Centre issues fresh guidelines on detection of Coronavirus cases in non-COVID hospitals

The Union Health Ministry has released a new set of guidelines to be followed on the detection of suspect/confirmed COVID-19 cases in non-COVID hospitals and other centers. There have been reports of hospitals being shut after a few healthcare workers (HCW) working there turned out to be positive for COVID-19. Also, some non-COVID health facilities have reported COVID-19 cases in patients admitted for unrelated/nonrespiratory illness, causing undue apprehension among healthcare workers.

Although the Ministry had issued comprehensive guidance to prevent the occurrence of Hospital Acquired Infection (HAI) in health facilities, the practise of universal precautions might still be lacking in many of our hospitals, the Ministry has observed. 

A COVID-19 case with mild/asymptomatic/atypical 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.

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HICC to monitor infection prevention norms

The guidelines are intended for both — COVID-19 healthcare facilities (public and private) as well as non-COVID ones. Under those guidelines, Hospital Infection Control Committees (HICC) has been given the responsibility to handle the situation.

"This committee will ensure that HCWs are properly oriented with infection prevention norms. Authorities need to be informed if anyone is infected and those must be kept under isolation in the same hospital. Only one dedicated HCW should look after the patient with all the necessary precautions," Joint Secretary for Health, Lav Aggarwal told media on Tuesday.

Move to COVID centre, quarantine close contacts

The Ministry said a person tests positive, he/she shall be moved to a dedicated COVID centre with all safety precautions and all those who came in contact with the person must be put under a 14-day quarantine. Their details must also be shared with the local health authorities. 

All close contacts (other HCWs and supportive staff) of the confirmed case should be put on Hydroxychloroquine chemoprophylaxis for a period of seven weeks, keeping in mind the contraindications of HCQ, the Ministry says.

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When a suspect/confirmed COVID-19 HCW is identified

If HCWs are suspected/confirmed COVID-19 cases, the aforementioned protocol has to be followed. The worker should be immediately taken off the staff roster. All healthcare facilities (HCF) must have a staffing plan in place including a contingency plan for such an event to maintain continuity of operations.

Staff in HCF can be divided into groups to work on a rotation basis every 14 days and a group of backup staff which is pooled in case some high-risk exposure/HCW with suspected COVID-19 infection is detected, the Ministry has recommended.

The Ministry has observed that there could be two likely scenarios after single/multiple cases are reported at non-COVID facilities based on which decision on whether to continue operations there will be based.

Socio-demographic reasons:

• Hospital’s catchment area is a large cluster of COVID-19.
• Catchment area is having a population which has a large number of vulnerable individuals having multiple co-morbid condition, poor nutritional status and/or having individuals not able to practice social distancing e.g. slum clusters.

Internal Administrative Reasons:

• The health facility is not up to the mark in IPC practices.
• Non-fulfillment of guidelines regarding the triaging of patients in the outpatient department and emergency.

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Risk assessment

Based on the scope of the cluster and degree to which the hospital has been affected (HCW patients and HCW contacts), degree of the risk to the patients visiting the hospital such as those with chronic diseases, etc. the decision can be made based on a risk assessment.

• If the hospital authorities are reasonably satisfied that the source case/s have been identified and isolated, all contacts have been traced and quarantined and adequate disinfection has been achieved, the hospital will continue to function.
• In addition to steps taken above, if the health facility still continues to report new hospital-acquired COVID-19 cases in the following days, it would be advisable to temporarily close the defined section of the health facility where the maximum number of HAI is being reported. After thorough cleaning and disinfection, it can be put to use again.
• Despite taking the above measures, if the primary source of infection could not be established and /or the hospital is still reporting a large number of cases among patients and HCWs, a decision needs to be taken to convert the non-COVID health facility into a COVID health facility under intimation to the local health department. In such a scenario, the entire healthcare workers of the facility should be oriented in Infection Prevention and Control practices and other protocols.

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(PTI Photo)