L) or peroxyacetic acid is used. 

Radiology Department:

  • Portable equipment should be used wherever feasible. 
  • Equipments are sanitized using standard cleaning procedures between patients. 
  • For patients requiring airborne/contact precautions, radiology technologists should perform room sanitizing after imaging while still wearing the same set of PPE as used during patient transfers.
  • N95 + Eye shield should be used for all Aerosol generating procedures within the imaging rooms. 
  • Post use the room should kept vacant for 1hr before next patient is taken in.

Dietary Department · 

  • Number of personnel in the kitchen should be limited.
  • Disposable trays, plates and other materials should be used.
  • All other utensils should  be washed using hot water and soap before each use 

Inpatient Areas

  • Entries to patient rooms by bundling treatment and patient care activities should be minimized.
  • Provision for identification and frequent monitoring of early warning scores should be ensured.
  1. Guidelines for Special situations (aerosol generating and non- aerosol generating procedure) Dialysis
  • Facilities should maintain at least 6 feet of separation between patients with suspected or confirmed COVID-19 and other patients during dialysis treatment.
  • Ideally, patients with suspected or confirmed COVID-19 should be dialyzed in a separate room with door closed or treated at a corner or end-of-row station.
  • Standard precautions for linen management and cleaning of equipment as per manufacturer’s guidelines should be followed.
  • If separate rooms are not available, maintain a distance of 6ft between suspect or confirmed COVID cases. 
  • Wet cleaning after each patient of all surfaces should take place.

Endoscopy

  • Only essential personnel should be present during procedures.
  • For patients defined as suspected, probable or confirmed COVID-19, enhanced PPE should be practiced during endoscopy, including the use of a N95 mask; isolation gown with water resistance; head cover; eye protection and face shield. The procedure should be conducted in negative pressure room when available.
  • For patients who are not suspected to have COVID-19, healthcare providers should perform endoscopy with PPE, including a face mask; isolation gown with water resistance; eye protection.
  • All specimen from patients with COVID-19 should be handled with extra precaution and with appropriate protective equipment.
  • Standard room disinfection should be conducted at the end of the session in rooms where non-COVID or low-risk patients had endoscopy.
  • For patients with suspected or confirmed COVID-19 who require emergency endoscopy, the endoscopic procedure should be performed at the end of the session and the room should be cleaned after these procedures with staff using appropriate PPE.
  • The disinfection and reprocessing of the endoscope and instruments used for a patient with COVID-19 will be similar to those used in standard practice.
  • Ethanol (62–71% concentration), 2% glutaraldehyde and 0.1–0.5% sodium hypochlorite are commonly used as disinfectants and can reduce the concentrations of coronavirus within 1 min of exposure time.

 Aerosol generating procedures 

  • Bronchoscopes should be disinfected with 0.23% of peroxyacetic acid followed by high level of disinfection in an automatic washing and disinfection machine if available, and sterilized finally with ethylene oxide.

Transplantation

  • Elective Deceased Donor transplant should be done only if donor is COVID-19 negative (both RT-PCR and Serologic test)
  • Transplant should only be carried out if both donor and recipient test negative (both serology (when available) and RT-PCR). The timing of the tests should be immediately before the transplant operation.
  • The transplant operation should be carried out with full personal protective gear as specified by the hospital guidelines.

Obstetric Care:

  • If ultrasound equipment is used, it should be decontaminated after use as per manufacturer’s guidelines. 
  • For COVID suspect or confirmed case: Where GA is planned for Caesarean section from the outset, all staff in theatre should wear full PPE, including a filtering face piece level 3 (FFP3) mask. In caesarean birth where regional anesthesia is planned, all staff in theatre should then don PPE with a fluid-resistant surgical mask and eye protection.
  • For non-suspect case, PPE as per institutional HIC should be followed.
  • If mother is suspect or confirmed then precautions should be taken while breast feeding or handling the new born.

