Limiting the Introduction of COVID-19 in Healthcare Settings COVID... · 2 days ago · Limiting...
Transcript of Limiting the Introduction of COVID-19 in Healthcare Settings COVID... · 2 days ago · Limiting...
Limiting the Introduction of COVID-19 in Healthcare Settings
2nd July 2020
Dr. Namita JaggiChairperson, Lab services and Infection control & Chief, Education & Research, Chair, ICC &AMSCArtemis Hospitals, GurugramHaryana, India
Artemis Hospitals
• A 400 plus bedded Tertiary care state-of-the-art Multispeciality Hospital located at Gurugram, India• 12 Centres of Excellence• Accreditations: NABH (2010), JCI (2012), NABL (2012), Green OT (2016), NABH Nursing Excellence
(2016)• Employees-1987. 805 nurses, 389 doctors ,306 paramedics and 487 administrative .AWARDS• Kayakalp Award for Excellence in promoting cleanliness , hygiene and infection control- 2019• D.L. Shah Quality Silver Award – For the case study End to End Care Delivery – 2019• FICCI Healthcare Excellence Award for Service Excellence- 2018• Best Super Specialty Hospital in Delhi – NCR- 2017 • Healthcare Transformation Awards – Mobile Innovations in healthcare- 2017• WHO Asia Pacific Hand Hygiene Excellence Award-2010-2011• Most Promising Startup of the year- 2007
DisclosureI have no financial relationships with commercial entities producing healthcare related products and/or services.
Disclaimer The content of this presentation draws from the recommendations in the WHO , CDC , APSIC and the Indian- HISI , ICMR and MOHWF . The content is subject to revision as new evidence on COVID -19 becomes available
Break
The
Chain
Visitors
Healthcare Staff
IPD
Clinics
Ambulatory care Centers (e.g. Dialysis)
Hospitals
OPD
Objectives
Patients1) To display COVID -19 statistics of the world and India as of today .
2) To outline the present state of preparedness in India
3) To present the strategies undertaken in Artemis Hospital ,India to limit the introduction of COVID -19 in Healthcare settings from Visitors , Patients ( Out patients and In patients ) and Healthcare workers
Where are we as on 2nd July 2020?
World• Total cases-10,811,206 (0.13% of the population of 7.8
billion is affected ), 90,000 HCW infected (.83%)• Deaths- 5,19,095• Recovered- 6,033527Mortality- 4.80%
Haryana• Confirmed- 14,941• Active- 4,202• Recovered- 10,499• Deaths- 240Mortality- 1.61%
Delhi• Confirmed- 89,802• Active- 27,007• Recovered- 59,992• Deaths- 2,803Mortality- 3.12%
At ArtemisTotal Tests : 1889Total Positives: 190 (10.05%)25 HCW ( 15 in Hospital ).7%Mortality: 11 (5.78% out of total positives)
India• Confirmed-6,05220.( 0.04% of the population of
1.3 billion ) ,60% cases in the <60 yrs . 2000 HCW infected (.33%)
• Active- 2,27,718• Recovered- 3,59,896• Deaths-17,848Mortality- 2.95%
89,802Delhi
33,318Gujarat
1,80,298Maharashtra
94,049Tamil Nadu
24,056Uttar Pradesh
Gurgaon• Confirmed- 5,463• Active- 1,292• Recovered- 4,079• Deaths- 92Mortality- 1.68%
COVID hospital
COVID Health care centre(Mod)
COVID care centreMild and v Mild )
Artemis Hospital
Dedicated COVID beds
Total 900 2,040 8,708 1 -
Total beds
1,79,882
1,29,689
4,93,101
400 100
ICU beds
19,272
10,349
- 103 16
Isolation beds
1,60,610
1,19,340
- 19 16
Indian Healthcare: A Snapshot
• Doctor: Patient Ratio-0.77:1000. WHO -1/1000
• Nurses ratio :1.7:1000 WHO 3/1000
Government Initiatives
Total Population: 1.3 billionTotal States- 28 States + 8 Union
Territories• Nationwide Lockdown for 68 days
(25th March- 31st May 2020)• Quick upgrade of Health
