Should clinic be closed if a COVID-positive patient comes

CMAAO Advisory: If you are taking all standard precautions, continue the clinic.

If you are not sure about the 100% safety standard precautions: fumigate the clinic for 24 hours with standard gas fumigation process

Continue next day with full standard precautions

Can a COVID-positive asymptomatic healthcare worker work in COVID-positive non-critical ward

CMAAO: Yes, the new US CDC guidelines state that essential workers who may have had exposure to the virus may continue to work provided they are asymptomatic, wear an N 95 mask at all times for 14 days after their last exposure and have their temperature checked before entering the workplace.

Can a COVID-positive asymptomatic healthcare worker work  

CMAAO: Yes, provided they wear N 95 mask all the time, follow social distancing, remaining 6 feet from co-workers and potential new patients. If they show symptoms, they should be sent home immediately and all surfaces at the workplace should be cleaned and disinfected.

What are the current CDC guidelines for healthcare workers to return to work

100 healthcare workers are positive in Mumbai alone. They cannot be left alone and not included in the healthcare working.

Current US CDC policy - Return to work for healthcare personnel (HCP) with confirmed COVID-19, or who have suspected COVID-19 (develop symptoms of a respiratory infection [cough, sore throat, shortness of breath, fever] but did not get tested for COVID-19).

Test-based strategy: Exclude from work until -

Resolution of fever without the use of fever-reducing medications and

Improvement in respiratory symptoms (cough, shortness of breath), and

Negative results of an FDA Emergency Use Authorized molecular assay for COVID-19 from at least two consecutive nasopharyngeal swab specimens collected ≥24 hours apart (total of two negative specimens). [See Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens for 2019 Novel Coronavirus (2019-nCoV).]

Non-test-based strategy: Exclude from work until -

At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (cough, shortness of breath); and At least 7 days have passed since symptoms first appeared

If HCP were never tested for COVID-19 but have an alternate diagnosis (e.g., tested positive for influenza), criteria for return to work should be based on that diagnosis.

Return to Work Practices and Work Restrictions

After returning to work, HCP should:

Wear a facemask at all times while in the healthcare facility until all symptoms are completely resolved or until 14 days after illness onset, whichever is longer

Be restricted from contact with severely immunocompromised patients (transplant, hematology-oncology) until 14 days after illness onset

Adhere to hand hygiene, respiratory hygiene, and cough etiquette in CDC’s interim infection control guidance (e.g., cover nose and mouth when coughing or sneezing, dispose of tissues in waste receptacles)

Self-monitor for symptoms, and seek re-evaluation from occupational health if respiratory symptoms recur or worsen

Crisis Strategies to Mitigate Staffing Shortages

Healthcare systems, healthcare facilities, and the appropriate state, local, in such scenarios:

1. HCP should be evaluated by occupational health to determine appropriateness of earlier return to work than recommended above
2. If HCP return to work earlier than recommended above, they should still adhere to the Return to Work Practices and Work Restrictions recommendations above.

[Criteria for Return to Work for Healthcare Personnel with Confirmed or Suspected COVID-19 (Interim Guidance); CDC’s Interim U.S. Guidance for Risk Assessment and Public Health Management of Healthcare Personnel with Potential Exposure in a Healthcare Setting to Patients with COVID-19.]

Should healthcare establishments be the first to open

CMAAO: yes. For them, every patient entering the hospital for the next six months is COVID-positive unless proved otherwise and every surface touched is virus positive and standard precautions taken.

What are these standard precautions

1. Tele-appointments
2. Teleconsultations
3. Visitors restriction
4. Physical distancing 3-6 feet
5. Wearing masks
6. Wearing gloves and shoe covers
7. Wearing PPE as per the risk
8. Hand hygiene
9. Respiratory hygiene and cough etiquettes
10. Surface disinfection
11. Overnight fumigation
12. Biomedical waste disposal

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA