Qurhealth webinar - Caring for Caregivers

Panelist Moderator
Slide 1/133
Prologue

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Dr. Hiranya S
Medical Student, St. George's University, Grenada
 Hiranya excelled in 10th grade and secured Dr. APJ Abdul Kalam Award, in Singapore.
 She continued her A levels successfully at CATS college, UK with scholarship and was awarded for her excellency in Chemistry.
 She is 18 years old and is currently pursuing Medicine at St. George’s University, Grenada, with scholarship. She enrolled in the
5-year MD program in August 2019.
 She has completed the 1st year, Premedical Science course, where she learnt Biochemistry, Psychopathology, Anatomy,
Physiology, Molecular Biology, Microbiology, and Genetics.
 She has secured a GPA of 3.9 out of 4.0 in her exam and has secured a position in the Dean’s list.
 She is a winner of Legacy of Excellence Award from her university.
 Apart from academics, she has a passion towards singing. She is a Singapore Book of Record Holder in Music and has won a lot
of title awards from various organizations and TV channels. She has also given numerous concerts across the Globe. She has a
YouTube channel too. Link: https://www.youtube.com/channel/UC9Mqzuc98hua09O0fv4Wsbw
 Recently, she has collaborated with the Tamil Nadu Police Department to sing an awareness song for COVID-19 pandemic which
had a great outreach in India and abroad.
 During this COVID-19 period, she is taking part in Webinars and Music Programs.

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Prologue - & There is Hope
COVID-19 Overview
 Infectious disease caused by SARS-CoV2 strain of the
coronavirus.
 Outbreak began in Wuhan, China in December 2019.
 “COVID-19” official name announced by WHO on 11th
February 2020.
 Declared a Pandemic on 11th March 2020 by WHO.

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Tests for COVID-19
 Viral or Diagnostic Test:
1. Molecular (RT-PCR)
2. Antigen Test
 Chest CT Scan Test
 Antibody Test
Source: WHO,CDC, FDA
Medicines
 Dexamethasone -
corticosteroid drug,
clinical trials done in UK.
 Favipiravir
 Remdesivir
 Tocilizumab
Source: Oxford University,
UK & MHLW, Japan
Vaccines
 AZD-12222 - Univ of Oxford-
AstraZeneca, in phase III trials.
 Inactivated COVID-19 –
Sinopharm in phase III.
 COVAXIN- Bharat Biotech
phase, phase I trials to
commence in July, 2020.
Source: Company press
release, ICMR
Alternate Therapy
 Daily practice of Yogasana,
Pranayama and meditation
 Haldi powder in hot milk
 Steam inhalation with fresh
Pudina (Mint) leaves or Ajwain
(Caraway seeds)
 Kabasura kudineer
Source: Ministry of Ayush and
National Institute of Siddha

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Challenges faced by healthcare workers
 Insufficient trained manpower
 Long working hours
 Absenteeism/ Absconding
 Insufficient financial and moral support
 Lack of PPE kit
 Running out of common medicines
 Lack of ventilators
 Increase in intake of patients
 Physical violence
 Social stigma
 Periodical updating of operational inputs
 Maintenance of protocols towards disposal of corpses

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My Perspective as a Medical Student
 Clinical team and Medical students in clinical years
getting exposed at the front line
 Pathogen exposure
 Quarantine after working with COVID-19 patients
 Unable to fulfill family commitments
 Psychological distress
 Fatigue
 Occupational burnout
Corona-free Countries- 6th July 2020, WHO
 Vatican
 Fiji
 Papa New Guinea
 Saint Kitts and Nevis
 Timor Leste
Source: Worldometer, Hindustan Times

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Rely on…!!

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Dr. Mahesh Joshi
Chief Executive Officer, Apollo Homecare - India
 A Passionate clinical business leader with over 2 decades of experience handling various roles at Apollo Hospitals Group.
 Served as Group Head Emergency Medicine-Apollo Hospitals for over a decade.
 Currently Chief Executive Office of Apollo Home Healthcare Limited.
 Internationally recognized as a pioneer leader in establishing Emergency Medicine specialty in India.
 Executive Co-Chairman Society for Emergency Medicine India.
 Founder Trustee-Save-Life Foundation-not for profit organization working in the field of Road Safety.
 Awarded Honorary fellowship of Royal College of Emergency Medicine in Recognition of his contribution to development of
International Emergency Medicine-2010.
 Life time Achievement award by Society of Emergency Medicine India.
 Kalakriti Award for Excellence.
 Pride of Telangana Award 2019.

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Dr. Jothi Clara Michael
Director, Nursing (Strategies & Planning – Gleneagles Global Group & Continental Hospitals), Parkway Healthcare
India Pvt. Ltd. AND Vice President – Association of Executives – India (ANEI)
 Alumni of CMCH Vellore with Professional journey over the past 32 years reaching pinnacle positions in both academia and clinical
arena in Nursing, Challenging various capacities and leadership in India and abroad.
 Currently the Director of Nursing (Strategies & Planning) - India Operations Division, Parkway Healthcare India Pvt. Ltd. (Gleneagles
Global Group and Continental Hospitals ) & Vice President, Association of Nurse Executives India (ANEI) & Tamil Nadu State official
member – CAHO, AHPI & INS.
 Previously positioned as Chief Clinical Governance Officer – Kauvery Corporate Office & Director – Nursing & Quality, Gleneagles
Global Hospitals Group (Hyderabad, Chennai, Bangalore, Mumbai) & Assistant Dean for Clinical Affairs, Sultan Qaboos University,
Muscat, Oman; National Advisory Board for Research Sultanate of Oman.
 Areas of Interest and Research Accomplishments: Women’s health, Pain management, Alternative Complementary Therapy, Quality
of care, Online course designing, EBP and training, Accreditation and Nursing profession & Ethics.
• International travel Award from (MNRS) Midwest
Nursing Research Society. 2008, USA.
• Deanship Training University of Wisconsin, USA 2008
and the Eta Pi Research Award for the Annual Eta Pi
Chapter Research Day held on 2005 at Oshkosh
• USA. Rotary Vocational Excellence Award
2013. Best Nurse Award Tamil Nadu MGR
Medical university Nurses Day May 013.
• A Healthcare poet which was appreciated
by University of Wisconsin. Lead the team
in hospital evacuation in 2015.
• Academic Excellence and Research Award
ICCR Omayal Achi Trust Sep 2013.
• Leading Corona nursing care across IOD.
Awards and Honors

