Dr Nikhil Bathija

1. REVISION IN STANDARD
OPERATING PROCEDURES (SOP)
UNDER COVID-19 PANDEMIC
DEPARTMET OF RADIATION ONCOLOGY, GCRI AHMEDABAD

2. COVID-19 outbreak forced significant
changes in the management of non-
communicable diseases worldwide
including cancer.Radiotherapy
departments faced a unique challenge to
provide a virus-free environment for both
patients and staff while operating.
Our hospital has reorganised practice
guidelines in many ways.
A Team of ONCOLOGISTS at our
institute had by then reached a
consensus on the STANDARD
OPERATING PROCEDURES based on
inputs from WHO and National Advisory.

3. CONTENTS
• NEW PATIENTS
• ON TREATMENT PSTIENTS
• INDOOR PATIENTS
• BRACHYTHERAPY TREATMENTS
• TELECONSULTATION
• STAFF EDUCATION AND ALERTNESS
• TRANSPORTATION
• FOLLOW-UP PATIENTS
• SANITIZATION
• PATIENT EDUCATION
• TREATMENT DURATION

4. Wear medical protective masks correctly
03. Please pull the mask to
the lower jaw to
immediately present a
three-dimensional
breathing space
01.Cover the nose and
mouth and hang the ear
straps on both sides of
the mask over the ears
02. Fix the bridge of the
nose to the shape of the
nose to prevent dirty air
from entering
How to wear medical surgical masks?

5. NEW PATIENTS
The patients visiting our facility for the first time were
screened for the symptoms of covid virus at the entrance of
the hospital.
The patients and the relatives were explained about the
risk factors and symptoms of the covid 19 infection.
Detailed history including travel, symptoms and contact
tracing was taken.
Patients suspected of covid infection were admitted at our
facility for the investigations, workup and proper
management.

6. The relatives were thoroughly informed about the risks of
attending opd during the pandemic and were also explained
about the precautions to check the spread of infection.
All the new patients and the attendees were properly
screened to contain the spread of infection in the hospital
premises.
A separate screening opd was setup to screen all the patients
visiting our facility.

7. ON TREATMENT PATIENTS
• The patients who were already undergoing radiation
therapy at G.C.R.I. were monitored regularly for
development of any new symptoms.
• Weekly blood tests were done to monitor the change in
absolute neutrophil count and if patient had complain of
cough , chest xray was advised accordingly.
• The patients on concurrent chemotherapy were closely
monitored as they were more susceptible to infection.

8. INDOOR PATIENTS
The patients undergoing radiotherapy were admitted and kept in
separate wards and social distancing was also maintained, as
required.
Temparature charting was done daily. If there was any alteration
patients were shifted immediately to the suspect covid ward for
covid rtpcr testing.
Only one relative was allowed to stay with the patient to check the
crowding in the wards.

9. BRACHYTHERAPY TREATMENTS
In the pre covid era, the intracavitary brachytherapy was done at 7
days interval.
This was changed due to covid-19 pandemic.
Before admitting the patient for brachytherapy, it was mandatory for
them to undergo rtpcr test, available at our facility and if tested
negative, they were shifted to the brachytherapy ward.
In addition, the duration between two brachytherapy sessions was
reduced from 7 to 3 days, to decrease the hospital stay of the
patients.
The patients were discharged only after completion of the entire
course of brachytherapy.

10. TELECONSULTATION
• Teleconsultation facility was setup for those patients who could not visit
our hospital , due to lockdown.
• The patients’ relatives were provided with an email id and mobile
number where they could reach out to the concerned authority and
submit their query.
• The concerned consultant would then reach out to patient to solve the
query as earliest as possible.
• With the help of teleconsultation a lot of patients received the best
medical help they deserved, at the comfort of their homes and without
the fear of contracting the disease during this pandemic.

11. TRANSPORT OF THE PATIENTS TAKING TREATMENT AT GCRI
• Due to covid pandemic many patients did not want to get
admitted in the wards for the risk of being infected.
• These patients preferred to visit on a daily basis for the
radiation therapy.
• However due to the travel restrictions it was difficult for
them to do the same.
• We provided them with official documents with the
details of their purpose of travel and also about the
treatment they were undergoing at our facility.

