08 June 2020
14:47Hospital Precautions and standing operative procedures during attending patient in various presentations during Covid -19 pandemic:Wards SOP’s:• All patients attending hospital shall be considered as Covid (+ Ive) unless and otherwise proven.
• Any admission with respiratory sign and symptoms or fever of unknown origin should be kept separately from patients that are admitted for relatively other problems.
• Be vigilant, cautious and conscious and report any remarkable symptom immediately to the concerned specialist.
• Any investigation or lab requirement pertaining to bed ridden patient shall be taken or done in full SOPs within ward by maintaining minimal physical contact and preferably distancing.
• Clinician shall follow same SOPs while attending patient and under no means will attend ward without recommended stocks and gloves.
• Beds should be at a distance of 8 to 10 feet.
• There should be a curtain between beds preferably.
• There will be no attendant except when called upon in need or as necessitate.
• If patient is oriented in time and space without respiratory problem, he or she shall wear Mask.
• Any one; Ward in & ward out, shall wash hand or use sanitizer before entering or leaving.
• All ward staff on duty should not leave there place of duty unreasonably and such move as to and fro shall be restricted guarding SOP’s.
• Rest room wash room utilized by patient should be washed frequently with disinfection spray as and when required.
• All wards will be disinfected as per SOP daily or twice whatever necessitates.
• Nursing Staff should wear face visor before attending any patient where as in the mean hours should wear disposable apron or washable gowns.
• Proper gloving be ensured and surgical gloves should be worn during duty hours whereas added polythene disposable gloves shall be used during attending patient.
• A fresh polythene glove shall be used for attending each patient.
• No attendant shall get access in ward unless under possession of relevant mandatory recommendations as Mask etc.
• No children below 12 years are allowed in hospital and the same goes for wards. However patients as and with such ages are exempted with strict abidance as per SOP.
• No aerosol procedure like nebulisation etc will be conducted in ward but at solitary room with preferably negative pressure.
• Air conditioning system with their filter grill should be wash & disinfected daily and necessary precautionary majors be taken to avoid any contaminated spread due to cooling system.
• All disposal infectious or non infectious should be disposed as if infectious disposal and precautions to be taken for proper discard by incineration.
• All donning and doffing procedure related to wearing as mask gloves or apron or visor shall be followed by SOPS for proper disinfection and reuse.
• Relevant info regarding update and review of SOPs will be put forth as and when and time to time.
• There will be an extra Covid charges to be charged from the patient as mandatory with in hospital charges as obligatory .ERE SOPs:• All patient attending ERE will be examined under strict protocol and as per recommended SOPs.
• Reporting in ERE will be through the preliminary level 3 safety station .
• If the provisional diagnosis at triage level 3 safety station is of fever or respiratory complain patient will be refered to Fever Clinic @ level 4 Safety Station (ERE) as suspected Covid -19ERE will have , Level 4 Safety Station
Here basic concerned is again suspected covid triage through symptoms and finding.• Triage for suspected Covid -19 at fever /respiratory/other clinic1. Fever evaluation clinic
Check for fever >38 Degree2. Respiratory evaluation clinicCough shortness of breath (etc)3. GIT ,CNS or others Symptoms• Vomiting, Loose motions, cerebral issues• If symptoms suggest provisional Covid -19 diagnosis as positive (suspect)
• Hold patient at Isolation Bay at EREProtocol at Bay• Separate from the rest of the patient• Detain /hold patient temp at Holding Bay• If test available at HC Facility Perform Covid testing/ Lab• If not refer to HC facilty for Covd -19 testingBay Environ Requirements• Single room with negative pressure.
(Negative pressure prevents airborne diseases like TB and Flu from escaping from room and infecting others . This is perform by a Machine that pulls air in to the room and filters it before moving out.A positive air pressure is used when patient has a weakened immunity in which a clean filtered air is constantly pumped in to keep contagious disease out of room.)• Ensure healthcare personnel (HCP) caring for the patient adhere to Standard, Contact, and Droplet Precautions• Only essential HCP with designated roles should enter the room and wear appropriate personal protective equipment.2. If symptoms suggest provisional Covid -19 diagnosis as Negative(asymptomatic)• Issue provisional clearance slip for OPD for further referral to OPD / ERE (non traumatic emergency cases only)OPD SOPs:• Clinician will wear mask, face visor gloves and shall be in possession of alcohol base sanitizers.
• All patients and their attendant shall wear mask and gloves and must maintain a distance of 01 meter.
