THE EXCHANGE | Newsletter May 2020
- 30 May 2020
- #Medanta Monthly Newsletter
Managing COVID-19 Cases
COVID-19 is an emerging, rapidly evolving situation.
The treatment guideline for the disease is also evolving. As per the current ICMR guideline, while managing COVID-19 patients, the first and the most important step is to differentiate between a symptomatic and an asymptomatic patient. This can be easily accomplished by taking detailed history. The next step is to categorize the patient as a suspected or a non-suspected case of COVID-19. This is done with the help of exposure risk stratification assessment as prescribed by the ICMR.
Identification and Stratification of Symptomatic Patients
A severely symptomatic patient has high respiratory distress with respiratory rate of over 30 per minute. The patient struggles to even speak a sentence. Pulse oximetry is typically less than 90% and the patient is unable to do activities of daily life.
Who is a suspected case?
As per the ICMR guideline, suspected category of patients include:
All hospitalized patients with severe acute respiratory infection, pneumonia, breathlessness, hemoptysis, respiratory distress requiring oxygen
What is contact?
Without PPE contact (distance<1 metre) of more than 15 minutes with a suspected or confirmed case two days prior to the onset of the symptoms and up to 14 days afterwards is considered significant contact.
Depending upon symptoms and suspicion, there are four possible patient categories:
Management of Asymptomatic Non-suspects
Situation assessment to understand why the individual sought consult
Management of Asymptomatic Suspects
Awareness about precautionary measures, disease transmission and minimizing risk of spread
Strict use of mask and hand hygiene
Management of Symptomatic Suspects
Management of Mildly Symptomatic Suspects
If COVID test is negative, the individual is discharged and advised general preventive precautions
Management of Moderately Symptomatic Suspects
Management of Severely Symptomatic Suspects
Management of Symptomatic Non-suspects
Categorization into mild, moderate and severe as explained earlier
As mentioned earlier, COVID-19 infection is a dynamic situation and ICMR guidelines are changing time-to-time. It’s advisable to stay updated and informed.
Tele-health in the Times of COVID-19
At a time, when social distancing is among the major measures used to fight COVID-19 pandemic, telemedicine is stepping-up as a key technology for safe and efficient communications.
The World Health Organization mentioned telemedicine among essential services in “Strengthening the Health Systems Response to COVID-19” policy. According to a new WHO policy, telemedicine should be one of the alternative models for clinical services and clinical decision support.
The Center for Disease Control and Prevention in the US and the National Health Service in the UK have recommended the use of telemedicine for identifying high-risk patients and treating other illnesses during the outbreak.
More recently, the Union Health Ministry of India also approved the use of telemedicine by registered medical practitioners to treat COVID-19 patients remotely or by using telemedicine tools.
Imbalance and shortage of healthcare professionals, together with unequal quality and access to healthcare services are challenges telemedicine can offer a solution to.
Other benefits telemedicine offers include:
Eliminated waiting time leading to better patient satisfaction
At Medanta, all our super-specialty doctors are available for tele-consults 24X7.
Our Internal Medicine team is engaged in virtually advising and counselling people on COVID-19, and directing them to the government approved centres.
To book a tele-consult
Download Medanta - eCLINIC mobile app
Call +91 124 4141 414
Patient Safety in Times of COVID
Amidst the COVID outbreak, as a tertiary care hospital, Medanta stays committed to delivering healthcare seamlessly while staying focused on safety of our patients, attendants and staff. Stringent infection control protocols have been instituted to ensure safety of non-COVID patients as we treat them seamlessly.
Safety @ OPD
Waiting lounges have been cleared off magazines, books and newspapers to prevent cross-usage. Separation of one metre is maintained between two individuals in the lounge.
Digital transaction is being encouraged.
Safety @ Emergency
When a patient reports to emergency, their history is taken while they are being triaged. The patient is enquired about travel history and any COVID symptoms such as fever, body ache, cold, cough or respiratory issues. In case there is slightest suspicion of COVID, the person is shifted to a separate zone where they are stabilized while following COVID infection control protocol and referred to a government approved COVID treatment facility. In absence of COVID suspicion, the patient is stabilized and transferred to an observation facility where treatment is initiated and sample is sent for COVID testing. Since Medanta has in-house COVID testing facility, it takes only 6-7 hours to get the results. Following a COVID negative report, the patient is shifted to ward as required. If ICU admission is required, the patient is admitted to a separate ICU designated for COVID result awaiting patients. After a negative report, the patient is shifted to the regular ICU.
Safety @ IPD
Any patient who requires hospital admission is first kept in the observation area where they are tested in-house for COVID. Only after a receiving a COVID negative report, which takes 6-7 hours, the patient is shifted to the ward. Until the COVID negative report comes, the patient is confined to the observation area, only allowed to use a lift dedicated to under-observation patients, and not allowed movement in the hospital except areas specifically designated for such patients.
