General Advisory for Hospitals

The medical infrastructure in the country needs to be prepared for any possible influx of patients on account of COVID 19. These will be reviewed as per the evolving situation. It is mandatory for all hospitals (public/private) to notify persons with Covid 19 affected persons (defined in attached annexure) to concerned district surveillance unit.

Covid 19 case definitions:

Suspect Case:

Patient with acute respiratory illness (fever and at least one sign/ symptom of respiratory disease (e.g., cough, shortness of breath) AND a history of travel to of residence in a country/area or territory reporting local transmission (See NCDC website for updated list) of COVID-19 disease during the 14 days prior to symptom onset;

OR

Patient / Health care worker with any acute respiratory illness AND having been in contact with a confirmed COVID-19 case in the last 14 days prior to onset of symptoms;

OR

Patient with severe acute respiratory infection (fever and at least one sign/symptom of respiratory disease (e.g., cough, shortness breath) AND requiring hospitalization AND with no other etiology that fully explains the clinical presentation;

OR

A case for whom testing for COVID-19 is inconclusive

Laboratory Confirmed case:

A person with laboratory confirmation of COVID-19 infection, irrespective of clinical signs and symptoms.

Indoor Facilities:

  1. Non-essential elective surgeries should be postponed.
  2. Some beds should be set apart and prepared for creating isolation facilities.
  3. All hospitals should mobilize additional resources including masks, gloves and personal protection equipment.
  4. All doctors, nurses and support staff in different specialities, including pre and para clinical departments, should be mobilized and trained in infection prevention and control practices.
  5. Hospitals must procure sufficient numbers of ventilators and high flow oxygen masks in preparation for future requirements.
  6. All hospitals must ensure that they have adequate trained manpower and resource pools for ventilator/ ICU care.
  7. Hospitals may ensure that stable patients are discharged as early as possible while further new admissions (of stable patients) are also restricted.
  8. Number of patient attendants should be strictly restricted to ‘one’ only.

IEC Activities:

  1. Patients must be educated about cough etiquette, Do’s and Don'ts, proper use of masks instead of using them indiscriminately and inefficiently; and personal hygiene. Hospitals should put up posters etc. to increase awareness amongst patients on Do’s and Don’ts regarding COVID 19.
  2. Patients must be counselled against attaching any kind of stigma to Corona virus patients or to facilities where such patients are admitted. They must be made aware that quick disclosure of symptoms and undergoing testing if advised is the surest way of battling COVID 19.

Administrative:

  1. All hospitals should carry out a preparedness drill.
  2. No suspected COVID 19 patient should be turned away from any hospital and the admission of any such patient should be notified.
  3. Similarly, all pneumonia patients must also be notified to NCDC or IDSP so that they can be tested for COVID 19.
  4. Hospitals to ensure social distancing in their premises.
  5. All unauthorized/authorized shops (excluding pharmacies) and eateries in the vicinity of hospitals should be compulsorily shut.
  6. Leave of all kinds (except under emergency and unavoidable circumstances) may be cancelled immediately.

OPD:

  1. All patients may be advised not to come for routine visits to the OPD if it can be avoided or postponed.
  2. At the entrance to the hospital, there should be team of HCWs with Non-touch thermometers checking the temperature of each person.
  3. All patients with fever (temp >38 celsius) should be asked to attend the special “Fever Clinic” which should be located at an area of the hospital away from routine OPD
  4. Staff attending the “Fever Clinic” must have received specialized training, provided with appropriate PPEs, and should be from a fixed group of HCWs.
  5. Patients suffering from other chronic diseases and minor ailments may be advised to either defer consultation or utilise OPDs in a different area of the hospital.