New Delhi: Union Ministry of Health and Family Welfare has released guidelines for Setting up Isolation Facility/Ward. The document is important in the wake of recent Covid 19 outbreak.WHO has declared the COVID-19 (SARS-CoV-2) outbreak as Public Health Emergency of international concern and has raised the risk assessment of China, Regional Level and Global Level to Very High and...
New Delhi: Union Ministry of Health and Family Welfare has released guidelines for Setting up Isolation Facility/Ward. The document is important in the wake of recent Covid 19 outbreak.
WHO has declared the COVID-19 (SARS-CoV-2) outbreak as Public Health Emergency of international concern and has raised the risk assessment of China, Regional Level and Global Level to Very High and "all countries should be prepared for containment, including active surveillance, early detection, isolation and case management, contact tracing and prevention of the onward spread of SARS-CoV-2 infection. Among the factors affecting cluster containment, Isolation of cases and quarantine of contacts is the mainstay of outbreak containment.
In this light guidance document has been prepared to establish an isolation facility at the level of the district hospital, a secondary health care facility. Following are its salient features
Quarantine and Isolation are important mainstays of cluster containment. These measures help by breaking the chain of transmission in the community.
Quarantine refers to the separation of individuals who are not yet ill but have been exposed to COVID-19 and therefore have the potential to become ill. There will be a voluntary home quarantine of contacts of suspect /confirmed cases. The guideline on home quarantine available on the website of the Ministry provides detail guidance on home quarantine.
Isolation refers to the separation of individuals who are ill and suspected or confirmed of COVID-19. All suspect cases detected in the containment/buffer zones (till a diagnosis is made), will be hospitalized and kept in isolation in a designated facility till such time they are tested negative. Persons testing positive for COVID-19 will remain to be hospitalized till such time 2 of their samples are tested negative as per MoHFW's discharge policy. About 15% of the patients are likely to develop pneumonia, 5 % of whom requires ventilator management.
Hence dedicated Intensive care beds need to be identified earmarked. Some among them may progress to multi-organ failure and hence critical care facility/ dialysis facility/ and Salvage therapy [Extra Corporeal Membrane Oxygenator (ECMO)] facility for managing the respiratory/renal complications/ multi-organ failure shall be required. If such facilities are not available in the containment zone, nearest tertiary care facility in Government / private sector needs to be identified, which becomes a part of the micro-plan. There are various modalities of isolating a patient. Ideally, patients can be isolated in individual isolation rooms or negative pressure rooms with 12 or more air changes per hour.
In resource-constrained settings, all positive COVID-19 cases can be cohorted in a ward with good ventilation. Similarly, all suspect cases should also be cohorted in a separate ward. However, under no circumstances, these cases should be mixed up. A minimum distance of 1 meter needs to be maintained between adjacent beds. All such patients need to wear a triple layer surgical mask at all times.
Nosocomial infection in fellow patients and attending healthcare personnel are well documented in the current COVID-19 outbreak as well. There shall be strict adherence to Infection prevention control practices in all health facilities. IPC committees would be formed (if not already in place) with the mandate to ensure that all healthcare personnel are well aware of IPC practices and suitable arrangements for requisite PPE and other logistic (hand sanitizer, soap, water etc.) are in place. The designated hospitals will ensure that all healthcare staff is trained in washing of hands, respiratory etiquettes, donning/doffing & proper disposal of PPEs and bio-medical waste management.
At all times doctors, nurses and para-medics working in the clinical areas will wear three layered surgical mask and gloves. The medical personnel working in isolation and critical care facilities will wear full complement of PPE (including N95 masks).
The support staff engaged in cleaning and disinfection will also wear full complement of PPE. Environmental cleaning should be done twice daily and consist of damp dusting and floor mopping with Lysol or other phenolic disinfectants and cleaning of surfaces with sodium hypochlorite solution. Detailed guidelines available on MoHFW's website may be followed.
B. Setting up isolation facility/ward
An isolation facility aims to control the airflow in the room so that the number of airborne infectious particles is reduced to a level that ensures cross-infection of other people within a healthcare facility is highly unlikely.
C. Checklist for isolation rooms
D. Wearing and removing Personal Protective Equipment (PPE)
Before entering the isolation room or area:
Leaving the isolation room or area
– remove the most contaminated PPE items first;
– perform hand hygiene immediately after removing gloves;
– remove the mask or particulate respirator last (by grasping the ties and discarding in a rubbish bin);
– discard disposable items in a closed rubbish bin;
– put reusable items in a dry (e.g. without any disinfectant solution) closed container; an example of the order in which to take off PPE when all PPE items are needed is gloves (if the gown is disposable, gloves can be peeled off together with gown upon removal), hand hygiene, gown, eye protection, mask or respirator, and hand hygiene
– Perform hand hygiene with an alcohol-based hand rub (preferably) or soap and water whenever un-gloved hands touch contaminated PPE items.
E. Transport of Infectious Patients
It is recommended that transport of infectious patients is limited to movement considered medically essential by the clinicians, e.g. for diagnostic or treatment purposes. Where infectious patients are required to be transported to other units within the hospital or outside the following precautions may be implemented:
For further details, on proforma and annexures regarding this guideline, click on the following link
https://www.rguhs.ac.in/scroll2020/Corona20032020.pdf
Hina Zahid Joined Medical Dialogue in 2017 with a passion to work as a Reporter. She coordinates with various national and international journals and association and covers all the stories related to Medical guidelines, Medical Journals, rare medical surgeries as well as all the updates in the medical field. Email: editorial@medicaldialogues.in. Contact no. 011-43720751
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