If a patient comes for a planned surgery, they have the option of getting a COVID test done at Medanta or any other government approved facility. Test results are considered valid for a maximum of 48 hours.
Safety @ Observation Area
The observation area where COVID result awaiting patients are admitted is in a separate hospital wing with restricted access.
Dedicated staff manage this zone and they do not mingle with the rest of the hospital staff.
Infection control measures prescribed for COVID facilities are followed here.
The staff uses PPE as advised for COVID treating healthcare workers.
No attendants / visitors are allowed in this area.
Depending on the area the staff is deployed at, they wear appropriate PPEs and follow relevant infection control protocols.
All of the above measures ensure safety of our patients and staff so that healthcare, including consultation, surgery, day care procedures, gets delivered in an uninterrupted manner.
Is Your Clinic COVID Ready?
Healthcare workers are highly vulnerable to COVID-19 infection. Following measures can help you prepare your clinic and train your staff to safeguard against the highly contagious infection:
Before Patients Arrive
Prepare the clinic
Know how to contact government authorities if there is a positive case.
Prepare the waiting area and patient rooms
Provide supplies-tissues, alcohol-based hand rub, soap at sinks, masks and trash cans.
Post signs at entrances and in waiting areas about prevention actions, cough etiquettes, social distancing, hand hygiene.
When Patients Arrive
Place staff at the entrance to ask patients about their symptoms.
- Provide symptomatic patients with tissues or facemasks to cover mouth and nose.
- Limit non-patient visitors.
Use disposable sheet on the examination table and hand rub after each patient
After Patients are Assessed
After patients leave, clean frequently touched surfaces such as counters, beds and seating using approved disinfectants.
Provide at-home care instructions to patients with respiratory symptoms. Consider tele-health options for follow up.
Train and Prepare Your Staff
Ensure that clinical staff knows:
- The right ways to put on, use, and take off PPE safely.
- Recognize the symptoms of COVID-19 - fever, cough, shortness of breath.
- Implement procedures to quickly triage and separate sick patients.
Source: Centers for Disease Control and Prevention
Home Triage Protocol for COVID Patients
Why is Home Care Required?
With increasing number of cases of COVID-19 admitting every patient in hospital will put serious pressure on our health care system. Since almost 80% patients have mild disease and may not require much medical intervention, most of these patients can be managed at home.
Who Can be in Home Care?
Patient and disease factors
Patient understands the disease process including warning signs.
A separate bedroom and toilet for the patient is available.
Access to gloves, face mask and other necessary medical supplies.
The patient and household members are capable of adhering to recommendations for home care.
Caregivers cannot include the following
Those with chronic heart, lung, or kidney conditions.
Patient Care at Home
Stay at home
For fever take tablet Paracetamol 650mg.
Cough etiquettes and use of mask
Cover your cough and sneezes with cloth or tissue paper.
Dispose the tissue or cloth carefully in a lid covered dust bin.
Wash hands with soap and water for at least 20 seconds or clean your hands with an alcohol-based hand sanitizer with at least 60% alcohol.
Avoid sharing personal household items
After using these items, wash them thoroughly with soap and water.
House hold cleaning
Clean all surfaces that are touched often, like tabletops, and doorknobs in sick room and bathroom with disinfectant like 1% Sodium Hypochlorite.
For Care Providers at Home
Monitor the person for worsening symptoms.
Know emergency warning signs.
Prevent spread of germs when caring for the sick
Have the sick person stay in a separate room as much as possible.
- Have them use a separate bathroom.
- Flushing of toilet to be done after closing the lid of the commode.
- Avoid sharing personal household items, like utensils, towels, and bedding
- Have them wear a face mask when they are around people.
Wash your hands often with soap and water for at least 20 seconds after interacting with the sick person. If soap and water are not readily available, use a hand sanitizer that contains at least 60% alcohol.
Wash clothes / bedding of the sick person thoroughly.
-If clothes / bedding is soiled, wear disposable gloves and keep the soiled items away from your body while washing. Wash your hands immediately after removing gloves.
Avoid having any visitors.
When to Report to Hospital/ Warning Signs*
Persistent Fever >1010F for 72 hours.
Breathlessness, feeling of air hunger, fast breathing rate.
Severe abdominal pain with diarrhoea or vomiting
Pulse rate >110/min
* Medanta protocol
**Subject to availability of apparatus.
Access to Healthcare
Patient should do video/tele consultation with their physician on 3rd, 7th and 14th day or earlier in case of warning signs
Please notify the emergency, ambulance staff and physician about your COVID-19 status before planning to visit hospital.
When to Discontinue Home Isolation
Negative test at the end of 14 days of isolation.
If the test is still positive at 14 days, extend isolation to 21 days and repeat testing at the end of 21 days.
Home Triage Protocol
Dr. Vikas Deswal, Dr. Sushila Kataria, Dr. A S Soin, Dr. Yatin Mehta