Protective Methods:
Settings and Designs-
- Provide proper, timely information and capacity
building among healthcare personals for being prepared for self
protection and testing if required, addressing the fact that an
infected symptomatic/asymptomatic healthcare personal can spread the
infection to colleagues , household members , public as well as non
infected patients of NCD etc.
- Establish and implement using regular guidelines of
wearing proper mask of safety standards as well as
changing it as per guidelines, other PPEs, social distance when
possible, WASH guidelines for sanitation-hygiene, good nutrition,
proper sleep and stress reducing measures, sanitizer or soap use as
per availability. Infection control training must be provided to all
HCWs. Must know steps and order of wearing and removing
personal safety gears – see Table 2 Applying different level of
protection for HCWs working in different settings see Table 1
- Avoid touching source of entry of covid-19 i.e. eye,
nose, mouth during working hours at hospital and if possible after
duty too. Inform timely if you have symptoms and with isolation take
proper treatment as per standard guidelines. During isolation don’t
forget to disinfect cloth etc. Nutrition is very important to help
body have sufficient energy to fight hence have a proper balance diet
with special recommendations. If you are not expert avoid self
medication and contact expert.
- Maintain daily disinfection of all surfaces of
hospital area with disinfectants. The virus may persist on surface for
several hours. For ward protection divide ward in
different areas – see Figure2 Conceptual scheme of
workplace protection for healthcare workers (HCWs). The green arrows
show the direction of movement of the HCWs; the red arrows show the
direction of movement of the coronavirus disease 2019 (COVID-19)
patients. The entrances to all rooms were marked with specific signs
warning the HCWs to move in the right direction. Patients testing
positive for COVID-19 were directed to the quarantine ward/ICU/other
wards as per triage considerations they were placed in
different isolation rooms/wards for further treatment. The
clean area comprised the office where the medical
staff worked, and measures were taken to prevent the virus from
entering this area. The disinfection room was the place where the HCWs
disinfected their personal belongings (cell phone, watch, and so on)
and performed hand hygiene. The preparation room was the place where
the HCWs dressed in appropriate personal protective equipment (PPE).
The negative pressure operating room was designated for the surgical
treatment of COVID-19 patients, and it is an effective measure to
control the source of infection and block the route of transmission.
- Key questions - does the work setting require close
contact with covid-19 infected confirmed cases? Do specific job duties
require close repeated or extended period of contact with covid-19
cases? Is there community spread of the virus in the workplace? Will a
worker paid if quarantined? What can be done for workers who have no
paid sick leave? How to ensure free of cost treatment to healthcare
workers particularly having low wages when government have fixed daily
treatment cost at several thousand per day in private facilities?
Other impacts? Why the expired healthcare workers families have not
yet received the benefits announced by the government?
- Rapid identification and isolation of covid-19 cases
to ensure symptomatic workers are not in public places, relaxing
room/waiting rooms, reception areas, emergency departments or other
common places used by healthy workers. Fresh joining health worker
history of travel etc and test must be done for covid-19 before
joining for isolating infectious cases.
- Gathering at workplace should be avoided to reduce
potential of exposure. Contact tracing of cases at workplace,
containment, education, communication for mitigation of further
problems. Restriction on public events like birthday etc at workplace.
- Proper ventilation, plastic shields, sneeze guards, masks, N-95,
respirators as per need of the work with training and drills.
- Allow sick worker to stay home and limit number of staff present for
high potential exposure tasks. Period check up of health workers for
assessing physical, mental and social well being should be done on
routine basis.
- Protection of workers right such as safety standards, regular
supply of PPE etc.
Discussion- Covid-19 infection presents with multitude of symptoms such
as fever ,cough, shortness of breath, sore throat, runny or stuffy nose,
body ache, pain abdomen, shivering/chills, fatigue, gastrointestinal
upset/diarrhoea, anosmia, anorexia, nausea, vomiting. In more severe
cases breathing difficulty/shortness of breath, persistent pain or
pressure in the chest, confusion, and signs of CNS involvement, cyanosis
(bluish lip or face). Covid-19 must be differentiated from seasonal-flu
and other respiratory diseases of upper and lower respiratory tract
through clinical sign / symptoms and laboratory investigations. CFR is
more for covid-19 as compared to seasonal flu. Treatment is mainly
supportive and symptomatic.
HCWs with high potential for exposure- covid-19 ward duty, laboratories
testing covid-19 samples, autopsy work, bronchoscopy, sputum induction,
dental procedures of covid-19 cases, aerosol generating procedures,
ambulance workers carrying covid-19 cases and dead bodies of covid-19
patients, housekeeping workers of covid-19 wards and ICU facilities
should be protected at any cost to ensure the continuous delivery of
health services.