COVID-19 TREATMENT GUIDELINEIN TANZANIA, MARCH 2021
Posted by ULY CLINIC
25 Machi 2021 06:25:25
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
14.3-5. RENAL DISEASES, PSYCHIATRY, MENTAL ILLNESS AND NEWBORN AND CHILD HEALTH SERVICES IN THE CONTEXT OF COVID-19
14.3.RENAL DISEASES IN CONTEXT OF COVID-19
Perform renal replacement therapy to Patients with COVID-19 infection who develop:
• Acute kidney injury with:
• Life threatening changes in fluid,
• Electrolytes and acid base balance OR
• Worsening of existing chronic kidney disease
Patients who are already on maintenance hemodialysis should be able to continue with hemodialysis therapy.
Bedside hemodialysis therapy should be done in dedicated area for dialysis therapy in COVID- 19 ICU
• If no available dedicated area for dialysis portable reverse osmosis water in a tank will serve the purpose for the dialysis.
• If more dialysis is expected in selected area, dialysis machine may be left in the same area for future dialysis.
Heparin injection will be used for patients with stable bleeding indices as per standard hemodialysis guidelines
• Saline infusion will be used in place of heparin injection in patients who are newly initiated on hemodialysis or for patients with contraindication for use of heparin injection
Health care worker should be on full PPE’s while performing dialysis and relate procedures and while discarding used consumables.
• Equipment that may come into contact with patients or potentially contaminated material should be disinfected according to standard protocols.
14.4. NEWBORN AND CHILD HEALTH SERVICES IN THE CONTEXT OF COVID-19
TRIAGING OF CHILDREN WITH RESPIRATORY TRACT INFECTION SYMPTOMS AND SIGNS IN OUTPATIENT DEPARTMENTS
WHO recommends triaging of all children coming to the health facilities to identify those with respiratory tract infections. Common symptoms of COVID-19 infection include fever, cough and difficulty in breathing. Therefore, triaging children with any respiratory tract infection is compulsory.
All health workers should be trained in protocols for COVID-19 screening, triage and isolation of all children arriving with common symptoms of cough, fever, and difficulty in breathing within the last 14 days. Health care workers should be trained in IPC including appropriate PPEs use in line with Guidelines.
1. Group all children identified at the point of triage who have respiratory symptoms to one area at least 1- 2 meters away from the other children in the waiting area and process them rapidly ensure social distancing is observed in the waiting area.
2. Screen and isolate all children with suspected COVID-19 as per the case definitions.
3. Children with signs and symptoms of pneumonia as per Integrated Management of Childhood Illness clinical algorithms should be prioritized for COVID -19 testing.
ADJUSTMENTS TO BE DONE WHEN MANAGING NEWBORNS AND CHILDREN IN THE CONTEXT OF COVID-19
Neonatal Care Units
No vertical transmission has been documented. Breast milk samples from the mothers who were Covid-19 patients were negative for SARS-CoV-2 (Cui et al., 2020; Zhu et al., 2020). However, health care workers need to take precautions so as not to transmit the virus to the newborn babies.
Breastfeeding protects against common causes of death and morbidity, also in the post- neonatal period and throughout infancy and childhood.
1. Appropriate PPE should be used correctly by all healthcare personnel, both when attending the mother and when examining or caring for the baby.
2. Where appropriate, early discharge of baby with a good condition with a parent or caregiver should be facilitated.
3. Infants born to mothers suspected, or confirmed COVID-19 infection, should be breastfed while applying necessary precautions for IPC.
4. Symptomatic mothers who are breastfeeding or practicing skin-to-skin contact or Kangaroo Mother Care should be admitted in a designated room NOT in neonatal care unit. A mother should wear a mask when breastfeeding or attending her child and perform hand hygiene before touching the baby with frequent disinfection on used surfaces.
5. In the event that the mother is too unwell to breastfeed or express breast milk, appropriate breast milk substitutes can be used.
6. Babies of COVID-19 confirmed or suspected mothers requiring admission to the Neonatal Care Unit (NCU) should be assessed and admitted in a designated area/room. If NO room is available, ensure space of 2m between babies and nurse in an incubator.
7. Minimize unnecessary clinical investigations for babies born to suspected /confirmed COVID-19 positive mothers.
8. All babies requiring respiratory support like CPAP should be nursed in an incubator if available.
9. Continue to promote, protect and support breastfeeding for all sick and preterm babies in neonatal care unit.
10. No visitors should be allowed in the isolation unit/room for the entire duration of the admission in the isolation unit.
11. All equipment used in neonates of COVID-19 positive mothers should be decontaminated and sterilized as per National IPC guidelines.
14.5.A PSYCHIATRY AND MENTAL ILLNESS IN CONTEXT OF COVID-19
14.5.A Inpatient handling
• Every patient with mental illness is at a very high risk for COVID-19 infection.
• Maximize precautions during handling of any patient.
• From the Emergency Medicine Department or casualty or outpatient department (OPD) for cooperative patients all vitals and respiratory symptoms screening should be done before bringing patients to psychiatry
- Review ward activities: patients contact durations, unnecessary attendance and increase physical distance.
- Attending acute patients’ arrivals: distance from patients to care providers- screen for any respiratory/somatic/fever complaints prior to the consent of the episode.
- Shorten time for hospitalization and clerkship- details from care givers, patients will be assessed while in the ward.
- To see patients in acute ward (only one doctor with one nurse) to see the patient at a time.
- Decongest staff at the acute ward
- Daily disinfection of surfaces in the wards
- Restrict number of visitors-only one at a time, reduce
• Liaison consultations: once consulted ask and ensure patient is thoroughly investigated and screened for respiratory symptoms. If is a suspect adhere to the safety measures, if collateral information is required relatives can be contacted through phone
• Rehabilitative services-if patient is suspected at occupation therapy centre should be transferred to Hospital for thorough investigations and confirmation.
• Handling outpatients at the OPD-every patient/care should sanitize, get tested for temperature before entering the OPD. Need to find a means to minimize patients and relatives’ congestion at the records and the OPD/pharmacy waiting space
• During consultation only the patient if very necessary only one caregiver should enter the consultation room. Maintain distance of at least 2 meters from the patient/relative and the doctor
• Medications: avoid use of benzodiazepines for COVID-19 suspects/positive cases as it worsens the respiratory distress. Short acting benzo like lorazepam or alprazolam are mostly preferred. But short acting injectable benzodiazepines are not available.
14.5 B. Occupational therapy
• Occupational therapist must be provided with the required Personal Protective Equipment in order to be safe from contracting COVID-19 during their practice.
• Occupational therapist should abide to all protective measures while attending patients.
• In patients will be initially assessed if they can comply with social distancing protocol during major ward round and while at the ward before attending OT interventions.
• Protective measures such as social distancing, hand sanitization and mask wearing should be well addressed to the patients.
• All therapeutic equipment should be regularly sanitized before any intervention.
• Individual sessions/interventions of patient will be done with social distancing highly observed.
• The individual interventions should not exceed an average of 30 minutes.
• Patients who are capable to implement therapeutic activities at home, they will be assigned graded task to do at home and reviewed in monthly basis.
• Patients who have not contracted COVID-19 should be educated about protective measures.
• Having more than one session in a therapy room should be avoided.
• Group therapy sessions should be done cautiously by considering the number of patients not exceeding five clients and preventive measures should be adhered to such as wearing face masks, observing social distancing and washing / sanitization of hands and therapy equipment.
• Home visits are not recommended during the COVID-19 outbreak.
25 Machi 2021 06:49:48
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