Guidelines for Operation theatre:

  • Minimum number of staff and equipment must be used in Operating room (OR).
  • A dedicated OR closest to the entrance may be dedicated for performing emergency procedures in suspect cases. 
  • OR and surrounding donning/doffing areas must be sanitized as soon as possible after each procedure.
  • After each procedure, all involved personnel, whenever possible, should shower. 
  • COVID suspect cases to be operated upon in standalone theatres and after each use hydrogen per oxide fumigation also to be carried out.
  • If the AC system is shared, the same protocol has to be carried out in other theatres which share AC.
  1. Guidelines for Home health, elderly care and teleconsultation
  • If possible and where appropriate, communication should be encouraged with the patient remotely through use of a mobile telephone or other similar device before a visit to check that they have no new symptoms on that day.
  • Healthcare staff should be told how to deal with the situation, if they arrive at a patient’s home and find that the patient’s condition has deteriorated or other symptoms that suggest COVID-19 
  • Staff has to perform hand hygiene first and last after each visit to a patient’s home and therefore ensure that they have an adequate supply of alcohol hand rub for all visits. Hand hygiene must be performed as per the 5 moments of hand Hygiene 
  • Surgical masks should be worn by healthcare workers when providing care to patients within 2m of a patient, regardless of the COVID-19 status of the patient.
  • Surgical masks should be worn by all healthcare workers for all encounters, of 15 minutes or more, with other healthcare workers in the workplace where a distance of 2m cannot be maintained.
  • Disposable gloves and a plastic apron are recommended for certain tasks including contact with body fluids such as bathing a person who is incontinent, handling soiled personal clothing and bed linen and clearing up spills of urine, faeces, vomit and handling waste
  1. Dead Body Management 
  • The health worker attending to the dead body should perform hand hygiene, ensure proper use of PPE.
  • Dead body should be placed in leak-proof plastic body bag. The exterior of the body bag should be decontaminated with 1% hypochlorite. The body bag should be wrapped with a mortuary sheet or sheet provided by the family members.
  • All surfaces of the isolation area (floors, bed, railings, side tables, IV stand, etc.) should be wiped with 1% Sodium Hypochlorite solution; allow a contact time of 30 minutes, and then allowed to air dry.
  • The personnel transporting the body must follow standard precautions (surgical mask, gloves).
  • The vehicle, after the transfer of the body to cremation/ burial staff should be decontaminated with 1% Sodium Hypochlorite.
  1. Action to be taken on detection of COVID -19 case in non-COVID health facility
  • Local health authorities  should be informed about the case.
  • The patient should be immediately isolated to another room. If the clinical condition permits, such patients should be masked and only a dedicated healthcare worker should attend this case, following due precautions. 
  • If the clinical status of the case permits, transfer such case to a COVID-19 isolation facility (Dedicated COVID Health Centre or dedicated COVID Hospital), informing the facility beforehand about the transfer, as per his/her clinical status, test results (if available), with information to local health authority.
  • Case records of such patients must be made available to the receiving hospital. 
  • Appropriate standard precautions must be followed while transporting the patient.This should be followed by disinfection procedures at the facility and the ambulance 
  • All contacts of this patient should be quarantined and followed up for 14 days. Their details must also be shared with the local health authorities.
  • All close contacts (other HCWs and supportive staff) of the confirmed case should be put on Hydroxychloroquine chemoprophylaxis for a period of 7 weeks, keeping in mind the contraindications of HCQ. 
  •  Ensure that active screening of all staff at the hospitals is done daily (by means of thermal screening especially at the start of shift) 
  • All healthcare and supportive staff are encouraged to monitor their own health at all times for the appearance of COVID-19 symptoms and report them at the earliest.

SECTION C : HOSPITAL SUPPLIES

Rational use of PPE for Non COVID hospitals and Non-COVID treatment areas of a hospital which has a COVID block

  •   Out Patient Department
  1. Help desk/ Registration counter

 Recommended PPE: Use of triple layer medical mask and latex examination gloves.

  1. Doctors chamber

 Recommended PPE: Use of triple layer medical mask and latex examination gloves.

  1.  Chamber of Dental/ENT doctors/ Ophthalmology doctors

Recommended PPE: Use of N-95 mask, goggles, face shields and latex examination  gloves.

The procedures generating aerosols procedures should be anticipated and face shields should be used when splash of body fluids should be expected.

  1. Pre- anesthetic check-up clinic

Recommended PPE: Use of N-95 mask, goggles and latex examination  gloves.

Goggles are recommended only when close examination of oral cavity/dentures is to be done.

  1. Pharmacy counter

 Recommended PPE: Use of triple layer medical mask and latex examination gloves.

It is advisable to use hand sanitizer over the glove frequently.