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Mr. B G Menon
Managing Director, ACME Consulting - Chennai
 Graduate Engineer, Ind. Engineering, from REC, Trichy (NIT), Madras University
 Fellow Member of the Cost and Management Institute of India.
 Founded ACME Consulting in 1996 in Chennai to provide Quality Consulting to the Services Sector. Began focusing on the
Healthcare Sector from 2005 onwards with the advent of the NABH.
 Today ACME Consulting is acknowledged as the largest Healthcare Quality Consulting Company in the Country, with over 1,000
Hospitals and Labs as Clients and Operations across 14 States.
 ACME has been adviser in Quality Improvement of Public Health Facilities to 7 State Governments, Kerala, Tamil Nadu, West
Bengal, Maharashtra, Assam, Meghalaya and Arunachal Pradesh and the National Health Mission, Govt. of India
 ACME is also the only Healthcare Consultancy Accredited by NABET of Quality Council of India, retaining the Accreditation for 14
years now without a break

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Dr. Deepashree
Senior Consultant & Clinical Lead, Interventional Radiology & Imaging Services,
Dr. Rela Institute & Medical Center - Chennai
 Current Position: Head of the Department IR and Fellowship Programme Director, Dr. Rela Institute and Medical Centre
 Academic Qualifications: MRCP, FRCR, CCT ( UK), EBIR
 Publications: National and international including chapters in few international books
 Areas of interest: HPB and Women’s interventions
 Awards and Achievements: Author of book - Art of Balance, Previous SIR international Scholar, Fitness Trainer, Zumba instructor,
Motivational Speaker, One of the winners of ICONIC WOMEN AWARD

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Dr. Puneet Parashar
Chief Happiness Officer & Founder, #HappierBeings - Noida
 18yrs of hands on experience of leading people across segments, timelines and cultures. Brings on-ground touch to issues and
opportunities in curating practical experience for facilitation, coaching, counselling, talk sessions and workshops on professional
happiness.
 Taking all the possible roads stepped outside the box to externalize innerness and submitted to prolonged on the job excitement for
training, developing and coaching people. Founded #HappierBeings an initiative on science of happiness for escalating professional
happiness to enable organizations achieve #happinesstifictemperament at work for sustained success and growth path.
 Spent last 5yrs years in researching, practicing, designing and delivering experiential workshops on science of happiness.
 Promotes goodness of Vedas for curating purpose and joyful working.
 Describe value of community and cause. Created #happierbeings – a global select community for advancing & spreading the cause of
happiness.
 Speak and promote benefits of creating and maintaining #happinesstifictemperament.
 Experiential session techniques that keep attendees engaged instead of just sit and listen.
 Make audience lean to their inner contriving over running and catching exteriorities of life.
 Describe personal purpose model for inner happiness. Bringing hands on experience of entering industry against all odds and taking
all challenges to imbibe the conscious chosen path of happiness.
Certifications
• 2017 "Happiness Coach“ by Berkeley
Wellness Institute, CA-USA.
• 2017 "NLP" by INTCENTFCC, Rishikesh -
India.

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Dr. (WgCdr) A Nagasubramanaian
Medical Director, Fortis Hospitals - Bannerghatta Unit, Bengaluru
 30 yrs. of experience in health care in various roles
 A Doctor, soldier, an administrator, a teacher, social worker rolled into one
 After 14 yrs. of meritorious stint in Indian Air force joined corporate world in 2013
 Started a 100 bedded corporate hospital from scratch and ran it successfully as the Facility Director
 Apart from working in various corporate hospital groups, also worked with healthcare startups
 Adjunct faculty in IIHMR and Christ University
 Had been associated with accreditation of various hospitals
 Competent communicator in Toastmaster International
 Member of Lions International serving in various roles – currently Dist. chairperson for CSR activities
 Authored a book “Manual on Medial Logistics for armed forces personnel”
 Recipient of Air Officer In chief Medal, compassionate care award
 National level Certified skill trainer in health care
 As Honorary Director of Vonisha Service Foundation serve the underprivileged slum children bridging their educational and health
needs

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 A seasoned Healthcare Management Professional, Rajarajan is a powerful blend of a visionary leader with a global perspective
and strong business acumen
 He has been associated with various successful ventures in India and abroad especially in areas of Multi-specialty Hospitals,
Oncology, Cardiology, Diagnostics and in his penultimate assignment in Bengaluru, India - he was the COO of a flagship unit of an
Oncology giant
 He is a member of American College of Healthcare Executives (ACHE), Life Member of Consortium of Accredited Healthcare
Organizations(CAHO), The Research Foundation for Hospitals and Healthcare Administration (RFHHA) & Telemedicine Society of
India
 At Global Mantra Innovations, he leads QurHealth, India from Bengaluru as their Sr. Vice President for Health-Tech solutions and
partnerships like Family Health Book Suite, etc.
Rajarajan S
Sr. Vice President - QurHealth

