Covid-19 pandemic management includes the two critical aspects - adequate testing to identify the disease and appropriate patient care after identification. During the entire process, maintaining patients’ safety is a major concern for healthcare professionals. A safe environment is the need of the hour not only for the Covid19 patients but also for the healthcare Professionals who are working overtime and beyond capacity during this Pandemic period. Availability of proper Personal Protective equipment like N-95 masks, body cover, goggles and face shields for healthcare workers round have become a dire need to ensure healthcare worker safety. Patient safety activities include prevention, reduction, reporting, and analysis of medical error to minimize the adverse impacts. Accurate diagnosis of a disease is important aspect of Patient safety. If a wrong drug is suggested or administered, it is called a medication error – which doctors, nurses and Pharmacists need to be careful about. Ensuring blood-safety is another important domain - blood transfusion should be done in a proper way.
Dr. Subhrojyoti Bhowmick, Patient Safety Expert and Clinical Director, Peerless Hospital (Kolkata), told BE, “Correct identification of every patient is very important as we are receiving a huge number of patients. To ensure that we never use the patient’s name or bed number but have 2 specific patient identifiers like the date of birth and the responsible doctor’s identity. Treatment protocols are based on guidelines issued by the government of West Bengal and ICMR. Bar coding is carried out at the Pharmacy in order to prevent medication mixing. We are carrying out regular prescription audits to ensure medication safety at our Hospital.”
Commenting on the equipment safety, Dr. Bhowmick added, “To regulate and check the medical devices (including the ventilators) frequently is vital because Covid-19 patients require support from critical equipment occasionally. Any transgression of it can lead to serious problems.” Prevention and control of any infection, radiation safety and safe surgery are key patient safety areas. WHO has declared the World Patient Safety Day on September 17 since 2019 - to mark the importance of patient Safety in the healthcare sector. This year theme is ‘Healthcare worker safety’ which is very pertinent considering the Challenging time for healthcare workers fighting the Pandemic. A safe healthcare worker can ensure hundreds of safe patients.
Covid-19 testing strategy in India
In the last seven days, as of September 23, the WHO informed that India (625,651 cases), the US (283,363 cases), and Brazil (212,458 cases) have reported the maximum number of new cases. So, adequate testing and treatment maintaining adequate safety, both in urban and rural areas, is of utmost importance. The ICMR has directed for routine surveillance in containment zones and screening at points of entry. To identify the cases fast, the council has recommended early testing and declared that the choice of testing in order of priority will be - Rapid Antigen Test (RAT), Reverse transcription polymerase chain reaction (RT-PCR), TrueNat and then CBNAAT testing. Early detection is also important not only to save a certain patient, but to safeguard the larger population. The ICMR has approved around 1000 testing labs in both public and private sectors.
Who should test?
1. All Influenza like Symptoms (ILI) symptomatic individuals including health care workers and frontline workers.
2. All asymptomatic direct and high-risk contact individuals (from family or workplace) who are hospitalised or seeking hospitalisation, people aged more than 65 years, immune-compromised persons and people with comorbidities, patients diagnosed with malignant disease, patients undergoing aerosol generating surgical or non-surgical interventions etc.
3. All asymptomatic high-risk individuals in containment zones.
Where testing is a necessity:
Deployment of the rapid antigen test is recommended in all containment zones identified by state governments, all central and state government medical colleges and government hospitals, all private hospitals, all private labs approved by ICMR. RAT test is a necessity in these as it does not require a specialised machine and the result can be interpreted between 15 to 30 minutes with naked eyes. It helps to detect the disease in mass much sooner than any other test.
• A single RT-PCR or TrueNat or CBNAAT or RAT positive test is to be considered confirmatory, without any repeat testing.
• If symptoms develop following a negative RAT test, a repeat RAT or RT-PCR is recommended