  1. Sanitary staff 

 Recommended PPE: Use of triple layer medical mask and latex examination gloves.

  • In-patient Department (Non-COVID Hospital &Non-COVID treatment areas of a hospital which has a COVID block)
  1. Ward or individual rooms: Clinical management

 Recommended PPE: Use of triple layer medical mask and latex examination gloves.

  1. ICU/ Critical care: Critical care management 

Recommended PPE: Use of N-95 mask, goggles, face shields and nitrile examination  gloves.

The procedures generating aerosols procedures should be anticipated and face shields should be used when splash of body fluids should be expected.

  1. Ward/ICU/Critical care: Dead body packing

Recommended PPE: Use of N-95 mask, goggles, face shields and nitrile examination  gloves.

  1. Ward/ICU/Critical care (Non-COVID): Dead body transport to mortuary

Recommended PPE: Use of N-95 mask, goggles, face shields and nitrile examination  gloves.

  1. Labor room : Intra-partum care

Recommended PPE: Use of triple layer medical mask, face shields, sterile latex gloves.

N-95 masks should be used if the pregnant woman is a resident of containment zone.

  1. Operation theatre: Performing surgery and administering anaesthesia

Recommended PPE: Use of triple layer medical mask, face shields, goggles and sterile latex gloves.

Goggles should be used when the personnel is involved in areosol generating procedures.

N-95 masks should be used if the patient is a resident of containment zone.

  1. Sanitation : Cleaning frequently touched surfaces/ floor/ changing linen

 Recommended PPE: Use of triple layer medical mask and latex examination gloves.

  • Emergency Department (Non-COVID)
  1. Emergency : attending emergency cases 

 Recommended PPE: Use of triple layer medical mask and latex examination gloves.

  1. Emergency : Attending to severely ill patients while performing aerosol  generating procedure

 Recommended PPE: Use of full complement of PPE (N-95 mask, coverall, goggle, Nitrile examination gloves, shoe cover)

  • Other Supportive/ Ancillary Services
  1.  Routine Laboratory: Sample collection and transportation and testing of routine (nonrespiratory) samples

           Recommended PPE: Use of triple layer medical mask and latex examination gloves.

  1. Routine Laboratory: Respiratory samples

 Recommended PPE: Use of N-95 mask and latex examination gloves.

3.Radiodiagnosis, Blood bank,etc.: Imaging services, blood bank services,etc.

 Recommended PPE: Use of triple layer medical mask and latex examination gloves.

4.CSSD/Laundry: Handling linen

 Recommended PPE: Use of triple layer medical mask and latex examination gloves.

5.Other supportive services including kitchen: Administrative financial engineering and dietary services,etc.

 Recommended PPE: Face cover should be used

  • Pre-hospital (Ambulance) Services 

1.Ambulance Transfer to designated hospital: Transporting patients not on any assisted ventilation

 Recommended PPE: Use of triple layer medical mask and latex examination gloves.

  1. Ambulance Transfer to designated hospital: Management of SARI patient

 Recommended PPE: Use of full complement of PPE (N-95 mask, coverall, goggle, Nitrile examination gloves, shoe cover)

3..Ambulance Transfer to designated hospital: Driving the ambulance

 Recommended PPE: Use of triple layer medical mask and latex examination gloves.

Points to remember while using PPE

  1. Standard precautions should be followed at all times.
  2. Hand hygiene, respiratory etiquettes which must be followed at all times along with wearing of PPE.
  3. A laid down protocol should be followed for disposing off PPEs.

Reuse of PPE in exigency

  • Heat sensitive equipment (PPE): Preferably with Hydrogen peroxide vapor, Ethylene oxide sterilization technique
  • Cloth items (gowns, cloth masks): Preferably Autoclaving or washing with soap and hot water.
  • Face shields and goggles: Immersion in 0.5% Sodium Hypochlorite solution or cleaning with 70% alcohol.
  •  Heat sensitive equipment like N95 masks directly coming in contact of the skin: Though Hydrogen peroxide vapor is the preferable method, UV C radiation may be utilized, if available. 
  • Disposable N95 respirators may be re-used or worn for extended use as long as they are able to seal, were not worn during an aerosol generating procedure or have reached the end of their use by being soiled, damaged or moist from sweat or insensible fluid loss through breathing. The N95 masks can be utilized up to 5 cycles of usage and decontamination. DO NOT use ALCOHOL AND CHLORINE [bleach]-based disinfection methods