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QurHealth, India is a Division of GMI
Empower Healthcare Ecosystem
to generate value through their data
Bio-Statistics, Data Analytics, Natural Language Processing, Deep
Neural Network, Artificial Intelligence and Machine Learning
Scalable Multi-layer
Architecture Platform
150 mil. USD Company
Managing 800k Providers in US + 800 Dialysis
Centres + 43 Peta Bytes of HealthCare Data
Strong Leadership
700+ Team Members in US + India
Global Mantra Innovations – Research & Innovations centre for Ventech Solution Inc., USA
www.qurhealth.com info@qurhealth.com +91 95660 88520

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Caring for Caregivers - Beyond Hospitals
Home Healthcare - different world as compared to hospitals
Uncontrolled
environment
More logistical
challenges
More distributed care
Individualised/
personalised

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CARE GIVER VS EMPLOYER CONCERNS
INSECURITY OF JOB
PAYCUTS
RISK OF EXPOSURE/ACQUIRING
COVID-
LACK OF KNOWLEDGE ABOUT
COVID
ANXIETY AND WORRY ABOUT
FAMILY
CARE CONTINUUM
BUSINESS
CONTINUUM
RETAINING
EMPLOYEES

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INTERVENTIONS
Leadership
Signals –
communication,
walking the talk ,
Education and
awareness-lot of
time and effort
Engaging-
MOTIVATIONAL
ACTIVITIES,
PARENTS
,mental health
and emotional
wellbeing
Safety--PPE
availability,
replacement,
tracking
Appreciation
by patients,
from all levels,
Health
screening-
morning and
evening health
tracker -15
nurses -1
support
employee
Transportation
support
Support-
physician
oversight,
insurance cover,
incentive to
work
Newer roles

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We Care for Our Providers
5th
March,2020
The Campaign for “we
care our providers”
started on 5th March
2020 with an intent to
safeguard our care
providers and patients. PSCC
General &
Emotional
Well being
Towards
Hostel Safety
Towards
Care Delivery
02
05
01 03
04
Education &
Engagement
Towards
Transportation
Safety

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We Care for Our Providers – Towards Care Delivery
Daily monitoring of vitals and Covid related signs for patients and family members
Covid screening was made as a mandatory measure for enrolments.
Regular escalations to designated physicians - HCQ Prophylaxis was initiated
PPE was provided to all transaction nurses
Weekly distribution of masks, gloves, and disinfectant solution to providers
Nurses were stationed at patient place to reduce the risk of exposure during transportation.
Home evaluations were done to ensure safety of the nurse to stay at patient place
3
4
5
6
1
2
7
Towards
Care
Delivery

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We Care for Our Providers – Towards hostel Safety
Created isolation room in the hostel for
emergency management
Mandatory weekly disinfection of hostels
Availability of hand sanitizers and
masks in hostels
Weekly visits to hostel by safety officer
Maintaining social distancing of Beds etc.,.
in hostel rooms.
1
2
3
4
5

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We Care for Our Providers – Transport Safety
1
Twice a day
disinfection of
Transport
vehicles
2 3 4 5
Reduce the
number of
employees in
each vehicle by
adding new
vehicles
Drivers and
employees had
daily vitals
monitored
Nurses who are
working with
high risk
patients were
transported
separately.
Mandatory use
of Masks &
sanitization
before on
boarding the
vehicle

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We Care for Our Providers – General & Emotional wellbeing
24
A SPOC was assigned to 10 care providers who is
responsible for the health and wellbeing of the nurse.
1
Dry fruits / snacks were distributed to nurses where-
ever food issues were identified.
Regular physician evaluations for
sick providers through SPOCS
Health trackers were maintained for
all employees.
COVID – what’s app groups were created
by the SPOCS for quick escalations and
support
Nurses identified with symptoms of Covid were
placed under isolation and enrolled for Stay I @
Home / Facility as per physician advice.
Daily calls by unit nursing officer to
reduce the stress level and to understand
the ground challenges in stay model.
Complete monitoring and support
were provided to the nurses under
paid leave.
2
6
5
4
37
8

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We Care for Our Providers – General & Emotional wellbeing
Education
&
Engagement
1 2
3
4
5
6
7
8
9

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We Care Our Providers – Glimpses

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Ongoing Support
Travel assistance
Replacement
Re-joining
Amplified Health insurance cover for COVID
LEARNING
EACH DAY

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Panel Discussion - Session Overview and Highlights
Initiate your family and your Health
Records Management with MyFHB by
clicking and downloading from
https://cutt.ly/XyPT6Zm
Discussion on:
 Absenteeism and Absconding
 Willingness of the Clinical Team
 Susceptibility of Home Care workers

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A Perspective of Best Practices from Ground Zero
NURSING RESOURCE MANAGEMENT
 Flexible duty timing – Be open in plan – ABC rotation.
• 6hrs/8hrs
• Rotation of staff in COVID ICU & non COVID areas periodically to reduce stress
 Involving team leaders of COVID unit in decision making
 Optimising usage of PPE- separate stock for COVID unit.
 Optimising nurse : patient ratio
• ICU- 1:1/1:2/1:3
• Ward- 1:3/1:5/ 1:7/1:10 (Depending upon condition of the patient – Acuity based)
 COVID (Hazard) allowances for staff
 Nutrition & Immunity Boost for staff in the COVID unit.
• Vitamin C, B complex and zinc supplements.
• Betadine gargle before and after shifts and during break.
• Protein, vitamin C rich diet and hydration.
• Egg, milk, pulses and kashayam (medicinal tea).