infrastructure- Hospitals & Testing labs
• Rapid Response team- Special task force designed by ICMR https://www.icmr.gov.in/crrteam.html
• Vande Bharat mission- 30,000 Indians brought back from 40 countries
• Guidelines by MoHFW on COVID 19 testing, case Management, Infection control, Quarantine, BMW etc.-Regularly updated
• Mitigating inevitable hardships-Pradhan Mantri Gareeb Kalyan Yojna-food for needy
• Medical insurance cover of Rs 5 million per healthcare worker
• INR 1.7 trillion (~USD 22 billion) relief package
• Economic stimulus measures• Aarogya Setu App
Healthcare Facilities
India Haryana
Total hospitals 81,447 2,148
Govt. hospitals 37,960Primary- 35,467Secondary- 2,258Tertiary- 235
668
Private hospitals 43,487 1,480
Dedicated Health facilities in India for COVID 19
Manpower
MagnitudeMagnitude of operational COVID testing labs• Total labs - 1047• Government labs – 760• Private labs – 287• Total samples tested up to June 29, 2020 –
83,98,362 (Upto 2 Lakh samples/day) Antigen testing started few days back. ( 7.1%)
23 lakh people quarantined in Armed forces facilities , govt centers , Hotels ,
• Transmit or acquire infection .• Discouraged /Restricted esp older
visitors and High risk patients • One attendant per patient at a time.• Movement within the healthcare facility
restricted. • No vendors allowed .• Encouraged to speak on telephone • Not allowed entry if suffering from fever
, cough or shortness of breath or directed to a fever clinic (separate entrance ).
• Hand hygiene , masking and social distancing .
ManagementVisitor Management
Thermal
ScreeningScreening through
Questionnaire
Screening
Separate entrance for Visitors
Social distancing Hand hygiene &
Masking
Education and training Visual Alerts
• Visual alerts, such as banners, boards and standees have been placed for awareness of visitors on sign and symptoms of COVID-19 including instructions on who to notify if they develop symptoms
• Respiratory etiquette and hand hygiene
Education and training : By the infection control nurses
Trainings imparted on• Appropriate use of mask
and PPE • Hand hygiene, Respiratory
etiquette• Limit touching of high
touch surfaces • Social distancing• Movement within the
facility
Educational brochures
Patient Management-Out Patient
Rapid triage , Rapid identification and Rapid Isolation .
Restricting Patient visit to Hospital
Online Consultation
3rd floor
ICU Wards
ICU Wards
ICUWards
ICU Wards
Fever Clinic(Screening)
Emergency(Suspected/confirmed COVID cases)
Sample collection
Main entry
OPD( Non-COVID area)
Dedicatedlift
DedicatedLift
Pre-operative suspected
Non-COVID area
COVID area
Symptomatic patient
Positive patient
Symptomatic patient
OT
Emergency surgery
Pre-Operative patients
Elective Surgery
Grey corridor
Suspected patient –This way Home
IsolationMild symptomatic
Screening
If -ve If +ve HomeIsolation
Negative patientNegative patient
Hand Hygiene
Social distancing
Masking
Respiratory etiquette
Fever Clinic
Holding
area
Screening Room
Transfer to suspected
area
Sample collection
Testing strategy
Newer Additional Strategies 23/06/2020
•Rapid Antigen detection test – Need of the hour (chromatographic immunoassay for qualitative detection of antigens to SARS-CoV-2.)•Standard Q COVID-19 Ag detection assay.•This test only takes 15-30 minutesRT PCR App
Public Health authorities
In- patients• AIM :Infected patients should not pose a risk to other patients and
healthcare workers .
• Arrive by grey corridor . Zoning followed .
