08/05/2020
Beautiful post by Dr Arup Halder.
I am sharing it here coz it might also be helpful for paramedics and chamber assistants.
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What we may follow in our personal chamber 'post lockdown ' ?
The personal chambers will be opened post lockdown . We have many questions in our mind how we can run our chambers amidst COVID 19 pandemics ? The virus is so infectious that it is impossible to evade an infection possibly for us. Still we can adopt few measures to keep everyone safe. Though we know everything will not be viable in all set ups. The extra economical burden of safety measures, the logistics in each chamber will have different implications for different healthcare providers. But here is an attempt to formulate a rough idea.
Methods of spread of infection:
1. Droplets
2. Contact
3. Aerosol
Who should be protected:
1. Patients
2. Assistants
3. Relatives
4. Doctor
5. Family
Basic principles
1. Minimum gathering
2. Minimum waiting
3. Patient segregation
4. Minimum physical visits
5. Minimum touch
Strict rules for first 2 months, then according to circumstances.
Appointment:
1. Over phone
2. Preferably over WhatsApp
3. Brief history of fever/ cough/ respiratory distress/travel/ contact/ healthcare workers/ family history ( preferable to fill it up before alloting time)
4. 10 to 15 minutes for each patients and slots according to that
5. All suspects should be alloted to last half of consultation
6. If the doctor and patient both agree all patients may go for tele consultation from suitable platforms
7. All patients should wear masks
8. Only one companion will be allowed. The same details should be filled up for the companion also with name and phone number. The companion should ware masks also.
9. The patient should strictly follow the consultation time, otherwise, may be subjected to cancellation of appointments.
10. For showing reports patients' companions would be preferable along with the prescriptions
11. All patients and companion should be instructed to take care of their personal safety measures.
Reception:
1. The receptionist should be in PPE
2. All patients and companion will be screened with thermal gun
3. There should be adequate physical distancing within the in reception area
4. There should be area for hand washing and sanitizer for patients and companion after arrival, before consultation and after consultation
5. All reports and prescriptions should be ready at hand before consultation
Chamber and consultation:
1. The doctor should be in PPE
2. If possible the table of consultant should be surrounded by a transparent plastic curtain hanging from above, so that communication and vision are not hampered, at the same time providing a barrier between patient and consultant.
3. The measurement of blood pressure and other physical examination may be performed from a small covered window in that plastic curtain, the exposed and touched areas of patients should be sprayed with sanitizer.
4. All reports and prescriptions can be visualized accross the curtain and no need to touch.
5. The prescription will be handed over accross the window in the curtain.
6. The doctor should sanitize the hand after each consultation, and if suspected patients are consulted should change the gloves also.
7. It is preferable to use two sets of instruments for suspected and non- suspected patients.
8. There should be atleast 3 chairs in the consultation room. One chair for the companion and one for patient kept at least 2 meters apart. During physical examination patients should be invited to a closer chair behind the plastic curtain. The examination should be done turning the patient's face sideways.
9. After all consultations are finished the doctor should take a bath or thorough cleaning of limbs and face. He should leave the formal outside dress on arrival and keep it in a closed space. During chamber time he should be on scrubs. He should avoid any wrist watch, rings or ornaments. Seperate pens should be there in chamber. Any chamber items should not be carried home.
10. Mobile phones should be inside a transparent plastic packet, the packet should be discarded after all consultations. We should avoid picking up phones during consultation.
The following procedures should be avoided in chamber:
1. Nebulisation,
2. PFT
3. Sputum inductions.
4. If patients need ENT or oral examination the consultant should always be extra careful.
Personal protective equipments and cleaning of chamber:
1. Ideally there should be 3 sets of PPE for each persons
2. After all consultations the used PPE should be washed in 1% hypochlorite and soap water and air dried
3. The other dry set should be used for next day consultation.
4. There should be adequate gloves and surgical masks in the chamber.
5. The plastic curtain should be washed with alcohol based solution after all consultations
6. The floor and tables and furniture should be washed with hypochorite/phenol based or other suitable disinfectant.
7. All other instruments should be washed with alcohol based solution, if compatible.
8. If possible should go for a proper sanitization of the chamber periodically ( according to recommendations, if available in future)
9. All biomedical wastes should be discarded according to Government protocols.
Inspite of all the measures there will be high chances in health care providers to catch the infections. In case of suspicion should go for isolation and quarantine for 14 days, and test and treat himself according to the government guidelines.
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