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BUDDY CHECK & ACCIDENTAL EXPOSURE
HEALTH IN HANDS OF PEOPLE – SAFETY IN HANDS OF NURSES
Buddy check is required at both donning & doffing for checking wear and tear of PPE.
ACIDENTAL EXPOSURE
STEP 1
STEP 2
Stand in the doffing area
Do not remove PPE
Doffing will be done by Buddy
Quarantine staff
Wait until help comes from the command areaSTEP 3
STEP 4
STEP 5

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POWER BREAK FOR NURSES
Appropriate break to be given for nurses during shifts (once every 2hrs) to overcome exhaustion.

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BIOBREAK
* Bio-break needs to be recommended once a shift to prevent UTI and especially in women who are menstruating.
STEP 1 - Wash hands and exit patient care area
STEP 2 - Doff off the PPE and wash hands following 7 steps of Hand hygiene
STEP 3 - Complete your Bio break and hydrate yourself
STEP 4 - Don a new set of PPE and re-enter patient care area

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Nurse Patient Mutual Goal Setting
Minimal patient close contact & Maximize patient connect
WhatsApp
& Video calls
Plan work and
arrange articles
on a trolley
GREET & SMILE
Perform care
maintaining 2-3 ft
distance and still
stay connected
with the patient
Plan for next Visit
Discuss with the
patient about the
next visit
Orient about call
bell

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Nurse Patient Mutual Goal Setting

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EMERGENCY MANAGEMENT- ANTICIPATORY PREPAREDNESS
 Early identification and recognition of
• Happy hypoxia
• Acute respiratory distress syndrome
• Prevention of cytokine storm
• COVID-19 pneumonia
• Thrombosis - DIC
• Cardio vascular complication
• Acute liver injury
• End organ failure
 Minimum dose of corticosteroids (case to case basis), avoid NSAID’s, treating with convalescent plasma and
Tocilizumab.

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NIV in treatment of COVID Patients- should be used with airborne precautions.
• In an NIV mask there are two main places where gases and potential aerosols will leak. (They are
between the patient and the mask (patient leak) & when venting is required, through the venting or
exhalation port (intentional leak).
• Appropriate PPE should be employed.
• A well-sized and fitted mask should be used to reduce patient leak.
• A non-vented mask should be used, and where venting is required an exhalation port and a filter to
reduce exposure of exhaled aerosols from patients should also be used.
AEROSOL GENERATING PROCEDURES
ET
INTUBATIONCPR BRONCHOSCOPYTRACHEOSTOMY MOUTH CARE
ORAL
SUCTIONING
AEROSOL GENERATING PROCEDURES: A REMINDER FOR HCW’S SAFETY!

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LEADERSHIP VISIBILITY
 Visit of CNO’s & HIC nurse in the COVID unit.
 Connecting COVID unit to the board room with SLT.
 Involvement of Administrators, ID team, Nursing leaders, HIC nurse, Nurse educators, Safety nurse and Purchase.
 Connecting with staff in the COVID unit
• Debriefing sessions
• WhatsApp conference calls.
• Recreation

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PATIENT ENGAGEMENT MODEL
 Connecting through video counselling.
 Hi- tech, Hi- touch care approach.
 ICU counselling & updating of patient condition by
physician team on a daily basis.
 Telenursing home care for stable COVID patients.

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TELENURSING COVID-19 HOME CARE
 Its a comprehensive health care package to ensure safety of patients
with COVID 19 infection eligible for Home Isolation in a domiciliary
setting.
 Eligibility Criteria:
1. Age <50 yrs.
2. No comorbidities or with comorbidities like DM,SHT well
controlled.
3. Mild symptoms including Fever, myalgia, diarrhea, loss of smell
/taste, mild cough, throat pain.
4. Easy access to health care system in case of emergency.
5. Adequate facility for home isolation.

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QUALITY INDICATORS FOR
STAFF SAFETY IN COVID
UNITS
Sl No QUESTIONS Date Description of the incident
Accidental exposure
a)Wear and tear of PPE (during nursing care)
b)Doffing
2 Daily screening of staff
3 Exposure to blood and body fluids
4 Needle stick injury
5 Iatrogenic injury
Health status of staff
a)Weight loss
b) Urinary tract infectiom
c)GI disturbances
d) Stress induced heatrh issues
Prophylaxis taken
a) Vitamin C supplements
b) Zinc supplements
c)Tab HCQ
d) Betadine gargle
8 Number of nurses suspected for COCID-19
9 Number of nurses positive for COVID-19
10 Number of working hours with the suspect patient
11 Number of working hours with the positive patient
12 Number of shifts worked in suspect unit
13 Number of shifts worked in COVID unit
Nurses satisfaction index
a) Are the nurses satisfied working in a COVID unit
b) Are the nurses having a sense of withdrawal
QUALITY INDICATORS FOR STAFF SAFETY IN COVID UNITS
1
6
7
14

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Discussion on:
 Quarantining of Medical Staff
 Motivators & Detractors
 Perks & Benefits – Long term effect

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WASH Scheme by QCI India & International Best Practices for HCWs
WASH
(Workplace Assessment for Safety & Hygiene)
A Scheme from the Quality Council of India
Objective of the Scheme
To help ANY TYPE OF organization assess
their preparedness to restart and run
operations safely against COVID-19

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KEY ELEMENTS
1. Management Role
A. To ensure all Govt. Regulations in place for
COVID.
B. Documentation in place evidencing
compliance.
C. Ensuring no discriminatory practices
followed.
D. Nominate A SENIOR STAFF TO OVERSEE THE
CRISIS
E. Provide RESOURCES FOR PPE, Equipment,
Sanitizers.
2. Ensuring Business Continuity
A. Identify risks & possible disruptions to
business
B. Have measures to eliminate / minimize
these
C. Provide for resources for implementing
them
D. Have processes in place for restarting
operations.