• Guidelines -MOHWF ,ICMR followed
• Clinician initiated – Testing Rapid antigen test /RTPCRand information sent to public health authorities .
• Droplet and contact precautions .PPE ,Negative pressure ,• No movement into other zones .Portable X-rays , Ultrasound ,Dialysis
.Separate timings for visit to diagnostic areas . Cleaning . Staff in PPE . Patient masked .
• Continuing education of Clinicians
Identification & Management of Healthcare workers with COVID -19 – Active strategy
• Aim :Prevent exposure of at- risk patients and staff to symptomatic COVID positive healthcare workers
• Healthcare workers Education . Masking , Social distancing , PPE Respiratory etiquette and hand hygiene .
• Self assessment by healthcare workers Encouraged to report .
• Screening of all healthcare workers at entry in each shift .
• Healthcare workers reporting of breach of PPE .Risk assessment by quarantine committee.
• If sick - leave, admission to hospital and other support is provided . No punitive action or salary cut .
Algorithm for Exposure of HCWs to COVID-19 patient
Based on the MOHWF guideline
Non-COVID area
ICU Wards
ICU Wards
ICUWards
ICU Wards
Fever Clinic(Screening)
Emergency(Suspected/confirmed COVID cases)
Main entry
OPD( Non-COVID area)
DedicatedliftDedicated
Lift
Pre-operative Suspected
COVID area
OT
Grey corridor
Screening
Location wise distribution of Infected Healthcare workers
Nurse Coordinator
Doctor
Others (Billing staff, Security)
Total Healthcare workers infected- 25 (All June cases)Hospital exposure- 15.
Chemo day care Nurse
OPD Nurse
SecurityIPD Billing PCSOPD Billing PCS
Trainings
Security
Food & Beverage
COVID Ward
ICU
Online Trainings
PPE Donning & Doffing
Mock drill team
Fight with COVID-19 at Artemis?
20th Jan 2020- Alert Raised for nCoV epidemic by e-mail and lecture taken for all HCW .
27th to 29th Jan 2020- Training imparted to 64 staff posted at point of entries
30th January 2020- Mock Drill on Preparedness for nCoVepidemic . Ist case in India – Kerala .
31st January - 1st February 2020- Sample collection Training at ICUs and 3rd B
Feb 2020- Mass Education and awareness Videos
March- Guidelines released for Case definition, BMW management, Sample collection and testing strategies,
PPE usage etc
April- COVID Action Plan released, Healthcare worker and Patient Safety Guidelines, BMW management rules
amended. Ist case in Artemis on 2nd
May and June Antigen testing - Shortage of Supplies: Reuse of mask and face shields
Geared up for
the Battle…
……
Together let’s fight
COVID-19
THANK YOU
Resources• CDC. Operational Considerations for Containing COVID-19 in non-US Healthcare
Settings https://www.cdc.gov/coronavirus/2019-ncov/hcp/non-us-settings/index.html
• CDC. Management of Visitors to Healthcare Facilities in the Context of COVID-19: Non-US Healthcare Settings https://www.cdc.gov/coronavirus/2019-ncov/hcp/non-us-settings/hcf-visitors.html
• World Health Organization https://www.who.int/health-topics/coronavirus#tab=tab_1
• Indian Council of Medical Research, New Delhi https://www.icmr.gov.in/pdf/covid/strategy/Testing_Strategy_v5_18052020.pdf
• COVID19 India: National Centre for Disease Control (NCDC) https://ncdc.gov.in/index4.php?lang=1&level=0&linkid=132&lid=549
• Ministry of Health and Family Welfare https://www.mohfw.gov.in/• Situation update for World- https://www.who.int/emergencies/diseases/novel-
coronavirus-2019/situation-reports/?gclid=EAIaIQobChMIm9jd8NWm6QIVmXwrCh3nqQDpEAAYASABEgLCJvD_BwE
• Situation update for India- https://www.covid19india.org/