Additional guidelines for N95 

  •  N95 masks should be worn only once and not shared with anyone. If they are soiled, damaged or wet, they should be replaced immediately.
  • N95 masks should not be exposed to UV radiations, microwave, autoclave and alcohol sterilization.
  •  For extended re-use of N95 masks, it should be air dried by simply drying in air for 3 days in a safe open paper bag. Do not keep in Sun and use it on 4th day. N95 masks can also be heated in an oven at 70oC for 30 min and keeping the metallic nose clip away. It can also be placed in a traditional rice cooker at 150-160o C. Chemical sterilization at 480 ppm H2O2 for 45 minutes can also be done.

SECTION D : HOSPITAL STAFF

  1. Ensuring safety and protection of HCWs including mental health needs
  • “Employee Safety Committee” should be formulated to ensure regular monitoring of health status of staff
  • An internal helpline should be created so that staff can direct their concerns if any.
  • Culture of greeting people with “ namaste” should be promoted.
  • Social distancing should be ensured during break hours.
  • Mandatory E training / webinar should be conducted for all staffs regarding operational plan post COVID and post lockdown when they resume work after lockdown
  • Housekeeping staff should be addressed and motivated and ensured that they are well equipped to perform enhanced level of cleaning
  • Mandatory self reporting form should be filled by staffs to gather data about the symptoms, travel history,history of contact with suspect or confirmed COVID-19 cases.
  • Separate safety policy should be made for pregnant workers.

Staff Strategies For Ensuring Self-care And Well-being

DO’s

  • Regular eating, drinking and sleep should be maintained and adjusted according to the duty shifts.
  • Breaks should be taken for deep breathing exercises, relaxation and “Me” time.
  • Talk to your colleagues and extend and receive support from each other.
  • Remain connected with the family and friends
  • Stay informed and updated with the latest, credible information from public health resources.
  • Participate in workplace discussions to stay informed about latest status and guidelines.
  • Mental health should be gauged by monitoring yourself for any symptoms of excessive anxiety or depression or prolonged stress.
  • Take care of yourself and family.
  • The honor and noble calling of medical profession should be appreciated.

DONT’s

  • Media exposure as a continuous stream of news and updates on social media platforms should be avoided.

Caring For Patient Psychological Well-being

  • Patients should be educated about basic hygiene such as hand-washing, cough etiquette, social distancing and staying at home to discussions on prevention or early detection.
  • Misconceptions should be corrected and rumors which cause unnecessary panic should be avoided.
  • Patients should be counselled about stress management.
  • If a patient is found to have severe  emotional issues or exacerbation of pre-existing psychiatric illness he should be referred to a  specialized mental health care.
  1. Interim Operational Considerations for Public Health Management of Healthcare Workers Exposed to or Infected with COVID-19

High risk exposure:

  • Close contact with a person with COVID-19 in the community; OR
  • Providing direct patient care for a patient with COVID-19 (e.g., physical exam, nursing care, performing aerosol generating procedures, specimen collection, radiologic testing), without using proper personal protective equipment(PPE) or not performing appropriate hand hygiene after these interactions
  • Having contact with the infectious secretions from a patient with COVID-19 or contaminated patient care environment, without using proper personal protective equipment (PPE) or not performing appropriate hand hygiene 

Low risk exposure 

  • Contact with a person with COVID-19 having not met criteria for high-risk exposure.

Recommendations for staff protection:

  • Triage areas and source control should be established.
  • Standard hygiene practices should be reinforced
  •  Safety measures whilst dealing with OPD/Clinic patients
  • Safety measures whilst caring for hospitalized COVID-19 patients
  • Casually exposed HCWs should not be self-quarantined.
  • Prophylactic drug should be given for HCWs
  • Special precautions must be followed for aerosol generating procedures (AGP)
  • Environmental and engineering controls involve adequate ventilation of all health care facilities and proper environmental disinfection
  • Access to personal protective equipment (PPE) for health workers
  • Emotional needs of HCWs must not be ignored.

Reference Link : https://phfi.org/wp-content/uploads/2020/05/Post_Lockdown_Lifting-Resumption-of-Hosptial-Services-compressed.pdf

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