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KEY ELEMENTS
3. Communications
A. Identify your stakeholders impacted by the
crisis.
B. Inform them of all mitigation measures in
place.
C. Inform suppliers on measures to follow.
D. Put up signage prominently on hygiene
practices.
4. Safety & Hygiene Measures
A. Screening of employees, visitors &
contractors.
B. Provision for reporting screening results.
C. Ensure hygiene & appropriate use of PPE
D. Keeping workplace clean and sanitized
E. Waste management, proper collection &
disposal.
F. Practicing social distancing.

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KEY ELEMENTS
5. Preventive Measures
A. Staff isolation facility till medical help
arrives
B. Keeping hospital emergency contact
numbers
C. Movement control at entrance, inter
department
D. Ensuring proper ventilation, air quality
E. Monitoring effectiveness of preventive
measures.
6. Training & Awareness
A. For all employees on implementing
guidelines
B. On preventive measures
C. For supervisors on monitoring
implementation
D. For suppliers on measures at their
workplaces

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KEY ELEMENTS
7. Managing Public Interactions
A. Identify requirement for public interaction
B. Minimize physical face to face to extent
possible
C. Ensure these are conducted in a safe
manner
8. Transportation
A. Safe transport of people – staff, visitors,
GOODS
B. Driver screening, vehicle disinfection
C. Social distancing inside vehicle
D. Vehicle permits to travel
E. Isolation, sanitization of incoming
materials.

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BEST PRACTICES
(Source: NHS, UK)
1. Triage patients remotely using online consultations
2. Enable maximum staff to work remotely
3. Keep staff separate for patients with COVID & others
4. Regular staff risk assessment to be done
5. Minimize face to face contact with maximum signage
6. Avoid multiple contacts with single consultation
7. Plan appointments to minimize waiting times and maintain social distancing
8. Avoid co-locating practices for COVID patients with other services like labs, pharmacies
9. For home visits
A. Ensure number of staff visiting patient minimal
B. Visit is carried out by most appropriate professional
C. Staff multi-task to avoid multiple visits

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Discussion on:
 Best Practices - COVID-19 free
Countries
 Quality, Accreditation & Excellence –
Compliances during the difficult
times

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Preferred Practice to Preventive Practices - Perspectives to Clinical Team
The COVID-19 pandemic has threatened the humanity at a global level to a large extent by the
burden of the disease with significant mortality and to a certain extent as a by product of the
necessary efforts to contain the same.

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Droplet
A microscopic virus-filled particle of breath or spittle, around 5 to 10 microns — about the size of a red blood cell — that comes
out of the nose or mouth of an infected individual when they breathe, speak, cough or sneeze. Droplets generally fall to the
ground within a few feet of the person who expels them.
Aerosol
A virus-packed particle, smaller than 5 microns, that's also expelled from an infected person's mouth when breathing, speaking,
coughing or sneezing. Unlike a droplet, smaller aerosol particles can remain suspended in the air.
"They'll continue to float and follow the air streams in a room,"
Fomite
An object covered with virus particles, possibly because someone recently sneezed or coughed respiratory droplets onto it, or
swiped a germ-covered hand on it. A countertop or a phone could become a fomite in that same manner. The particles could
survive from several hours to several days.

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What is mandatory in every hospital ?

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 Regardless of whether you choose a cloth or surgical mask, she says, be aware that this doesn't mean you can suddenly be in
prolonged close contact with others. These masks might buy you a few extra minutes of protection, she says, but "not hours.
Not lengthy periods of time.“
 Chu says polypropylene is great as a physical filter but has another benefit: It holds an electrostatic charge. In other words, it
uses the power of static electricity. Think of the static cling that can happen when you rub two pieces of fabric together, says
Chu. That's basically what's happening with this fabric: That "cling" effect traps incoming — and outgoing — droplets. "That's
what you want — the cling is what's important," Chu says.
 The best bet for the material to slip in as a filter is polypropylene
 Shape also matters:
 Avoid masks with exhalation valves.
 Keep it clean.
The WHO also suggest not touching the mask while using it. To remove the mask, a person should do
so from behind to avoid touching the front of it.

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PPE should be SITRA/DRDE approved
 Quality should meet or exceeds ISO 16603 class 3 exposure pressure, or equivalent
 Although Ministry of Health has not specified any GSM requirements for PPE, team of experts have recommended using 7O
GSM.
 For PPE, these standards may include for fluid resistance, leak protection, filtering capacity, or resistance to tears and snags.
 It is important to know that the use of PPE alone will not fully protect you from acquiring an infection or passing an infection
to another person.
 Even if PPE successfully protects you while it is worn, improper removal and disposal of contaminated PPEs can expose the
wearer and other people to infection.

