All isolation wards should have separate entry and exit and they should not be co-located with post-surgical wards or dialysis units and labour rooms.
Amidst the 21-day nationwide lockdown, India is stepping up its efforts to deal with the coronavirus outbreak and the setting up of isolation wards is one of its top priorities. Indian Railways is considering setting up isolation wards in trains for rural and remote areas.
Considering these efforts, here’s a look at what the Ministry of Health and Family Welfare has said about the logistics of setting up isolation wards.
What is isolation and why is it required?
Since COVID-19 is a highly contagious disease, it is important that patients tested positive for it and those who are suspect cases are kept separately, in designated facilities till the time they are tested negative for the disease. Further, patients with COVID-19 will remain hospitalised till the time two of their samples test negative for the disease as per MoHFW’s discharge policy. This is an important step since some individuals, even though they show no symptoms of the disease can still be carriers of the virus, which means they can still pass it on to others. Therefore, it is important to identify dedicated intensive care beds to isolate positive and suspected cases.
Indian doctors come out of an isolation ward after attending to people who returned from China and under observation at the Government Fever Hospital in Hyderabad. (AP Photo)
What does it take to isolate a patient?
According to the ministry, in resource-constrained settings, COVID-19 patients can be housed in a ward with good ventilation, with a minimum distance of one meter between two adjacent beds. Further, all such patients need to wear a triple layer of surgical masks at all times. Similarly, suspected cases can be housed in a separate ward with similar conditions. The ministry has cautioned that “under no circumstance, these cases should be mixed up.”
On the other hand, healthcare workers need to adhere to infection prevention control (IPC) practices as prescribed by IPC committees in all health facilities dealing with such patients. These facilities also need to train hospital staff in how to washing hands, respiratory etiquettes, donning and proper disposal of personal protective equipment (PPEs) and bio-medical waste management. Like the patients and suspected cases, healthcare workers also need to wear a triple layer of surgical masks and gloves and for those workers working in isolation and critical wards, the use of PPEs and N95 masks is essential. The support staff, which is in charge of disinfecting and cleaning is also required to wear PPEs.
How are hospital surfaces cleaned in such wards?
As per the ministry, environmental cleaning needs to be practiced twice in such wards, which involves damp dusting and mopping floors with phenolic disinfectants and cleaning of surfaces with sodium hypochlorite solution.
Setting up an isolation ward
Ideally, COVID-19 patients should be housed in single rooms, but due to limited resources, they can be housed together in common wards with a distance of one meter between adjacent beds. For a ten-bed facility, a space of 2000 sq. feet is required. All isolation wards should have separate entry and exit and they should not be co-located with post-surgical wards or dialysis units and labour rooms. “It should be in a segregated area which is not frequented by outsiders,” the ministry has said. Such rooms also need to have a double-door entry with a changing room and nursing station, along with adequate room ventilation. In case the room is air-conditioned, it needs to be ensured that there are 12 air changes per hour and that exhaust air is filtered.
Further, for patients that require aerosolization procedures such as intubation, suction nebulisation, a negative pressure is desirable and such rooms should also not be connected with centralised air-conditioning. In case air-conditioning is not available, a negative pressure in the room should be created by using three-four exhaust fans that drive air out of the room. Significantly, medical staff designated to the isolation wards should not be allowed to work in other wards.
The checklist for an isolation ward includes eye protection gear, face shield, gloves, reusable vinyl or rubber gloves, hair covers, particulate respirators, medical masks, gowns, collection containers for used equipment, soaps and alcohol-based hand rubs.
Entering and exiting isolation wards
Before entering isolation wards, the medical staff needs to ensure that they have collected all required equipment, have performed hand-hygiene and have put on the PPE. Preferably, this should be done in the following order, performing hand hygiene, donning the gown, mask or respirator, eye protection and gloves.
On the other hand, before exiting from an isolation ward, PPEs should be removed in a manner that prevents self-contamination. Ideally, this can be done by removing the most contaminated PPE items first, performing hand hygiene immediately after removing gloves, removing the mask or particulate respirator, discarding disposable items in a closed rubbish bin, putting reusable items in a dry closed bin. In case the gown is disposable, the ministry advises removing the gloves together with the gown upon removal, followed by hand hygiene, removing eye protection, mask or respirator, followed by hand hygiene again.