Advisory for Managing Health Care Workers Working in COVID and
Non-COVID Areas of the Hospital
[MoH&FW (EMR Division)/18.06.2020]
1. Background
2. Purpose of the document
3. Institutional Mechanism for preventing and
responding to Healthcare Associated Infections (HAIs) among HCWs
4. Action for Healthcare Workers
5. SOP for health work force deployment during
COVID-19
5.1 SOP to be followed in case HCW reports
exposure/breach of PPE
5.2 SOP to be followed in case HCW reports
symptoms suggestive of COVID-19
5.3 Regular quarantine of healthcare workers
after performing duty in COVID-19 areas
1.
Background
The
health care personnel working in hospitals are at increased risk of acquiring
the COVID-19 disease, if there is a breach in the personal protection while
managing patients.
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.
2.
Purpose of the document
The
purpose of the document is to provide guidance on preventive measures,
isolation and quarantine of health care functionaries.
3.
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 trainings 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 chemo-prophylaxis under medical supervision.
v. Provisions have
been made for prompt reporting of breach of PPE by the hospital staff and
follow up action.
4.
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.
5.
SOP for health work force deployment during COVID-19
5.1
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 possible breach of PPE
·
Performed aerosol generating procedures
without appropriate PPE.
·
HCWs without mask/face-shield/goggles:
o having
face to face contact with COVID-19 case within 1 metre for more than 15 minutes
o having accidental exposure to body fluids
·
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:
·
For doctors, nursing officers and other
health workers with high risk exposure, the quarantine period shall be
initially for one week only.
·
Thereafter taking profile of such doctors,
nursing officers and other health workers, a decision shall be taken by the
Nodal Officer/Head of the Department (or his appointed Sub-committee) for
further period of one week.
·
After a week, they shall be 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/pre- symptomatic
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.
5.2
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.pd.
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).
5.3
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.