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Although cases of COVID‐19 infection can happen despite strict measures, the infection is less likely to spread with the
proposed infection prevention measures.
 Guidelines for staffing
 Patient evaluation and triaging; patient categorization
 Guidelines for patient scheduling in OPD
 Guidelines for risk categorization and safety precautions
 Guidelines for Elective procedures / Day case procedures
 Guidelines for COVID ward/ HDU/ ICU
 Guidelines for general housekeeping / Cafeteria
 Guidelines for imaging services
 Guidelines for MRD

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Guidelines for the Staff Rotation and Training
You need a chef to cook – having the kitchen and ingredients is not enough !!!
 Staff can be posted for shorter working hours than usual and should be called in rotation.
 At any given time, 33% to 50% of staff should be working at the clinic.
 Staff must get training in donning and doffing of personal protective equipment and should be provided with appropriate
PPE.
 The staff should be encouraged to do frequent hand washing with soap and water for at least 20 seconds. In between,
hands disinfectants can also be used.
 The staff should get training for phone booking, patient interviews on the phone, documentation of patient details and
history, getting informed consent signed, social distancing, and hand hygiene

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TRIAGING

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Guidelines for patient evaluation and triaging;
Patient categorization
 Flu symptoms – Flu clinic – COVID ward-COVID PCR ( 2
samples if first sample is negative, if both are negative,
then CT
 Non flu symptoms – Transit ward- COVID PCR for all
elective admissions

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 The diagnostic value of this modality has been proven in clinically suspicious cases with inconclusive laboratory test results, as
well as asymptomatic individuals with known exposure.
 In many healthcare settings, such as developing countries, CT imaging may be the only available diagnostic test due to a
shortage of diagnostic laboratory kits, while validated COVID-19 laboratory test kits are limited in quantity even in
industrialized nations.

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Experienced staff should be deputed to take the patient's history of travel, occupation, contact, and
cluster (TOCC) and a declaration form along with a written informed consent document can be used to
ascertain the following points.

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OPD SERVICES

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Guidelines for scheduling of the patients
 Pre scheduled appointments
 Few walk ins
 All after screening and self declaration at the reception
The patient should be encouraged to visit the clinic alone or with only one attendant to avoid crowding in the clinic as
carriers might be asymptomatic, and therefore, it would be wise to presume that every person walking in the clinic can
be a potential source of infection.

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Risk Stratification of Procedures
The factors taken into account for the risk categorization of the procedures were—
the type of procedure (aerosol‐generating procedure vs non-aerosol generating procedure), body part on which the
procedure is being performed (face/body), and the duration of the procedure.
Contact with mucosa/saliva, body secretions during the procedure, minimally invasive or non invasive nature of the
procedure, and ability of the patient to be masked or not were also considered as important factors for risk categorization
The aerosol producing procedures have the highest risk, and the long duration of a procedure also increases the risk due to
longer contact time with the patient.

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Guidelines for Elective and
Emergency Surgeries

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CATH LAB/ DAY CASE / IR PROCEDURES
 Workload: All cancer-related procedures including TACE, PTBD, Biopsies will continue and a case basis consideration for the
emergent cases will be considered by clinical lead.
PRIORITIZATION OF IR PROCEDURES
 If the procedure is non-urgent, it is advisable to defer it until the patient has cleared COVID-19 from his or her swabs. If the
procedure is urgent, then the patient is managed as per a confirmed COVID-19 case.
 Staff Management: All the staff will work according to a special rota as decided by the clinical lead. Two separate teams will
be formed within the IR team and the teams will work separately avoiding any cross-contact between the members of each
team.

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PPE recommendation for performing IR procedures
a. COVID-19 patients & suspected cases of COVID-19 is:
i. Surgical cap,
ii. N95/FFP2 mask,
iii. Eye protection (face shield or goggles),
iv. Full-length long-sleeved gown and gloves.
For all other categories of patients,
i. For low-risk patients (i.e.. without COVID-19
risk factors) surgical mask is used.
ii. For moderate to high-risk patients including
patients with pneumonia and patients under
quarantine for close contact with known
COVID-19 patients, the N95/FFP2 mask is
recommended.

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HPB SURGERIES
 In view of the increasing fear of asymptomatic carriers, it has been decided to test all patients for COVID 19 before major HPB
surgeries.
 List of patients for the following week to be prepared and approved by surgery and anesthesia teams and a tentative schedule
to be released. Blood product availability also needs to be confirmed
 As per RIMC policy, only one attendant per patient would be allowed to stay in the hospital during the entire perioperative
period and he/she will also be tested. If for any unforeseen reason, another attendant has to come in the place of the existing
attender, it can happen only after his/ her testing.
 Regarding testing for COVID 19, nasopharyngeal and oropharyngeal swabs will be taken for RT PCR assay. It has also been
decided to do 2 samples before surgery.
 No visitors are allowed inside the hospital other than the attendant who has been tested. The attendant is not allowed to
leave the hospital and their food and accommodation will be arranged by the hospital.
 No visiting is allowed inside the ICU – video calls will be arranged for those who request so.
 Daily counselling in the ICU can also be arranged over phone.

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Sequence of steps to be followed :
Step 1: Once decision for surgery is made, the patient along with attendant should be seen by surgical team and screened for
any symptoms / signs suspicious of COVID 19. Blood product availability also needs to be checked.
Step 2: Once cleared – dates for sampling should be fixed.
Step 3: First sample: Patient and the attendant to be admitted as a guest in the hospital provided facility and the first sample
should be taken. They should not be seen by the medical/nursing team. If any medical or nursing support is required, they
should be moved to the transit rooms and remain there until the first PCR report is negative. All other investigations should be
done only after the first report.
Step 4: Second sample: Second sample should be taken at least 48 hours after the first sample, preferably the day before
scheduled surgery -

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COVID WARD/ICU/HDU
 4 doctors on duty
 2 doctors in ward – 100 beds
 1 In HDU – 8 beds
 1 in ICU – 12 beds

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IP SERVICES

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CAFETERIA

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Guidelines for General
Housekeeping

