Pre-Triage

Initial Dealing with Suspected Patients

Have patients call first.

1. If they are not severe and have criteria for testing, this can be set up before they arrive.

2. Test outside with staff in PPE (benefit: no cleaning necessary, no contamination)

3. Try to BATCH your tests to save PPE & save time. Only change whatever PPE is necessary between patients.

4. Otherwise try to get them into a testing room with the least exposure in the clinic (e.g. use a side entrance); ensure appropriate PPE; clean room after.

Pre-Triage

For any person arriving at the Facility: Do Pre-Triage.

You may have to slightly adapt this to your local reality. Use as many trained staff as you can.

Below is a sample only. Check with your facility what the latest being used is. If more than 2-3 days old - recheck!

Train and Empower your entry point staff.

NOTE - If the patient has Respiratory or GI symptoms or has Travelled:

• 1. 1. Have the chart flagged or marked so that nurses/MD’s know the patient has symptoms or an Exposure and can be sent to the COVID Part of the facility

     2. The nurse or MD must know to put a mask and gloves on before entering the room.

At some point very very soon - a patient with Respiratory/GI symptoms with no Travel will be considered COVID+.

Remember: YOU MUST Monitor and TEST PRE-TRIAGE.

At least EVERY DAY, better 2X / day

Minimize exposure to the rest of the Facility.

• 1. After Pre-Triage, if a suspected patient can enter a designated room from another outside door - go for it!

  2. Otherwise send the patient directly to the room and minimize their exposure to the clinic.

  3. Waiting rooms only if necessary:

As patient volume increases, suspected cases will need to wait.

• • Consider setting up completely separate waiting areas for possible COVID and Non-COVID cases.

    • e.g., some hospitals use the Garage as a designated COVID Waiting Area.

    • If this is physically impossible, then use physically separate waiting areas.

  • If separate waiting areas are not possible, divide the single waiting area into potential COVID infected cases and non-infected cases :

    • Create as much space as possible between zones and patients.

    • Use physical barriers between the two spaces - dividers, wood, plexiglass.

    • You may need to get creative.

Testing Location

1. 1. Testing outside for stable patients is not just desired - it is necessary: no contamination issue. You should start planning to do this immediately.

   2. Try to BATCH your tests to save PPE & save time. Only change whatever PPE is necessary between patients.

   3. Weather can make outside testing a little more difficult - but doable.

      • Start to plan to do this with a tent, or drive by testing.

      • or use a drive-by door.

   4. Testing Criteria - Refer to Public Health

Pregnant Patients

1. Get Pregnant Patients out of COVID areas.

2. Do not see Acute pregnant patients in COVID zones.

3. You should Strongly consider moving Outpatient Pregnancy OUT of the Facility early if separation is difficult.

TESTING FOR COVID

Testing will not be covered in detail here.

Please refer to guidelines for doing 1 swab in oropharynx, then both narines and into viral medium.

Ensure staff are wearing appropriate PPE to test. (See next section PPE).

In general, places that have succeeded in controlling spread have used an aggressive testing strategy to identify and isolate cases. Eg South Korea

Cleaning Guidelines

This is crucial - Start examining now.

This is not an exhaustive or thorough guide. It points out main concepts. Please inform yourselves about Cleaning. You may need to get to the next level - very fast.

Concept: Potential for Exposure

High-touch surfaces: High-touch surfaces are those that have frequent contact with hands = High Risk

Eg doorknobs, telephone, call bells, bed rails, light switches, wall areas around the toilet and edges of privacy curtains, desks, computers, faucets.

Low-touch surfaces: Low-touch surfaces are those that have minimal contact with hands.

Eg include walls, ceilings, mirrors and window sills.

Concept: Level of Cleaning

Hotel clean: A measure of cleanliness based on visual appearance that includes dust and dirt removal, waste disposal and cleaning of windows and surfaces

Hospital Clean: is “Hotel clean” with the addition of disinfection, increased frequency of cleaning, auditing and other infection control measures in client/patient/resident care areas.

Ensure Staff Safety: eg Laundering of material must be done with workers protected with appropriate PPE and tecnhniques that do not cause unecessary exposure - eg a pile of soiled in a workers arms exposing their face.

Ensure Staff Training: Are staff adequately knowledgeable in: cleaning product use, dilutions etc; cleaning procedures. Post Aerosol Cleaning procedures

Bottom Line:

Disinfection of every exam room between each suspected patient

Disinfection every 1-2 hours of waiting rooms or High Touch areas of the whole facility

Hospital Level cleaning of High Touch Surfaces is priority One