COVID-19: Govt issues detailed advisory for safe ENT practice
New Delhi, June 04: The Ministry of Health Affairs has issued guidelines for safe ENT practise in the wake of COVID-19.
The Health Ministry says that tele-consultation would be preferable. Prior tele-consultation can be done to identify patients requiring physical examination, the guidelines also say.
Appointment system:
- One patient at a time in examination room, if possible, without attendant
-
Sufficient
time
should
be
given
for
patient
evaluation
and
for
time
in-between
patients - Walk-in patients without appointment should be discouraged
Screening:
All
patients
entering
ENT
OPD
should
be
screened
using
screening
proforma
and
thermal
screening.
The
objective
of
screening
is
to
minimise
exposure
to
staff
and
to
patients.
Screening
is
to
be
done
to
pre-screen
all
patients
before
entry
and
to
minimise
entry
to
the
OPD
premises.
Patients
having
symptoms
suggestive
of
Covid-19
(
Whether
ENT
Symptoms
or
Respiratory
Symptoms)
should
be
seen
in
a
separate
"Covid-19
screening
Clinic"
and
not
in
the
ENT
OPD.
This
is
so
that
other
patients
in
the
ENTOPD
are
safe.
Also,
personnel
manning
the
Covid-19
Screening
Clinic
will
have
a
different
level
of
PPE.
Entry point:
Regulate
entry
of
patients
and
ensure
the
use
of
mask,
hand
hygiene
and
social
distancing,
as
per
the
standard
protocols
advocated
by
the
Health
Ministry.
Within the OPD room:
- ENT OPD room should be well-ventilated.
- ENT doctors should wear Level I PPE kit (N95 mask, gown, gloves, goggles/ face shield) in OPD chamber.
-
Avoid
performing
endoscopy
(Nasal
endoscopy,
90
rigid
or
flexible
endoscopy
for
larynx) in routine OPD. -
If
endoscopy
has
to
be
performed,
it
should
preferably
be
performed
in
a
separate
demarcated area with Level II PPE kit(Cover-all gown, N-95 mask, gloves and goggles). - Doctor should change gloves if they get soiled and refrain from eating/drinking during OPD timings.
-
Doctor
should
encourage
patients
and
their
attendant
to
follow-up
with
tele-
consultation based upon his/her assessment.
Endoscopy and biopsy:
Because
of
risk
of
aerosol
generation
during
biopsies
and
endoscopies,
all
HCP(doctor,
nursing
staff
and
technical
assistant)
need
to
wear
Level
II
kit
(Cover-all
gown,
N-95
mask,
gloves
and
goggles)
during
these
procedures.
It
is
preferable
to
have
separate
donning
and
doffing
area
with
a
supervisor
for
both
procedures.
Protocol for ENT, head and neck surgery ward:
COVID 19 suspect patients should be treated in a separate ward for COVID 19 patients, and
should be shifted to ENT ward only after confirmation of COVID negative status.
Ensure that suspected and confirmed cases of COVID-19 patients are kept separately.
Patients
should
be
screened
for
COVID
19
before
admission
(refer
to
Annexure
I)
Only
one
patient's
care-taker
should
be
allowed
at
a
time
who
is
also
screened
like
above.
They should comply to strict precaution for COVID 19 like wearing of mask, frequent hand washing and social distancing.
Ensure that appropriate hand washing facilities and hand-hygiene supplies are available.
Hand sanitisation and social distancing posters must be displayed in multiple areas of ward.
Keep the patient's personal belongings to a minimum.
Examination instruments should be properly sterilized as per standard sterilisation protocol after every use.
Ward should be with minimum furniture for proper cleaning and disinfection.
Visitors should not be allowed.
Corridors and rooms should be well-ventilated.
Scheme for the ENT and head and neck surgery ward:
- Distancing of at least 2 meters in between patient beds is mandatory. Additional distance if feasible is desirable as care taker may also be accompanying patients.
- Ward should be demarcated into separate areas for patients with high aerosol generating potential (e.g. Tracheostomized patients) and for patients with ENT patients
- If possible, patients in the ward can be segregated depending on the time from admission.