COVID-19 TREATMENT GUIDELINEIN TANZANIA, MARCH 2021
Posted by ULY CLINIC
24 Machi 2021 20:09:25
The guidance is based on proper case management aspects intended for clinicians involved in the care of patients with suspected or confirmed COVID-19. It is not meant to replace clinical judgment or specialist consultation but rather to strengthen frontline clinical management and the public health response.
NOTE. THIS GUIDELINE IS THE POPERTY OF MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN
13. IPC IMPLEMENTATION MEASURES
IPC is a critical and integral part of clinical management of patients and should be initiated at the point of entry of the patient (OPD/emergency department). Standard precautions should always be routinely applied in all areas of health care facilities.
a. Standard precautions
Standard precautions include;
• Hand hygiene
• Use of PPE to avoid direct contact with patients’ blood, body fluids, secretions (including respiratory secretions) and non-intact skin.
• Appropriate handling of sharps
• Safe waste management; cleaning and disinfection of equipment; and
• Cleaning of the environment.
b. Implementing IPC for suspected or confirmed COVID 19 infection
At triage
• Give suspect patient a medical mask and direct patient to separate area, isolation room if available.
• Keep at least 1-2meter distance between suspected patients and other patients.
• Instruct all patients to cover nose and mouth during coughing or sneezing with tissue or flexed elbow for others.
• Perform hand hygiene after contact with respiratory secretions
Apply droplet precautions
Droplet precautions prevent large droplet transmission of respiratory viruses.
• Use a medical mask if working within 1-2 meter of the patient.
• Place patients in single rooms.
• If an etiological diagnosis is not possible, group patients with similar clinical diagnosis and based on epidemiological risk factors, with a spatial separation using examination screens.
• When providing care in close contact with a patient with respiratory symptoms (e.g. coughing or sneezing), use eye protection (face-mask or goggles), because sprays of secretions may occur.
• Limit patient movement within the institution and ensure that patients wear medical masks when outside their rooms.
Apply contact precautions
Droplet and contact precautions prevent direct or indirect transmission from contact with contaminated surfaces or equipment (i.e. contact with contaminated oxygen tubing).
• Use PPE (N95, eye protection, gloves and gown) when entering room and remove PPE when leaving.
• If possible, use either disposable or dedicated equipment (e.g. stethoscopes, blood pressure cuffs and thermometers).
• If equipment needs to be shared among patients, clean and disinfect between each patient use.
• Ensure that health care workers refrain from touching their eyes, nose, and mouth with potentially contaminated gloved or ungloved hands.
• Avoid contaminating environmental surfaces that are not directly related to patient care (e.g. door handles and light switches).
• Ensure adequate room ventilation. Avoid movement of patients or transport.
• Perform hand hygiene.
Apply airborne precautions when performing an aerosol generating procedure
• Ensure that healthcare workers performing aerosol-generating procedures (i.e. open suctioning of respiratory tract, intubation, bronchoscopy, cardiopulmonary resuscitation) use PPE, including gloves, long-sleeved gowns, eye protection, and fit-tested particulate respirators (N95 or equivalent, or higher level of protection).
• Whenever possible, use adequately ventilated single rooms when performing aerosol-generating procedures, meaning negative pressure rooms with minimum of 12 air changes per hour or at least 60 litres/second/patient in facilities with natural ventilation.
• Avoid the presence of unnecessary individuals in the room.
• Care for the patient in the same type of room after mechanical ventilation commences
c. IPC measures at community level
Include;
• Washing hands frequently;
• Practice respiratory hygiene;
• Maintain social distancing;
• Avoid touching eyes, nose and mouth;
• If you have fever, cough and difficulty breathing, seek medical care early;
• If you have mild respiratory symptoms and no travel history to area where the disease has been reported;
c. i. Washing hands frequently;
Washing hands frequently with soap and water or use an alcohol-based hand rub if your hands are not visibly dirty.
c. ii. Practice respiratory hygiene
When coughing and sneezing, cover mouth and nose with flexed elbow or tissue – discard tissue immediately into a closed bin and clean your hands with alcohol-based hand rub or soap and water.
