Considering the possibility of healthcare workers (HCWs) contracting the novel coronavirus, the Ministry of Health and Family Welfare has issued specific guidelines for all states and union territories.
The guidelines are applicable for COVID-19 healthcare facilities (public and private) that are already receiving or preparing to receive suspected or confirmed coronavirus patients as well as non-Covid healthcare facilities.
The government has suggested, “The Hospital Infection Control Committee (HICC) shall be responsible for establishing a mechanism for reporting of development of symptoms suggestive of COVID-19 in HCWs. These include surveillance for fever/cough/breathing difficulty through either self-reporting or active and passive screening at the beginning of their shift. The committee will also monitor patients (who have been admitted for non-Covid illness) for development of unexplained fever/cough/breathing difficulty during their stay.”
The government has also detailed the standard operating procedure for HICC that will be implemented immediately when an HCW tests positive for the virus. “The HICC shall immediately inform the local health authorities about the case, assess clinical status of the patient prior to referral to a designated Covid facility. 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. If the clinical status of the case permits, transfer such case to a COVID-19 isolation facility (dedicated health centre or dedicated hospital), informing the facility beforehand about the transfer, as per his/her clinical status, test results (if available), with information to local health authority,” the guidelines add.
The Union Health Minister has also asked the states and UTs to ensure that “all health facilities (HCF) must have a staffing plan in place including a contingency plan for such an event to maintain continuity of operations. e.g. staff in HCF can be divided into groups to work on rotation basis every 14 days and a group of back up staff, which is pooled in case some high risk exposure/HCW with suspected COVID-19 infection is detected.”
Decision on further use of non-COVID facilities where a case has been reported
The likely scenarios could be socio-demographic reasons – a) Hospital’s catchment area is a large cluster of COVID-19 b) Catchment area has a population which has a large number of vulnerable individuals having multiple co-morbid condition, poor nutritional status and/or having individuals not able to practice social distancing e.g. slum clusters. Based on the scope of the cluster and degree to which the hospital has been affected (HCW patients, and HCW contacts), degree of the risk to the patients visiting the hospital such as those with chronic diseases etc. the decision can be made based on a risk assessment to:
# If the hospital authorities are reasonably satisfied that the source case/s have been identified and isolated, all contacts have been traced and quarantined and adequate disinfection has been achieved, the hospital will continue to function.
# In addition to steps taken above, if the health facility still continues to report new hospital acquired COVID-19 cases in the following days, it would be advisable to temporarily close the defined section of the health facility where the maximum number of HAI is being reported. After thorough cleaning and disinfection it can be put to use again.
# Despite taking the above measures, if the primary source of infection could not be established and/or the hospital is still reporting large number of cases among patients and HCWs, a decision needs to be taken to convert the non-Covid health facility into a Covid health facility under intimation to the local health department. In such a scenario, all healthcare workers of the facility should be oriented in infection prevention and control practices and other protocols.
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