PROTOCOL FOR COVID-19 IN HEALTH CARE FACILITY

LAGOS STATE MINISTRY OF HEALTH
HEALTH FACILITY MONITORING AND ACCREDITATION AGENCY
PROTOCOL FOR COVID-19 IN HEALTH CARE FACILITY

This protocol entails infection prevention and control for COVID-19 at the healthcare facility in Lagos State.

Planning

1. Each healthcare facility must have a plan and team to address COVID-19 preparedness.
2. Each team member should be assigned responsibility for coordinating planning and COVID-19 response.
3. The plan should have a written protocol for preventing, identifying, monitoring and reporting COVID-19 among the facility patients and staff.
4. A copy of the written protocol should be made available at the facility and accessible by staff.
5. The plan should monitor and track COVID-19 related staff absences.
6. The plan should have a person(s) assigned for internal communicating and educating staff, patients and their families regarding COVID-19 e.g. with information materials- posters, brochures, SOPs.
7. The plan should have a person(s) assigned responsibility for notification or communications with the Lagos State COVID-19 response team through the following phone numbers; 08000CORONA, 08000267662 or HEFAMAA lines;  09015637023, 09057273396, 09038795500, 08172704228 or the MOH of the LGA.
8. The written protocol should have a process for triage and identification of patients for suspected COVID-19.
9. A designated location, separate from other clinical triage and evaluation areas (utilizing the principles of social distancing) for isolation of patients with possible COVID-19 has been determined.
10. A process to conduct symptom and temperature checks for staff, patients and visitors at the entrance to the facility has been determined.
11. A process to ensure mandatory adequate hand washing with dispensable soap and running water, including the use of alcohol-based hand sanitizers has been instituted at the entrance to the facilities and also within.
12. A process to ensure the practice of social distancing by staff and patients has been determined through designated markings on the floor or furniture arrangement.
13. A process to ensure adequate availability and use of appropriate PPE by staff has been determined.

Ensuring Screening, Triage, Early Recognition, and Source Control

• Educate and encourage Health Care Workers (HCWs) to have a high level of clinical suspicion.
• Establish a well-equipped triage station at the entrance to the facility, supported by trained staff.
• All staff should ensure standard precautions, including face mask.
• Institute the use of hand held infra-red thermometer for temperature check and screening questionnaires according to the updated case definition. Please refer to NCDC portal. The questionnaires should ask for symptoms of COVID-19 such as fever, cough, difficulty with breathing, tiredness, sore throat, and muscle aches, including history of travel to areas with reported cases, close contact with a confirmed case and exposure to healthcare facility with reported case.
• If the case definition for COVID-19 is met and the patient is a suspected case, be RED ALERT, ensure full PPE and the patient should immediately be given a mask and directed to a separate area (an isolation room if available). Educate on cough and sneezing etiquette.
• Institute appropriate referral to Lagos State COVID-19 designated isolation and treatment facilities through putting a call to the toll free lines specified above. Please ensure the patient is evacuated to the appropriate Lagos State COVID-19 isolation and treatment centres through the COVID-19 response team for testing and evaluation. Don’t discharge patient to go free.
• Post signs in public areas reminding symptomatic patients to alert HCWs.
• Hand hygiene and respiratory hygiene are essential preventive measures.

Applying Standard Precautions for all Patients

• Ensure that all patients cover their nose and mouth with a tissue or elbow when coughing or sneezing
• Offer a medical mask to patients with suspected COVID-19 while they are in waiting/public areas or isolation / in cohorting rooms
• Perform hand hygiene after contact with respiratory secretions; hand hygiene includes either cleansing hands with an alcohol-based hand rub or with soap and water, alcohol-based hand rubs are preferred if hands are not visibly soiled or wash hands with soap and water when they are visibly soiled.
• Ensure social distancing principle is practiced by staff and patients.

Implementing Empiric Additional Precautions

Contact and droplet precautions

• In addition to using standard precautions, all individuals, including family members, visitors and HCWs, should use contact and droplet precautions before entering the room of suspected COVID-19 patients.
• Patients should be placed in adequately ventilated single rooms. For general ward rooms with natural ventilation, adequate ventilation is considered to be 60 L/s per patient.
• When single rooms are not available, patients suspected of having COVID-19 should be grouped together.
• All patients’ beds should be placed at least 1 meter apart regardless of whether they are suspected to have COVID-19.
• Where possible, a team of HCWs should be designated to care exclusively for suspected cases to reduce the risk of transmission.
• HCWs should use a medical mask (N 95 respirator).
• HCWs should wear eye protection (goggles) or facial protection (face shield) to avoid contamination of mucous membranes.
• HCWs should wear a clean, non-sterile, long-sleeved gown and also use gloves.
• After patient care, appropriate doffing and disposal of all PPE and hand hygiene should be carried out. A new set of PPE is needed when care is given to a different patient.
• Equipment should be both single-use and disposable or dedicated equipment (e.g. stethoscopes, blood pressure cuffs and thermometers). If equipment needs to be shared among patients, clean and disinfect it between use for each individual patient (e.g. by using ethyl alcohol 70%).
• HCWs should refrain from touching eyes, nose, or mouth with potentially contaminated gloved or bare hands.
• Avoid moving and transporting patients out of their room or area unless medically necessary. Use designated portable X-ray equipment or other designated diagnostic equipment. If transport is required, use predetermined transport routes to minimize exposure for staff, other patients and visitors, and have the patient wear a medical mask.
• Ensure that HCWs who are transporting patients perform hand hygiene and wear appropriate PPE.
• Routinely clean and disinfect surfaces with which the patient is in contact.
• Limit the number of HCWs, family members, and visitors who are in contact with suspected COVID-19 patients.
• Maintain a record of all persons entering a patient’s room, including all staff and visitors.

Airborne Precautions for Aerosol-Generating Procedures

• Perform procedures in an adequately ventilated room – that is, natural ventilation with air flow of at least 160 L/s per patient or in negative- pressure rooms with at least 12 air changes per hour and controlled direction of air flow when using mechanical ventilation.
• Use a particulate respirator at least as protective as a US National Institute for Occupational Safety and Health (NIOSH)-certified N95, European Union (EU) standard FFP2, or equivalent.
• When HCWs put on a disposable particulate respirator, they must always perform the seal check. Note that facial hair, beards can prevent proper functioning of a respirator.
• Use eye protection (i.e. goggles or a face shield).
• Wear a clean, non-sterile, long-sleeved gown and gloves. If gowns are not fluid-resistant, HCWs should use a waterproof apron for procedures expected to create high volumes of fluid that might penetrate the gown.
• Limit the number of persons present in the room to the absolute minimum required for the patient’s care and support.

Using Administrative, Environmental and Engineering Controls

These controls address the management and basic infrastructure of the health care facility and aim to ensure adequate administration of staff, ventilation in all areas in the health care facility, as well as adequate environmental cleaning. Staff should be effectively rotated to prevent overwork and fatigue. Ensure social distancing, and separation of at least 1 meter should be maintained between all patients. Both spatial separation and adequate ventilation can help reduce the spread of many pathogens in the health care setting. Ensure that cleaning and disinfection procedures are followed consistently and correctly. Cleaning environmental surfaces with water and detergent and applying commonly used hospital disinfectants (such as sodium hypochlorite) is effective and sufficient. Manage laundry, food service utensils and medical waste in accordance with safe routine procedures.