Pigment International

REVIEW ARTICLE
Year
: 2020  |  Volume : 7  |  Issue : 2  |  Page : 66--68

Staff and clinic protection during COVID pandemic


Vinod Hanumanthu1, Raihan Ashraf1, Rashmi Sarkar2, Muthu Sendhil Kumaran1,  
1 Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Dermatology, Venereology and Leprology, Lady Hardinge Medical College, New Delhi, India

Correspondence Address:
Dr. Muthu Sendhil Kumaran
Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012
India

Abstract

The impact of novel coronavirus pandemic (COVID-19) on the healthcare system has been devastating and the medical fraternity is facing challenges to tackle this catastrophic outbreak. With regard to dermatology practice, we review various outbreak response measures to be followed by the dermatology staff at clinic in constrained environment. Preventive measures like social distancing, hand hygiene practices and protective measures such as introduction of personal protective equipment (PPE) for staff, standardization of clinical guidelines and continuing medical services via teleconsultation are recommended. Physical consultation has been limited to emergency-based services. Although teledermatology would never replace physical consultation, it might serve as an adjunctive role in providing adequate services to the non-emergent conditions and minimizes the risk of exposure of both doctors and patients. Non-urgent visits of the patients are being discouraged and elective dermatology procedures are being postponed. Dermatologists should also recognize and educate health care workers about primary cutaneous features of COVID-19 as well possible dermatological side effects arising from prolonged usage of PPE and hand hygiene practices. Limited office-based and in-patient services with a parallel increase in teledermatology consultations will allow effective dermatologic care and services to the public while ensuring minimum transmission of the virus.



How to cite this article:
Hanumanthu V, Ashraf R, Sarkar R, Kumaran MS. Staff and clinic protection during COVID pandemic.Pigment Int 2020;7:66-68


How to cite this URL:
Hanumanthu V, Ashraf R, Sarkar R, Kumaran MS. Staff and clinic protection during COVID pandemic. Pigment Int [serial online] 2020 [cited 2021 Feb 27 ];7:66-68
Available from: https://www.pigmentinternational.com/text.asp?2020/7/2/66/302076


Full Text



 INTRODUCTION



Coronavirus disease 2019 (COVID-19) has emerged as a significant public health emergency and has had a profound impact on healthcare, socio-economic issues, and national programs in India. Novel SARS‐CoV‐2 (severe acute respiratory syndrome coronavirus-2) virus is transmitted primarily through respiratory droplets, fecal–oral route, and is characterized by respiratory symptoms causing severe disease and fatalities.[1] Herein, we review various outbreak response measures to be followed. Protective measures such as introduction of personal protective equipment (PPE) for staff, standardization of clinical guidelines, and continuing medical services via teleconsultation are recommended. These control measures are required for decreasing the risk of transmission and improving the quality of care provided to COVID-19 patients.

 MEASURES TO BE IMPLEMENTED IN DERMATOLOGY CLINICS DURING COVID PANDEMIC



Outbreak response measures such as canceling of cosmetic procedures, deferral of elective surgeries, and closure of nonemergent clinics along with the merger of special outpatient clinics including immunobullous, psoriasis, leprosy, and so on, with general clinic are advocated. Laser clinics should be closed completely owing to a high likelihood of transmission through aerosols. Twenty-four hours urgent services should be provided exclusively for patients with complicated skin disorders such as erythroderma, severe blistering diseases, severe cutaneous adverse drug reactions, and COVID-19-related skin rash after ensuring proper self-protection for health care workers. The outpatient department (OPD) waiting room should be designed to maintain ample social distancing among patients. Dermatology staff assessment at the clinic, before and after the end of daily work is imperative.[2] Provision of PPE, gloves, N95 mask, and face shield or protective glasses to residents and staff who are likely to come in direct contact with patients at the clinic is necessary. Wearing of protective face masks and ensuring hand hygiene by using hand-rub or washing of hands with soap and water by patients is recommended at entry, before all dermatological consultations. Ideally, wash basins operated with foot pressure should be installed at both entrance and exit. In addition, all patients should be properly screened by obtaining a good clinical history along with mandatory measurement of body temperature. If the body temperature is detected to be high, then the patient should be referred to the nearest COVID screening center and tested as per the Indian Council of Medical Research (ICMR) algorithm.[3]

 TELEDERMATOLOGY AS A SELECTIVE MODE OF CONSULTATION DURING COVID-19 PANDEMIC



Teledermatology uses telecommunication as a medium to transfer medical information to and from a dermatologist. In addition to providing consultation for management of dermatological conditions without the risk of infection transmission, it also provides a medium for teaching undergraduate and postgraduate students.[4] A few studies on utilization of teledermatology have shown that outcomes from live interaction and standard care were similar with respect to feasibility and precision.[5] Nevertheless, the efficacy of this new framework consistently relies upon the nature and quality of the video, images sent, and patient compliance. Few authors argue that teledermatology is a virtual model meddling with patient–doctor relationship, rather than thinking of it as a substantial option for dealing with them. These days, however, teledermatology must be considered as a useful tool in our hands so as to keep away from every chance of virus transmission and to spare patients’ and doctor’s lives, with the expectation of ‘restarting stronger than before.’ Considering the risk-benefit ratio during this pandemic, teledermatology acts as an effective substitute to physical visit, whereas in an ordinary setting this virtual framework could be utilized as an enhancement to standard dermatological care. Information about management protocol of COVID-19 pandemics has to be provided to all medical fraternity working in clinics, through web-based media such as WhatsApp or Telegram groups. These web-based media could also act as a good platform for sharing views, news, posing inquiries about complicated patients, and even small conferences or meetings for educational purposes. The academics for teaching and training of dermatology residents such as journal clubs, clinico-pathological case discussion, seminar, and dermatology procedures can be continued during the pandemic by facilities available for distance learning using these online platforms. Thus, increasing the teleconsultation facilities and decreasing outpatient services can reduce the risk of contamination and virus transmission among the residents, faculty, and other healthcare workers.

