Covid times

Dear Friends,

Corona Virus is here to stay for quite some time, and so we have to change our ways of Medical Practice, to keep ourselves , our families and our staff safe. Here are some important tips for safe practice , though every one can add or modify to some extent, depending upon his type of practice and specialization.

OPD

1. Your Receptionist/ front desk person is most important. He should be properly trained. He has to be there with N 95 mask, Face Shield, gloves, cap and a smart phone. This much is also mandatory for yourself and staff alike.

2. Try to make your practice appointment based. Put a limit on the number of patients. Receptionist should take a brief history of travel, symptoms, family history etc. pertaining to Covid and then give appointment to those only who fit into your criteria, with time limitations.

3. The chronic patients should transfer their records to you digitally through your Reception so that you read them without touching.

4. Receptionist should ask patients to come with only one attendant and report their arrival telephonically. He should ask them to step in when their term comes.

5. You can do history part and complaints by video calling and then call the Patient inside for examination when necessary. This will reduce the interaction time and viral load.

6. Don’t keep cloth sheet on examination couch. Have a Plastic or rexene cover only. It can be surface cleaned by 1% solution of sodium hypochlorite and is ready for next patient after 10 minutes. .

7. Instruct for face mask and hand sanitization for everyone entering your Hospital.

8. Keep the door open so that no one touches door handle.

9. Sanitise/ wash your hands after examining every patient with gloves on. Sanitise your tools
also with 1% hypochlorite solution every time.

10. Try finish all your OPD and rounds in single sitting. After that Sanitise your table chair etc
with 1% hypochlorite solution .

11. Allow only single attendant with patient at a safe distance. While examining patient, go from
back side.

12. Always use fresh paper for prescription.

13. For cash prepare three gullacks with key. Let the patient count money and put directly in it.
Open it after minimum 72 hours. The virus may stay on currency upto 72 hours.
INDOOR AND OPERATIVE

1. Admit only if very necessary. Allow only single attendant with patient and not rotary attendants. Explain the rules to follow strictly.

2. Have full investigations including Covid. If patient refuses for Covid investigation, document it and take his signature. If patient refuses for signature, document it and put your signature and one staff as witness. Very important.

3. If any operative procedure is necessary, besides taking full informed consent, take consent that if patient turns out to be Covid positive later, he has to be shifted to Covid designated Hospital.

4. Try to do minimal invasive procedure e.g. pop, Kwires External fixation, mippo etc. Avoid power tools which generate maximum aerosols. Use hand reamers and hand drill. Low speed drilling to be done.

5. If operation has to be done essentially, treat patient as Covid positive, do whatever minimum necessary is possible with full precautions as you do for Hepatitis B C or HIV positive patient.

6. Avoid GA.Prefer Regional anaesthesia. Even if GA necessary, avoid Intubation . Use deep sedation, local and ketamine etc.

7. If intubation is very necessary, only Anaesthetist with one assistant should be in OT. Surgeon and others should enter OT after 15 minutes of intubation. Same way after completing operation , surgical team should move out and join only 15 minutes after intubation.

8. The patient should be kept in OT a little longer, till he is fully conscious and then transferred to his room directly, which should be a single room. Only after Covid report comes negative, the patient should be shifted to General Ward.

9. Full surface cleaning of OT should be done by 1% solution of sodium hypochlorite .leave it for half hour. Repeat again and then carbolic acid. Next case should be taken into OT atleast 2 hours after first case leaves. If possible more.

10. Surface sanitization of wards with 1% sodium hypochlorite solution should be done every 2 hours, depending upon the patient footfall.

11. Negative pressure and laminar flow OT,s are not safe. Have a positive pressure OT if possible. Window AC is good. Exhaust with hepa filter at outlet is desirable.

12. Put the Instruments in bleaching powder/ sodium hypochlorite solution for half an hour, then wash with detergent before autoclaving.
HOSPITAL ECONOMY IN COVID TIMES

Your expenses will increase in the upkeep of your Hospital. I suggest to increase your charges by 15% to 20% depending upon the patient footfall in your Hospital. That will take care of your increased expenses.

Thanks &Regards
Dr. AK Sirohi
President IMA Uttarakhand

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