12. STAFF EDUCATION AND ALERTNESS
• The staff at GCRI were educated about the
pandemic through various mediums
• The SOP of the Institute was layed out precisely
as planned
• The number of staff was limited as social
distancing was strictly adhered at all possible
venues.

13. HYPOFRACTIONATION
• We followed alternate radiation schedules in order to decrease the number
of days the patient had to visit the hospital for radiation treatment.
• For example in cases where palliative radiotherapy was advised, the
schedule which was favoured was 20gy/5# as opposed to 30gy/10#, keeping
in mind the diagnosis, the site of treatment and patient’s general condition.
• In other cases too, the hypofractionated schedule if possible was preferred.

14. • The waiting area, opd rooms, examination rooms and the file
collection area , all were sanitized twice on a regualar basis with
hypochlorite solution.
• The linac couch as well as the xray simulator couch were also
sanitized every time before taking a new patient.
• The patients and realtives were requested to sit separately in
the waiting area to maintain adequate social distancing.
• The whole staff of our department including the technicians on
the machines , the cleaning staff, servants, physicists, were
provided the proper masks , face shields and gloves.
SANITIZATION

15. • All the doctors were provided personal protective equipments
including n95 masks, face shields.
• The staff underwent training for donning and doffing of the
personal protective equipment.
• The doctors also attended training lectures to identify the
signs and symptoms of covid infection, for early diagnosis and
immediate treatment.
• The staff were screened regularly for the symptoms and
adequate steps were taken accordingly.

16. EDUCATION OF THE PATIENTS REGARDING PROTECTION
AGAINST CORONA VIRUS
In the present scenario the main focus is
always on preventing the spread of the
infection. We tried to achieve this goal by
educating the patients as well as the relatives
about the ways to protect themselves against
the virus.

17. All the patients attending the opd and undergoing
treatment at our setup, were explained about the following
All the patients were advised to wash their hands regularly
with soap and water.Importance of Hand hygiene was
explained thoroughly. The steps of handwashing were
demonstrated multiple times.
Hand sanitiser was available for the doctors as well as for the patients and
attending relatives.
Every consultation room was provided with hand sanitisers.
The patients were educated regarding the benefits of using hand
sanitisers.
Those patients who could not use sanitiser were explained about the
benefits of handwashing with soap and water.
The doctors were also asked to wash their hands before and after
examining the patient.

18. Wear N95 mask / surgical surgical
mask
• Mask was mandatory for everyone attending the opds.
• Each and every patient was explained about the proper method
of wearing a mask and also how often they should change their
masks.
• They were also advised to wear masks even at times of
treatment and simulation if possible.
• The relatives were strictly advised to wear masks to prevent
spreading of infection to their patients.

19. WHO RECOMMENDS

20. Multiple training sessions were held at our opd waiting area, for the patients and
their relatives , explaining the precautionary measures, signs and symtoms,
benefits of early diagnosis and what care should be taken if the patient tested
covid positive.
The patients who were covid positive and asymptomatic , were advised home
isolation and the relatives were explained about the care to be taken and when
to visit the hospital.
Radiation treatment was interrupted when the patient became covid positive,
and was resumed only after resolution of symptoms or after 15 days from the
diagnosis day , whichever was longer.

21. • This notice was placed on the
entrance door of our department,
so that everyone entering the
department would follow the
guidelines.
• The instructions were written in the
local language as well.

22. Social distancing being maintained at the radiation
oncology opd waiting area in our hospital.
We practiced social distancing with marking area for
relatives to stand in line.
S..O..C..I..A..L D..I..S..T..A..N..C..I..N..G

23. NO ONE CAN ESCAPE THIS GUN
The security guard using the
infrared no contact thermometer,
on all the patients visiting the
hospital as a part of the
screening procedure.

24. HOSPITAL DISPLAYS
Patient education in
local language is
must

25. NO COMPROMISE IN THE QUALITY OF
TREATMENT
HYPOFRACTIONATION SCHEDULES FOR
APPROPRIATE PATIENTS

26. LET’S HOPE FOR THE BEST
GO CORONA, CORONA GO.....
THANK YOU