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 Contact time of at least 10 minutes is necessary for both bacillocid extra or hypochlorite
 Hypochlorite should be used mainly on hard, non-porous surfaces (it can damage textiles and metals)
 Surfaces (Table surfaces, slabs, walls, windows, equipment surfaces etc.):
 Wipes are recommended over spray for all reachable surfaces and high-touch areas including stainless steel, rubber and
equipment surfaces.
 Spray should be avoided in general, as coverage is uncertain and spraying may promote the production of aerosols.
 Floor: Mop is recommended.
 PPE: Housekeeping staff should wear appropriate PPE when handling and transporting used patient care equipment (gloves)
or while cleaning/disinfecting corona ward (N95 mask, gown, heavy duty gloves, eye protection ( if risk of splash). Boots or
closed work shoes)
 Housekeeping staff should wash their hands with soap and water immediately after removing the PPE, and when cleaning
and disinfection work is completed.
 The procedure room (eg. Cath lab, Radiology etc.) downtime is typically between 30 minutes to 1 hour after each patient for
passive air exchange for awaiting COVID 19 report.

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Guidelines for Imaging Services

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Chest Radiograph
 Long track record
 Easy to perform
 Short turn around time
 Portability advantage over CT - ICU pt
 Useful in late presentation
 Insensitive - mild and early disease
 Sensitivity - 25 -69%, specificity - 93%,
PPV - 26.9 %, NPV - 96.5 %
 No influence on outcome *

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Computed Tomography
 Increased sensitivity in early disease
 Helps disease characterization and
severity
 Provides alternate diagnoses
 Pulmonary thromboembolism
 Sensitivity, specificity, PPV, NPV - 97%,
25%, 65% and 83%
 ACR, RCR - No role of CT in diagnostic
assessment of pts with suspected
COVID-19

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Findings in CT
Typical Findings
 GGO - Peripheral, subpleural
 Consolidation
 Intralobular lines
 rounded GGO
 Reverse halo sign
Indeterminate Findings
 Nonspecific GGO distribution
 Non rounded opacities
Atypical Findings
 Lobar or segmental consolidation
 Discrete lung nodules
 Cavitation
 Septal thickening with effusion

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Pulmonary Thromboembolism

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CT
Classification
System
by
RSNA

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Guidelines for MRD- Medical Records Dept.
1. During the pandemic period of COVID-19, we will try to avoid issuing the out patient records to the clinics unless
it is absolutely necessary for review of the old case records, history and treatment details for further continuity of
care as per physician/clinic requirements.
2. Instead of issuing the original records it is recommended to issue the photo copies of the most essential
documents like discharge summary, history sheet, medication records and OPD prescriptions - copies to be
taken by MRD staff and to send it to the concerned consultant or emergency ward as per doctors request and
necessity.
3. Once the consultation is completed, the new progress notes and treatment advice records are to be send to
MRD in a protected envelope and these documents are to be attached in the original patient medical records in
chronological order as per the existing OPD document arrangement methods.
4. In case if the original records are necessary for the clinics, it is to be issued on request of the consultant or OPD
personnel to the clinics. Patients records required for the visits to the emergency ward will be issued in a
secured MRD bag and access to these records are restricted only to doctors and nurses with minimum
handling.
5. Before and after handling the medical records, It is recommended for the doctors and nurses to use hand hygiene
techniques as per the hospitals IPCC policy.

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6. When the records are received back In MRD, the staff receiving the records must use the gloves/hand sanitizer
as per IPCC policy. Once records are received back in the MRD it is kept in the separate allotted place of the
department for next 24hrs.
7. After 24 hrs. the records are to be taken out from the allotted place checked, arranged and filed in the
permanent filing area as per the exiting MRD policy
8. If records are required to be reissued within 24 hours then only photocopies of the previous consultation will be
sent to the OPD. The photocopying will be done in MRD by MRD personnel with gloves and face shield with
cleaning of the photocopier glass cover with hand rub before scanning another record.

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In - Patient records for Non-COVID Wards
 If a previously registered patient gets readmitted then the previous IP records are to be send to the admission desk or
emergency room. The staff handling the medical records must follow hand hygiene policy as per the IPCC recommendations.
 All the Inpatient medical record shall be kept under the strict supervision of the nurse- In-charge at the respective nurses station
area during the patients stay in the hospital. The medical records are not to be taken inside the patients room.
 If most importantly needed only the medication chart can be carried to the bed side.
 It is recommended that if possible, documentation to be done by another medical practitioner other than one examining the
patient unless it cannot be avoided.
 The medical records are to be kept covered in a transparent plastic envelope and hand hygiene according to IPCC requirements
to be followed before handling medical records
 The concurrent monitoring of medical records to be done by infection control nurse/surveillance team during their routine
rounds to avoid infection spreading through medical records.
 After the patient is discharged the plastic covers should be removed and discarded in the ward itself and the file returned to MRD
by placing it in a new plastic envelope and kept in a cardboard box/carry bag for 5 days in a separate shelf/area in the MRD filing
area.
 Contaminated files - for example with body fluids: - In case any files are contaminated in the non-covid ward, files shall be sent
in yellow bag to MRD Department. After mandatory 24 hours quarantine period, photocopies of all patient documents will be
done. The duplicate copy is attested by the Medical Director and a cover note duly signed by medical records manager and
medical director mentioning the cause of contamination is attached to the file.

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In - Patient Records for COVID Wards - Isolation Ward / COVID ICU
 After discharge of COVID positive patients, the records of confirmed COVID19 positive cases the staff inside COVID area will
be placing the Medical record in red cover
 This will be received in a yellow plastic cover which is carried by the staff outside COVID ward ,The staff receiving the
records from outside should be wearing a full PPE ((face mask with eye shield, Gown, Gloves)) while the records are being
placed in the yellow cover.
 This yellow cover will be labelled on the outside with the date of receiving the record and placed in a card board box and
kept in a separate area in the secured area of MRD untouched for 5 days.