• OPD reception should have through and through glass or plastic shield at reception to avoid close contact and exposure to reception staff.
• There will be fewer OPDs at a time and in a day.
• There will be minimum number of patient in OPDS to avoid rush hence to maintain proper social distancing etc.
• There will be an extra Covid charges to be charged from the patient as mandatory.
• All admission /investigation and laboratory test shall be with in compliance of SOPs
• Admission for surgeries shall have necessary Covid testing as mandatory or will not be entertained.
• All clinician shall be in possession of their relevant Mask /Visor / gloves /sanitizer at their own or the same can be provided by hospital at minimum charges.
• However disinfection and necessary related cleansing will be at the disposal of hospital.Lab SOP’s:• All staff will wear gloves gown, mask and visor with preferably PPE if available.
• There will be one patient at a time in laboratory with rest in waiting area under compliance of SOP.
• Reception should have through and through glass or plastic shield at reception to avoid close contact and exposure to reception staff.
• All waste and disposal should be treated as if biosafety level 3 labs.
• All donning and doffing procedure related to wearing as mask gloves or apron or visor shall be followed by SOPS for proper disinfection and reuse if washable.
• Relevant info regarding update and review of SOPs will be put forth as and per time to time.Radiography SOPs:• All staff will wear gloves gown, mask and visor with preferably PPE if available.
• There will be one patient at a time in Radiology with rest in waiting area under compliance of SOP.
• Reception should have through and through glass or plastic shield at reception to avoid close contact and exposure to reception staff.
• Staff should practice social distance avoiding unnecessary close contact.
• Relevant info regarding update and review of SOPs will be put forth as and when and time to time.
• Reception should have through and through glass or plastic shield at reception to avoid close contact and exposure to reception staff.
• Any surface that shall have direct contact with machine or couch shall be disinfected before new matchable patient.
• Relevant info regarding update and review of SOPs will be put forth as and when and time to time.Operation theatre SOP:• Surgeries shall have necessary Covid testing as mandatory or will not be entertained.
• Emergency surgeries that has limited time span shall be considered as Covid positive and all SOP’S with pre and post surgical intervention will be carried out accordingly and as per Covid SOPs.
• All C-Sections /Labor and NVD deliveries will get through Covid testing prior to attending hospital as mandatory.
• It will be customary to wear mask, gown and gloves by all staff attending OT.
• Anesthetist is the prime contact that is vibrantly exposed to the threat where as the next on threat are surgeon and assistant on table.
• Anesthetist should ideally be in PPE and should follow protocol with heart and spirit.
• Since intubation and further anesthesia is an effective aerosol procedure any such threat can only be minimized by taking care.
• Disinfection of O.T, collection of histopathology and disposal of waste should be practiced as per SOP and in strict compliance.
• All instrument used be sterilized with standard solutions and methodology.Minor OT:• All protocol relevant to standard recommendation will be followed.
• Waste bandages and swab will be discarded as per SOPDialysis SOP:• It is a very difficult situation for dialysis department since many patients are chronic and undergoes twice or thrice dialysis weekly
• As such it is difficult to conduct Covid testing test every time and now and then.
• Such patient otherwise needs to be treated without undergoing test and the risk to exposure increases many fold.
• It is therefore suggested that any new comer should go for Covid testing before he comes for dialysis and all individuals who are on weekly treatment as chronic shall get a monthly testing.
• Mean while dialysis machine should be cleaned with full disinfectiing meathod as per SOP after each dialysis as if virtually Covid patient has been put on.
• All staff members should ideally be under PPE or at least washable gown and disposable gloves and mask.
• Hand sanitizers should be a regular practice and disinfection after every case is a must.
• No touch technique should be executed and attendant along shall stay out with mask and gloves.
• By now extra charges in the name of Covid changes are applicable that should be the part of treatment.ICU Protocol:• ICU will be treated a Covid Wing.
• Every one while working in ICU whether as a Covid Wing or not shall be under strict precaution with PPE or to the utmost full sleeves gown gloves face visor, shoes and cap.
• All disposal as waste will be treated as infectious and disposed as infectious item.
• Donning and doffing of kit will be conducted as per SOP.
• All beds shall be at a recommended distances with shielding effect by curtain or stand.
• Any aerosol procedures being done should be cautiously performed after taking necessary precautionary measures.
• Suction intubation, bedding, shedding cleansing & changing must all go through strict compliance of declared SOP.
• Relevant info regarding update and review of SOPs will be put forth as and per time to time.
(Dr Raza)