 SETTING UP OF A SPECIAL UNIT FOR DEALING WITH SUSPECTED COVID-19 CASES



A special setup to deal with suspected cases of COVID-19 such as facility for infectious and respiratory illness is necessary. An infectious disease expert and dermatology resident should be active at this facility. Dermatology residents should be prepared regarding how to approach patients suspected to have COVID-19. All COVID-19 suspected patients should be referred to the nearest screening center. Adequate instructions need to be given to patients with mild sickness, regarding the management of infection at their homes. Also, setting up of segregated inpatient ward in case of requirement of hospitalization of COVID-19 positive dermatology patients during the crisis is necessary. Psychologic training materials, prepared by a specialist at the hospital, should be provided to all clinic staff and patients along with access to proper psychologic consultation when needed. The dermatology faculty and residents should be effectively engaged with providing consultations to the staffs of different emergency clinics to manage the cutaneous side effects of prolonged PPE use and repeated hand washing.

 PREVENTIVE MEASURES TO BE TAKEN DURING COVID PANDEMIC



Irrespective of the guidelines, medical professionals are considered a high-risk category as they are exposed to maximum number of non-triaged patients and their caregivers. As COVID-19 transmission occurs mainly through contact and respiratory droplets, maintaining physical distance of at least 2 meters is considered an effective measure to interrupt the chain of transmission.[6] During early stage of the disease, preventive measures of protection, screening, and isolation have shown to be efficient. Dermatologists should limit their non-emergency outpatient visits and cater to urgent cases after donning proper PPE. In order to continue the non-emergency dermatological services, switching over to digital medical practice is necessary and ‘teledermatology’ should be the solution. Residents and faculty should ensure their availability with teleconsultation mainly for patients with chronic skin diseases.

Fomites on magazines and newspapers should be removed from waiting areas. While performing unavoidable surgical procedures, goggles should be used to prevent contamination of conjunctiva in addition to appropriate sanitary mask. Alcohol-based hand sanitizers should be kept in each room along with the display of educational posters. Disinfectants ranging from hot water bath at 56°C for 30 minutes to 75% ethanol, peracetic acid, chlorine, and ultraviolet light (UV) disinfection can also be employed.[6] While performing surgical procedures, the risk of infection from an infected physician or staff member to the patient should also be considered.[7] Outpatient areas including clinic and operating rooms should be well ventilated, ensuring at least 12 to 15 air exchanges per hour. It is better to avoid the utilization of air conditioning to prevent the recirculation of cold air.

 MANAGEMENT OF DERMATOLOGICAL AILMENTS WITH RESPECT TO THE USE OF PERSONAL HYGIENE PRODUCTS AND PPE



Prolonged wearing of PPE exacerbates preexisting skin diseases due to excessive sweating, friction, and disruption of skin barrier. Conditions that can be encountered with prolonged PPE usage include itching, burning sensation, and stinging that may be in conjunction with erythema, papules, pustules, erosions, maceration, contact dermatitis, pressure-induced urticaria, acne, seborrheic dermatitis, and folliculitis. Normal lipid barrier of skin could be disrupted with the excessive usage of alcohol-based sanitizers and soaps, leading to hand dermatitis. Healthcare workers should be encouraged for frequent application of emollients and barrier creams after each hand washing and before applying PPE.[8] There has also been an increase in the occurrence of hair fall among treating doctors during the pandemic period, which may be attributed to stress. Treatment with an immunosuppressant agent and biological agents in any skin condition should be deferred in confirmed cases of COVID-19. Although there is no such evidence in the literature for or against the use of these agents, management of such patients should be decided on individual case basis, taking into account the severity of disease as well as the age and comorbidities of the patient.

 CONCLUSION



This pandemic has taught us that in addition to patient safety, safe clinical practices, and clinic staff protection are of utmost importance in delivering good patient care and we must endeavor to accomplish this objective. Dermatologists should recognize and educate healthcare workers about primary cutaneous features of COVID-19 as well as possible dermatological side effects arising from prolonged usage of PPE and hand hygiene practices. Limited office-based and in-patient services with a parallel increase in teledermatology consultations will allow effective dermatologic care and services to the public while ensuring minimum transmission of the virus. Dermatologists should be justified in maintaining a fine balance that warrants an urgent visit and prospective harm of delaying in-person visits against the risk of acquiring COVID-19 infection during the current pandemic.

Financial support and sponsorship

Nil.

Conflicts of interest

The authors reported no conflicts of interest.

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