c. iii. Maintain social distancing;
Maintain at least 1 meter (3 feet) distance between yourself and other people, particularly those who are coughing, sneezing and have a fever.
c. iv. Avoid touching eyes, nose and mouth;
Hands touch many surfaces which can be contaminated with the virus. If you touch your eyes, nose or mouth with your contaminated hands, you can transfer the virus from the surface to yourself.
c. v. If you have fever, cough and difficulty breathing, seek medical care early;
Tell your health care provider if you have traveled in an area where 2019-nCoV has been reported, or if you have been in close contact with someone with who has traveled from China and has respiratory symptoms.
c. vi. If you have mild respiratory symptoms and no travel history to area where the disease has been reported;
If you have mild respiratory symptoms and no travel history to the area where the disease has been reported, carefully practice basic respiratory and hand hygiene and stay home until you are recovered, if possible
Note
Vaccination is one of the disease preventive measures, upon availability of an approved vaccine beyond reasonable doubt, its use is recommended for early containment of the disease/pandemic, protection of healthcare workers and the general public.
Updated,
25 Machi 2021 07:29:01
References
1. THE UNITED REPUBLIC OF TANZANIA. MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDRENCORONAVIRUS DISEASE 2019 (COVID-19) TREATMENT GUIDELINES. MARCH 2021
2. Del Rio, C. and P.N. Malani, (2020). 2019 Novel Coronavirus—Important Information for Clinicians. JAMA, 2020. 323(11): p. 1039-1040.
3. World Health Organization, (2020). Coronavirus disease 2019 (COVID-19) Situation Report 46, 2020.
4. World Confederation of Physical Therapists (WCPT) (2020). Physiotherapy management for COVID 19 version 1.0 23 March 2020
5. Sohrabi, C., Z. Alsafi, N. O'Neill, M. Khan, A. Kerwan, A. Al-Jabir, C. Iosifidis, and R. Agha, (2020). World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19). Int J Surg, 2020. 76: p. 71-76.
6. Guan, W.-j., … Ye, C.-j. Zhu, S.-y. and Zhong N.-s., (2020). Clinical Characteristics of Coronavirus Disease 2019 in China. NewEngland Journal of Medicine, 2020.
7. van Doremalen, N., … Lloyd-Smith, J.O., de Wit, E., and Munster, V.J., (2020). Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. New England Journal of Medicine, 2020.
8. Yoon, S.H., K.H. Lee, J.Y. Kim, Y.K. Lee, H. Ko, K.H. Kim, C.M. Park, and Y.H. Kim, Chest Radiographic and CT Findings of the 2019 Novel Coronavirus Disease (COVID-19): Analysis of Nine Patients Treated in Korea. Korean J Radiol, 2020. 21(4): p. 494-500.
9. Zhao, D., F. Yao, L. Wang, L. Zheng, Y. Gao, J. Ye, F. Guo, H. Zhao, and R. Gao, A comparative study on the clinical features of COVID-19 pneumonia to other pneumonias. Clin Infect Dis, 2020.
10. Peng, Q.Y., X.T. Wang, L.N. Zhang, and G. Chinese Critical Care Ultrasound Study, Findings of lung ultrasonography of novel corona virus pneumonia during the 2019-2020 epidemic. Intensive Care Med, 2020.
11. Chen, N., M. Zhou, X. Dong, J. Qu, F. Gong, Y. Han, Y. Qiu, J. Wang, Y. Liu, Y. Wei, J. Xia,
T. Yu, X. Zhang, and L. Zhang, Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet, 2020. 395(10223): p. 507-51s3.
12. Zhou, F., T. Yu, R. Du, G. Fan, Y. Liu, Z. Liu, J. Xiang, Y. Wang, B. Song, X. Gu, L. Guan, Y. Wei, H. Li, X. Wu, J. Xu, S. Tu, Y. Zhang, H. Chen, and B. Cao, Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet, 2020.
