Training of HCWs on COVID-19

Training of HCWs on COVID-19

Introduction

Most patients with COVID-19 predominantly have a respiratory tract infection associated with SARS-CoV-2 infection. However, in a small proportion of cases, they can progress to a more severe and systemic disease characterized by the Acute Respiratory Distress Syndrome (ARDS), sepsis and septic shock, multi-organ failure, including acute kidney injury and cardiac injury.

About COVID-19

COVID-19 Infection prevention and control

Clinical management of COVID-19

What is triage?

The sorting out and classification patients or casualties to determine priority of need and proper place of treatment

What patients can do before and upon arrival to a healthcare facility?

  • Inform healthcare providers if they are seeking care for respiratory symptoms (e.g. cough, fever, shortness of breath) by calling ahead of time
  • Wear a facemask, if available, during transport and while at triage in the healthcare facility
  • Notify triage registration desk about respiratory symptoms as soon as they arrive
  • Wash hands at healthcare facility entrance with soap and water or alcohol-based hand rub
  • Carry paper or fabric tissues to cover mouth or nose when coughing or sneezing. Dispose paper tissues in a trash can immediately after use
  • Maintain social distance by staying at least one meter away, whenever possible, from anyone, including anyone that is with the patient (e.g., companion or caregiver)

What healthcare facilities can do to minimize risk of infection among patients and healthcare workers?

Communicate with patients before arriving for triage

  • Establish a hotline that:
    • Patients can call or text notifying the facility that they are seeking care due to respiratory symptoms
    • Can be used, if possible, as telephone consultation for patients to determine the need to visit a healthcare facility.
    • Serves to inform patients of preventive measures to take as they come to the facility (e.g., wearing mask, having tissues to cover cough or sneeze).
  • Provide information to the general public through local mass media such as radio, television, newspapers, and social media platforms about availability of a hotline and the signs and symptoms of COVID-19.
  • Healthcare facilities, in conjunction with national authorities, should consider telemedicine (e.g., cell phone videoconference or teleconference) to provide clinical support without direct contact with the patient.

Set up and equip triage

Visual Alert to Direct Patient with Respiratory Symptoms

If you are experiencing cold or flu symptoms like

  • Fever
  • Cough
  • Shortness of breath

REPORT Immediately to the registration desk!

Key requirements in triage or screening area

  • Screening questionnaire
  • Algorithm for triage PPE
  • Hand hygiene supplies
  • Infrared thermometer
  • Cleaning/disinfection supplies

Screening for COVID-19 - In Health Care Facilities

  • Conduct timely and effective TRIAGE (assignment of degree of urgency) for early identification of patients with acute respiratory infection (ARI) to prevent the transmission of pathogens to health care workers and other patients
  • Prioritize isolation and care of symptomatic patients
  • Prevent Overcrowding. Maintain a separate Flu-clinic for all patients coming with flu-like symptoms
  • Keep at least 1 meter distance between suspected patients and other patients
  • Instruct all patients to cover nose and mouth during coughing or sneezing with tissue or flexed elbow

Screening of visitors and close contacts

  • Screening of visitors and close contacts of a confirmed case should also be done
  • All high risk contacts of a confirmed case If asymptomatic: should be put under home quarantine for at least 28 days If symptomatic: should be lab tested for COVID-19

Sample collection and testing

  • Lab test can be offered when prescribed by physician as per ICMR Guidelines for COVID-19 testing
  • Currently, only hospitals and collection centres authorized by ICMR can collect samples for suspected cases of COVID-19
  • Samples are to be tested only in ICMR designated labs
  • On 21st March, ICMR announced that approved private labs can conduct the tests for COVID-19

Current Testing Strategy

  • All symptomatic individuals who have undertaken international travel in the last 14 days
  • All symptomatic contacts of laboratory confirmed cases
  • All symptomatic health care workers
  • All patients with Severe Acute Respiratory Illness (fever AND cough and/or shortness of breath)
  • Asymptomatic direct and high-risk contacts of a confirmed case should be tested once between day 5 and day 14 of coming in his/her contact

In hotspots/cluster (as per MOHFW) and in large migration gatherings/ evacuees centres

  • All symptomatic ILI (fever, cough, sore throat, runny nose)
    • Within 7 days of illness - rRT-PCR
    • After 7 days of illness - Antibody test (If negative, confirmed by rRT-PCR)

Home Quarantine

  • Appropriate for patients with mild infection who can be adequately isolated in the outpatient setting
  • Patients should be advised to stay at home and try to separate themselves from other people in the household wear a facemask when in the same room (or vehicle) as other people and when presenting to healthcare settings
  • Caregivers should ensure regular disinfection of frequently touched surfaces by the patient

