NEW DELHI: The Union health ministry in an advisory has suggested hospitals located in and around COVID-19 containment zones to treat all patients coming to them as suspected cases of coronavirus infection until proven otherwise and exercise standard care.
According to a ministry official, patients coming from containment areas should be tested for infection even if they do not show any symptom of COVID-19.
A COVID-19 case with mild or asymptomatic presentation may go undetected and inadvertently transmit the infection to other patients and healthcare workers, putting these individuals at risk of contracting disease and compromise the functionality of the healthcare facility, the ministry said while issuing guidelines to be followed on detection of suspected or confirmed COVID-19 case in a non-COVID health facility.
There have been some instances of hospitals having closed down as few health care workers (HCW) working there turned out to be positive for coronavirus infection.
Also some non-COVID health facilities have reported confirmation of COVID-19 in patients admitted for unrelated or non-respiratory illness, causing undue apprehension among healthcare workers, sometimes leading to impaired functionality of such hospitals, the ministry said.
Underlining that although comprehensive guidance to prevent occurrence of hospital acquired infection in health facilities were issued, "the practice of universal precautions might still be lacking in many of our hospitals", the ministry noted.
"As a matter of abundant precautions for hospitals located in proximity/catering to COVID-19 containment zones it might be desirable to treat all patients as suspect COVID-19 case until proven otherwise and exercise standard care," the ministry stated.
It stated that all infection prevention control guidelines should be strictly adhered to and followed at all times.
According to the guidelines, all close contacts of the confirmed case should be put on Hydroxychloroquine chemoprophylaxis for a period of 7 weeks, keeping in mind the contraindications of the drug.
The guidelines state that when a non-COVID health facility reports a coronavirus positive case, the Hospital Infection Control Committee (HICC) will ensure that active screening of all staff at the hospitals is done daily while encouraging all healthcare and supportive staff to monitor their own health at all the time for appearance of COVID-19 symptoms and report them at the earliest in order to minimize the possibility of an undetected contact/case amongst other patients/HCWs.
"Be on the lookout for atypical presentation (or clinical course) of admitted patients.
Follow all guidelines regarding triaging of patients in hospital emergency and outpatient departments," the guidelines stated.
All health facilities (HCF) must have a staffing plan in place including a contingency plan for such an event to maintain continuity of operations.
For example, staff in health facilities 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.
It also called for ensuring that the disinfection procedures are strictly followed.
When a coronavirus positive patient is identified in a health care facility, not designated as COVID-19 isolation facility, officials should Inform the local health authorities about the case, assess the clinical status of the patient prior to referral to a designated COVID facility and 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, following due precautions.
Complete case records of such patients must be made available to the receiving hospital and appropriate standard precautions while transporting the patient should be followed.
This should be followed by disinfection procedures at the facility and the ambulance.
Also, all contacts of this patient (other patients being managed in the same room or ward, healthcare workers who have attended to him/her, support staff who may have come in close contact, caretaker/visitors etc.) should be quarantined and followed up for 14 days.
"Once a suspect/confirmed case is detected in a healthcare facility, standard procedure of rapid isolation, contact listing and tracking disinfection will follow with no need to shut down the whole facility," it said If the hospital authorities are reasonably satisfied that the source cases have been identified and isolated, all contacts have been traced and quarantined and adequate disinfection has been achieved, the hospital will continue to function.