13. Xie, J., Z. Tong, X. Guan, B. Du, H. Qiu, and A.S. Slutsky, Critical care crisis and some recommendations during the COVID-19 epidemic in China. Intensive Care Medicine, 2020.
14. Australian and New Zealand Intensive Care Society, ANZICS COVID-19 Guidelines, 202, ANZICS: Melbourne.
15. Kress, J.P. and J.B. Hall, (2014). ICU-acquired weakness and recovery from critical illness.
N Engl J Med, 2014. 370(17): p. 1626-35.
16. Herridge, M.S., C.M. Tansey, A. Matte, G. Tomlinson, N. Diaz-Granados, A. Cooper, C.B. Guest, C.D. Mazer, S. Mehta, T.E. Stewart, P. Kudlow, D. Cook, A.S. Slutsky, and A.M. Cheung, (2011). Functional disability 5 years after acute respiratory distress syndrome. N Engl JMed, 2011. 364(14): p. 1293-304.
17. Brouwers, M.C., M.E. Kho, G.P. Browman, J.S. Burgers, F. Cluzeau, G. Feder, B. Fervers,
I.D. Graham, S.E. Hanna, and J. Makarski, (2010). Development of the AGREE II, part 1: performance, usefulness and areas for improvement. Cmaj, 2010. 182(10): p. 1045-52.
18. Schunemann, H.J., …Cuello, R. Waziry,and Akl, E.A., (2017). GRADE Evidence to Decision (EtD) frameworks for adoption, adaptation, and de novo development of trustworthy recommendations: GRADE-ADOLOPMENT. J Clin Epidemiol, 81: p. 101-110.
19. Moberg, J., A.D., …Morelli, G. Rada, and P. Alonso-Coello, (2018). The GRADE Evidence to Decision (EtD) framework for health system and public health decisions. Health Res Policy Syst, 16(1): p. 45.
20. Clinical Skills Development Service, Q.H. Physiotherapy and Critical Care Management eLearning Course. Accessed 21/3/20]; Available at https://central.csds.qld.edu.au/central/courses/108].
21. World Health Organisation, (2020). Infection prevention and control during health care when COVID-19 is suspected: Interim Guidance, M. 2020, Editor 2020.
22. Queensland Health,(2020). Clinical Excellence Division COVID-19 Action Plan: Statewide General Medicine Clinical Network,
23. The Faculty of Intensive Care Medicine. (2019). Guidelines for the provision of the intensive care services.; Available from: https://www.ficm.ac.uk/news-eventseducation/ news/guidelines-provision-intensive-care-services-gpics-%E2%80%93-secondedition.
24. Alhazzani, W., … Hayden, F., Evans, L., and Rhodes, A., (2019). Surviving sepsis campaign: Guidelines of the Management of Critically Ill Adults with Coronavirus Disease (COVID- 19). Critical Care Medicine, 2020. EPub Ahead of Print.
25. World Health Organization, (2020). Clinical Management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected Interim Guidance, 2020. p. WHO Reference number WHO/2019-nCoV/clinical/4.
26. Metro North, (2020). Interim infection prevention and control guidelines for the management of COVID-19 in healthcare settings,: https://www.health.qld.gov.au/ data/assets/pdf_file/0038/939656/qh-covid-19- Infectioncontrol- guidelines.pdf.
27. Stiller, K., (2013). Physiotherapy in intensive care: an updated systematic review. Chest,
144(3): p. 825-847.
28. Green, M., V. Marzano, I.A. Leditschke, I. Mitchell, and B. Bissett, (2016). Mobilization of intensive care patients: a multidisciplinary practical guide for clinicians. J Multidiscipline Health, 9: p. 247-56.
29. Hodgson, C.L. Zanni, L. Denehy, and S.A. (2014). Webb, Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults. Critical Care, 2014. 18(6): p. 658.
30. Australian and New Zealand Intensive Care seeliery, ANCS COVID 19 Guidelines 202 ANZICS Melhsore.
31. Zanni, M.J., denehy,L.(2014). Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults. Critical care. 18 (6): p 658.