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COVID-19 is like H1N1 flu, but more virulent

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COVID 19 has compelled hospitals to think beyond the basics of infection control. It has taught important lessons about infrastructural changes, biomedical waste management, staff training and more needed for infections control. In a free-wheeling interaction with Raelene Kambli, Dr B K Rana, Founding CEO, Quality & Accreditation Institute (QAI) reveals more about the changing infection control norms for hospitals in times of COVID-19

Do the current NABH norms for infection control suffice to combat a pandemic to this extent?

Accreditation standards require hospitals to implement a documented infection control programme, which includes various practices for infection prevention and control. In fact, the standard requires that hospitals should have the preparedness to deal with disasters, including disease outbreaks. Essentially, standards cover all aspects of infection prevention; however, many may not be ready to deal with infectious disease outbreaks like COVID-19. Nonetheless, the framework of accreditation certainly comes handy to deal with any such adverse situation. Standards certainly help hospitals to address issues better than those who have not implemented standards.

Given the current COVID-19 pandemic, what kind of changes do we require in the current infection control guidelines for hospitals and healthcare facilities?

Basics of infection control remain the same all the time. Following universal precaution is a norm; however, how much it is practised, maybe the cause of concern. Scientifically, all coronaviruses are similar in nature, particularly SARS-CoV-2 which is responsible for COVID-19 disease is similar to H1N1, though more virulent than H1N1. However, the precautions to be taken for H1N1 were not as much as we need for COVID-19. Therefore, strict implementation of infection prevention and control practises is a must, including extra precaution like proper use of Personnel Protective Equipment (PPE), changes in cleaning procedures and practices, handling and maintenance of equipment, heating ventilation and air conditioning systems, handling and disposal of bio-medical waste, along with strengthening the staff training.

What kind of measures should hospitals take to ensure that HVAC systems don’t become the reason for virus propagation?

HVAC works on a specific principle of heating, ventilation and air conditioning to maintain a specific temperature and humidity, the direction of air circulation, number of air changes and sterility of air through a filtration process. Therefore, the system is to be maintained in a manner that it does not allow virus particles to concentrate in a specific area and thereby increase the chances of people getting infected in that area. Further, if a known case of COVID-19 is admitted, that patient should be put in a room which has a separate air handling system and also negative pressure, so that virus can’t go out.

What measures should be taken to ensure bio-medical waste in these times are carefully disposed of without causing any exposure to the staff handling it?

It is very important that BMW is both handled and disposed of properly as it may be highly infected and the slightest error might result in a disaster. Staff need to be properly trained both in donning and doffing of the PPE  and disposal protocol. Staff responsible for disposal are also required to be trained in handling and also to be provided with adequate and proper PPE.

What should be the steps that hospitals need to follow while maintaining social distance?

Social distancing is one way of reducing the spread by breaking the chain of contact and thus reducing the chances of survival for the virus. In addition to social distancing, proper hand hygiene practices, surface cleaning and screening for the temperature of all entering into the building need to be practised and strengthened.

What should be done to avoid or manage future outbreaks?

It is difficult to say how to avoid such outbreaks in the absence of the information of its cause and origin. COVID-19 has taught us many lessons in terms of what we need to strengthen, particularly in the public health system. Better management of such outbreaks is to break the chain at the earliest which may be achieved through screening of people at the possible sources of spread, testing of suspected/contact cases and isolation.

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