RECOMMENDED CLEANING SCHEDULES IN THE CONTEXT OF COVID-19

Patient area Frequency Person / staff responsible Products/ Supplies Additional guidance
Triage area At least daily, twice daily preferable Environmental cleaning (EC) staff Cleaning solution (neutral detergent and water); Disinfectant (alcohol, chlorine based, other as approved*) Freshly made solutions, cloths, and mops for each cleaning session PPE: gowns and/or impermeable aprons, rubber gloves, medical mask, and eye protection (preferably face shield) DISINFECTANTS EFFECTIVE AGAINST COVID-19 (contact time 1 minute): Ethanol ≥70% Hydrogenperoxide 0.5% Hypochlorite from 0.1% (1,000 ppm) or 0.5% (5,000 ppm) Focus on high-touch surfaces, then floors (last)
Inpatient rooms / cohort – occupied At least daily, twice daily preferable EC staff OR clinical staff if possible Focuses on high-touch surfaces, starting with shared/common surfaces, then move to each patient bed; use new cloth for each bed if possible
Inpatient rooms – unoccupied (terminal clean) Upon discharge/ transfer EC staff Low-touch surfaces, high- touch surfaces, floors (in that order); waste and linens removed, bed thoroughly cleaned and disinfected
Outpatient / Ambulatory Care rooms After each patient visit and at least once daily terminal clean Clinical staff (after each patient); Terminal clean (EC staff) High touch surfaces to be disinfected after each patient visit; terminal clean as above (end of day)
Hallways / Corridors At least daily, twice daily preferable EC staff High-touch surfaces (e.g., railings)
Patient toilets Private (at least daily); Shared (at least three times daily) EC staff High-touch surfaces, including door handles, light switches, counters, faucets, then sink bowls, then toilets and finally floor (in that order)

SOCIAL DISTANCING

SOCIAL DISTANCING is a non-pharmaceutical infection prevention and control intervention implemented to avoid/decrease contact between those who are infected with a disease causing pathogen and those who are not, so as to stop or slow down the rate and extent of disease transmission in a community. This eventually leads to decrease in spread, morbidity and mortality due to the disease.

social-distancing
  • Social distancing is being named as social vaccine
  • Also called “physical distancing,” it means keeping space between yourself and other people outside of your home. To practice social or physical distancing
    • - Stay at least 6 feet (about 2 arms’ length) from other people
    • - Do not gather in groups
    • - Stay out of crowded places and avoid mass gatherings

Environmental
How To
Manage Used
Linen On
The wards

  • Wear PPE according to the risk when handling used or soiled linen
  • Handle soiled linen with minimum agitation to avoid contamination
  • Place soiled linen into leak-proof bags/bucket/containers at point of care
    • Handle, transport, and process used linen in a manner which:
    • - Prevents skin and mucous membrane exposures and contamination of clothing
    • - Avoids transfer of pathogens to other patients and or the environment
  • Never carry soiled linen against body; place soiled linen in a leak-proof bag or bucket
  • Perform hand hygiene after blood/body fluid exposure and after PPE removal If linen is grossly soiled:
    • remove gross soil (e.g. faeces, vomitus) with a gloved hand and using a flat, firm object
    • discard solid material into flush toilet and dispose of towel into waste
    • place soiled linen into a clearly labelled, leak-proof container (e.g., bag and closed bin) in the patient care area
  • Clean linen must be sorted and transported in a way to prevent contamination (i.e. closed bins)
  • Linen on the patient care wards should be stored in a designated area (i.e. a closet or room) or closed containers away from public access.

A. COVID-19
Isolation Wards

isolation-wards
  • Keep separate colour coded bins/bags/containers in wards and maintain proper segregation of waste as per BMW Management Rules, 2016 as amended and CPCB (Central Pollution Control Board) guidelines
  • As precaution use double layered bags (using 2 bags) for collection of waste from COVID-19 isolation wards to ensure adequate strength and no-leaks
  • Collect and store biomedical waste separately prior to handling over to CBWTF (Common Bio-medical Waste Treatment and Disposal Facility)
  • Use dedicated collection bins labelled as “COVID-19” to store COVID-19 waste (in addition to mandatory labelling) and keep separately in temporary storage room prior to handling over to authorized staff of CBWTF
  • Dispose General waste not having contamination as solid waste as per Solid Waste Management Rules, 2016
  • Maintain separate record of waste generated from COVID-19 isolation wards
  • Disinfect (inner and outer) surface of containers/bins/trolleys used for storage of COVID-19 waste with 1% sodium hypochlorite solution
  • Depute dedicated sanitation workers separately for BMW and general solid waste

B. Sample collection centers and laboratories for COVID-19 suspected patients

  • Report opening or operation of COVID-19 sample collection centers and laboratories to concerned SPCB.
  • Follow guidelines given for isolation wards
suspected-patients

C. Quarantine Camps/Home care for COVID-19 suspected patients

Less quantity of biomedical waste is expected from quarantine centers.

  • Treat the routine waste as general solid waste and dispose off as per SWM rules, 2016.
  • Biomedical waste, if any, generated from quarantine centers/camps should be collected separately in yellow coloured bags and bins
  • Inform CBWTF operators as and when the waste is generated for collection for treatment and disposal at CBWTFs
  • In case of home-care for suspected patients, collect biomedical waste separately in yellow bags and hand over to authorized waste collectors engaged by local bodies. ULB should engage
  • CBWTFs to pick-up such waste either directly from such quarantined houses or from identified collection points
bio-hazard

Disposal Of
Bio Medical Waste