Managing health care workers in COVID and Non-COVID areas of hospital: Health Ministry releases advisory

New Delhi: With the nation moving towards lockdown 4.0 and the government slowly mulling to open all healthcare facilities to the public, the Ministry of Health and Family Welfare has released Advisory for managing Health care workers working in COVID and Non-COVID areas of the hospital

The health care personnel working in hospitals are at increased risk of acquiring the COVID-19 disease if there is a breach in personal protection while managing patients, the advisory noted.

" The health-work force is a valuable and scarce resource. Large number of COVID-19 affected health personnel getting isolated for treatment and their close contacts undergoing quarantine affects the health/ hospital service delivery," it stated

With this background, the health ministry released a document to provide guidance on preventive measures, isolation and quarantine of health care functionaries. Following are its major recommendations

 Institutional Mechanism for preventing and responding to Healthcare-Associated Infections (HAIs) among HCWs

Hospitals shall activate its Hospital Infection Control Committee (HICC). The HICC in the health facility is responsible for implementing the Infection Prevention and Control (IPC) activities and organizing regular training on IPC for HCWs.

A Nodal Officer (Infection Control Officer) shall be identified by each hospital to address all matters related to Healthcare-Associated Infections (HAIs). With reference to preventing such infection among healthcare workers, he/she will ensure that: 

i. Healthcare workers in different settings of hospitals shall use PPEs appropriate to their risk profile as detailed in the guidelines issued by this Ministry (available at: https://www.mohfw.gov.in/pdf/GuidelinesonrationaluseofPersonalProtectiveEquipment.pdf and https://www.mohfw.gov.in/pdf/UpdatedAdditionalguidelinesonrationaluseofPersonalProtectiveE quipmentsettingapproachforHealthfunctionariesworkinginnonCOVID19areas.pdf )

ii. All healthcare workers have undergone training on Infection Prevention and Control and they are aware of common signs and symptoms, need for self-health monitoring and need for prompt reporting of such symptoms.

iii. Provisions have been made for regular (thermal) screening of all hospital staff.

iv. All healthcare workers managing COVID-19 cases are being provided with chemoprophylaxis under medical supervision.

v. Provisions have been made for prompt reporting of a breach of PPE by the hospital staff and follow up action

Action for Healthcare Workers

i. Ensure that all preventive measures like frequent washing of hands/use of alcohol-based hand sanitizer, respiratory etiquettes (using tissue/handkerchief while coughing or sneezing), etc. are followed at all times.

ii. He/she shall use appropriate PPE at all times while on duty.

iii. A buddy system* to be followed to ensure that there is no breach in infection prevention control practices.

iv. Any breach in PPE and exposure is immediately informed to the nodal officer/HoD of the department

v. HCWs after leaving the patient care units (wards/OPDs/ICUs) at the doctor's duty rooms/hostels/canteen or outside the HCF must follow social distancing and masking to prevent transmission to/acquiring infection from other HCWs who may be positive.

vi. Pregnant/lactating mothers and immuno-compromised healthcare workers shall inform their medical condition to the hospital authorities for them to get posted only in non-Covid areas  

*Buddy system: Under this approach, two or more-person team is formed amongst the deployed hospital staff who share responsibilities for his/her partner's safety and well-being in the context of (i) Appropriately donning and doffing of PPEs, (ii) maintaining hand hygiene and (iii) taking requisite steps on observing breach of PPEs. 

 SOP for health work force deployment during COVID-19

SOP to be followed in case HCW reports exposure/breach of PPE

All the Healthcare workers must report every exposure to COVID-19 to the concerned nodal officer and HoD of the concerned department immediately

The Nodal officer will get the exact details of exposure to ascertain whether the exposure constitutes a high risk or low-risk exposure as described below: 

• High-risk exposure:

• HCW or other person providing care to a COVID-19 case or lab worker handling respiratory

specimens from COVID-19 cases without recommended PPE or with a possible breach of PPE

• Performed aerosol-generating procedures without appropriate PPE.

• HCWs without mask/face-shield/goggles:

1 having face to face contact with COVID-19 case within 1 meter for more than 15 minutes

2 having accidental exposure to body fluid

• Low risk exposure:

Contacts who do not meet criteria of high risk exposure

The Nodal Officer/Head of the Department will form a sub-committee to assess the level of exposure and the risk as per assessment format at Annexure I. As per their assessment:

• High risk contacts will be quarantined for 14 days, tested as per ICMR testing protocol, actively monitored for development of symptoms and managed as per laid down protocol.

• If they test positive but remain asymptomatic they will follow protocol for very mild/mild/presymptomatic cases as described in para 5.2.1 (a) below. 

• If they test negative and remain asymptomatic, complete 14 day quarantine and return to work.

• Should symptoms develop, follow the guidance para 5.2.

• Low risk contacts shall continue to work. They will self-monitor their health for development of symptoms. In case symptoms develop, the guidance under para 5.2 would be followed.

 SOP to be followed in case HCW reports symptoms suggestive of COVID-19

5.2.1 If any healthcare worker who is manifesting signs and symptoms suggestive of COVID-19, he/she will be isolated immediately and the following procedure will follow: 

a. In case of mild/very mild/pre-symptomatic case, he/she will have an option of home isolation, subject to the conditions stipulated in the revised guidelines for home isolation of very mild/pre-symptomatic COVID-19 cases (available at: https://www.mohfw.gov.in/pdf/RevisedguidelinesforHomeIsolationofverymildpresymptomati cCOVID19cases10May2020.pdf). Such cases would end their home isolation as per timeline provided in the said guidelines.

b. In cases where home isolation is not feasible, such mild/very mild/pre-symptomatic cases will be admitted to a COVID Care Center#

c. Moderate cases that require oxygen therapy shall be managed at a Dedicated COVID Health Center#

d. Severe cases will be managed in a Dedicated COVID Hospital#

. For cases admitted COVID Health facilities, their discharge will be governed guidelines available at: https://www.mohfw.gov.in/pdf/ReviseddischargePolicyforCOVID19.pdf

# The details of categorization of health facilities as COVID Care center, Dedicated COVID Health Center and Dedicated COVID Hospitals along with categorization of patients (mild/moderate/severe) is available at: https://www.mohfw.gov.in/pdf/FinalGuidanceonMangaementofCovidcasesversion2.pdf. 

5.2.2 Those who test negative, will be managed as in non-COVID area as per their clinical diagnosis. Their resuming work will be based on the clinical diagnosis and the medical certification by the treating doctor.

5.2.3 For HCWs (with low risk exposure), who continue to work and develop symptoms:

• And test positive, further management would be based on their clinical presentation and as described in para 5.2 (1) (a) above

• Those who test negative, will return to work subject to medical certification for ailment

5.2.4 Discharge of COVID-19 positive HCWs will be in accordance with the discharge policy (available at: https://www.mohfw.gov.in/pdf/ReviseddischargePolicyforCOVID19.pdf).

 Regular quarantine of healthcare workers after performing duty in COVID-19 areas

Quarantine of healthcare workers, other than what is stipulated above is not warranted.

To read the full advisory click on the following link

https://medicaldialogues.in/pdf_upload/pdf_upload-128884.pdf

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