*Covid 19 pandemic* *Strategies for crowded OPDs*

At the moment the disease Covid 19 is in stage 2 in India. Community transmission has not yet documented so far. But surely will happen this week or in next couple of weeks..

To “‘flatten the curve” strategy countries are coming up with drastic measures including lockdown of cities and towns. In India most states don’t allow any small or big gathering.

What about our OPDs in government hospitals and smaller hospitals, nursing homes and private clinics ? Any guidelines available for this?… kindly share if you have any…

*Here are few suggestions :-*

*1)* we should never allow more than 5-10 people at any given time waiting for their turn in the OPD halls.. patients need to sit in the OPD at their alloted time slot given by the receptionist

*2)* Discourage healthy patients from coming to clinic for routine check up/ immunizations for next 2 weeks

*3)* Among the mildly sick patients allot a different time & a separate place to sit for patients with features of a respiratory( flu-like) illness ( _patient identification & triaging_ )

*4)* Encourage your patients to call up over phone for any mild respiratory illness .. many can be treated with simple remedies…( hopefully we’ll be protected from medicolegal issues of phone consultations)

*5)* Limit the number of persons who accompany the patients to the OPD clinics. _No senior citizens to accompany patients to the OPD…_

*6)* No medical representatives to visit doctors for two weeks…

*7)* No visitors for the inpatients

*8)* Avoid crowding at near-by canteens/ pharmacies while waiting ..

*9)* Patients to wash their hands with soap and water before entering the OPD hall.. _patients with cold, cough to wear mask,_ having posters of hand hygiene ,cough etiquette, corona disease, _warning about asymptomatic carriers_ , pasted at appropriate places in the hall..

*10)* . Encourage cashless transactions. People at cash counters to frequently scrub hands with sanitizers/ sterilium

*11)* Having a person standing at the entrance spraying sanitiser/ spirit over the hands of all who come to the OPD…

*12)* Focus on cleaning in OPD ( Use 1% hypochlorite solution freshly prepared) *-* Every 4 hrs: railings, doorknobs, surfaces (reception desk, doctors table)   *-* Floor every 24hrs  *-* Stethoscope and thermometer (prefer axillary) between every patient

*13)* All doctors in OPD and front desk receptionists, nurses to wear a mask 

*14)* Doctors , nurses to wear theatre clothes in the OPD, change dress when going home , clean fomites ( Mobile phones, stethoscope) before going home)

*15)* Having a well ventilated OPD waiting hall – shift to open air OPD if possible

*16)* Extending the OPD timings so as to avoid overcrowding

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