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 After 5 days the records will be removed with PPE- gloves, mask, apron and face shield and the outer laminated surface
wiped with disinfectant (70% alcohol). It will then be checked, assembled, coded and filed as per existing records
maintenance policy.
 Extra copies of discharge summaries of these patients will be done and filed in the outpatient records for continuity of care
if medical records of these patients are requested before the filing is done. Under no circumstances the records will be
reissued before the mandatory 5 days of quarantine
 Trolley used for shifting of records to be disinfected with Chlorhexidine Gluconate IP 0.5% and Ethyl Alcohol I.P.70%

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Guidelines for Discharge

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Previous Recommendation
Initial recommendation (published on 12 January 2020)
 WHO’s first technical package of guidance for the clinical management of the novel coronavirus, now known as COVID-19,
was published in early January 2020, shortly after a cluster of atypical pneumonia cases was first reported in Wuhan,
People’s Republic of China,3 and included recommendations on when a patient with COVID-19 is no longer considered
infectious.
 The initial recommendation to confirm clearance of the virus, and thus allow discharge from isolation, required a patient to
be clinically recovered and to have two negative RT-PCR results on sequential samples taken at least 24 hours apart.4 This
recommendation was based on our knowledge and experience with similar coronaviruses, including those that cause SARS
and MERS.5

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New Recommendation
New recommendation (published on 27 May 2020 as part of more comprehensive clinical care guidance1)
 Within the Clinical Management of COVID-19 interim guidance published on 27 May 2020,1 WHO updated the criteria for
discharge from isolation as part of the clinical care pathway of a COVID-19 patient. These criteria apply to all COVID-19 cases
regardless of isolation location or disease severity.
 Criteria for discharging patients from isolation (i.e., discontinuing transmission-based precautions) without requiring retesting:
• For symptomatic patients: 10 days after symptom onset, plus at least 3 additional days without symptoms (including
without fever and without respiratory symptoms)
• For asymptomatic cases: 10 days after positive test for SARS-CoV-2
• For example, if a patient had symptoms for two days, then the patient could be released from isolation after 10 days + 3 =
13 days from date of symptom onset; for a patient with symptoms for 14 days, the patient can be discharged (14 days + 3
days =) 17 days after date of symptom onset; for a patient with symptoms for 30 days, the patient can be discharged
(30+3=) 33 days after symptom onset).
• *Countries may choose to continue to use testing as part of the release criteria. If so, the initial recommendation of two
negative PCR tests at least 24 hours apart can be used.

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Finally …… What did this pandemic teach me - my perspective?
 Never take life for granted – especially health !
 Smallest are the mightiest
 Everything is relative and anything is possible ( we can work from home, stay without salons, gyms, malls)
 We all have a master chef inside us ( I can bake too !)
 We are social beings and social distancing is killing – is this the genetic preconditioning ?
 Its all about attitude – choice is ours !!
 Finally, we are heading towards a healthier world with all the best practices – Prevention any day is better than cure !!!

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PREFERRED PRACTICE PREVENTIVE PRACTICES

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SHEELA – Your Personalized Healthcare Assistant Features
Device
Recordings
Prescription Reminder
Appointments Reminder
Sleep Work
Flow
Water Intake
Workflow
BMI
Calculations
Discussion on:
 Clinical Martyrs
 Tip of the Iceberg - ?
 Will New Normal Stay?

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Science of Happiness & its Importance in Work Culture
#HappierMeHappierWorld
If you’re happy then
your work is happy and
whole world becomes
happy for you

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Science of Happiness & its Importance in Work Culture

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Panel Discussion - Section Highlights
Discussion on:
 How do you relax?
 Imbibing happiness @HCOs
 Mental Health

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Making of a COVID-19 Ward - A People Centric Experience
Pandemic faced may be once in life time
Preparation
Practice
Performance analysis
Perfecting the execution
People always first

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Making of a COVID-19 Ward - A People Centric Experience
What is different this time?
Are we ready?
What is at stake?
What is the future?
Unanswered questions
Silver linings

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Panel Discussion - Q & A, Closing Comments
Our Next Webinar
Quality Accreditation and Beyond – Winds of Change
Session 1 – 24th July, 2020 (1430 to 1630 IST)
Session 2 – 31st July, 2020 (1430 to 1630 IST)
Our Panelists:
1. Dr. Atul Kochar - NABH
2. Dr. Umashankar Raj Urs - Ramaiah Memorial Hospital, Bengaluru
3. Dr. Sanjeev K Singh - Amrita Institute of Medical Sciences, Kochi &
Faridabad
4. Dr. Lallu Joseph - CAHO & CMC Vellore
5. Dr. Alexander Varghese - New Mowasat Hospitals, Kuwait
6. Dr. B K Rana - QAI
7. Ms. Mandakini Pawar - CII - Institute of Quality
8. Ms. Rama Venugopal - Value Added Services & Chennai
Consultants Consortium
9. Mr. Rahul Rao - Healthcare Consultant, Bengaluru
and Few More Industry Stalwarts...
Discussion on:
 Role of HR & Leadership Team
 Operational SOP Reviews
 Bed, Ventilator, Respirator, PPEs –
Scarce resources

/133
Thank You
"
"
Never doubt that a small group of thoughtful,
committed citizens can change the world;
Indeed, it’s the only thing that ever has.
-Margaret Mead

Qurhealth webinar - Caring for Caregivers

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