Bouncing Back After COVID Lockdown - Keeping our Patients and Staff Safe

 Dr. Vinay Garodia- Director  Synergy Visitech Eye Center - Delhi

 These are unprecedented times and the whole world is dealing with a Pandemic of Corona Virus infection. There is a lot of panic and confusion amongst all of us. As of now, the country is in a lockdown. We at Visitech are providing emergency eye care services to ensure the safety of our patients and staff.

 Sooner or later, we are going to get out of this lockdown and start providing more essential services to our patients. We at Visitech have always given a lot of importance to the quality of services, along with the safety of patients. We continue to do so and look forward to providing the services with all possible precautions. The newer measures, which we intend to follow, are:

 The basic principles to be followed at our center:

·         Environmental Safety.

·         Minimize Crowds.

·          Minimize touching of potentially infected surfaces.

·          Minimize the duration of stay of patients in the center.

·         Social Distancing and Hand hygiene.

·         Patient safety measures.

·         Staff safety measures.

·         Being open to new suggestions, guidelines, discoveries to modify our protocols.

The measures being taken to achieve these goals are:

·         Maintaining good ventilation by keeping the doors and windows open. Avoiding Air-conditioners

·         Entry from the front of the building and exit from the back of the building to avoid crowding and smooth flow of patients

·         Regular mopping of the floor and all the surfaces with disinfectant 3 times a day

·         Regular mopping with the disinfectant of the railing, switches, lift switches, handles, keyboard, mouse, etc. every 2 hours

·         Daily fogging of the center with disinfectant once a day

·         Posters and Instructions about need for Mask a usage, Hand hygiene, cough etiquettes at various points in the center

·         Placement of hand sanitizer dispensers at multiple locations in the center.

·         Encouraging patients to use the closed dustbins to discard their used tissue papers

·         Avoid nonimportant visits and visitors

·         Minimize visits of non-essential people like Vendors, Medical Representatives, Attendants

·         No attendant or maximum one attendant (for vulnerable patients)

·         Universal Face masks. Every staff and doctors to be wearing Surgical masks. Patients and Attendants advised coming with their own masks on and ALWAYS to keep the mask on. This is for your own safety and safety of others. Those who don’t have masks would be provided a Sterile (autoclaved) Re-usable cloth mask at a nominal charge.

·         Ensure the patients and attendants are wearing the mask properly, covering nose and mouth at all the time during their stay at the center

·         Health Education regarding hygiene and prevention provided to everyone visiting the center

·         Pre-visit and Pre-entry screening based on history and symptoms regarding COVID 19 infection: Fever, Cough, Breathlessness, H/o Contact with COVID positive patients, Foreign travel, etc.

·         Thermal screening at the entrance for everyone (including patient, attendant, doctors, staff, visitors), done by a guard wearing proper protection. If required, one more staff member shall be posted to assist the guard.

·         Everyone entering the center washes their hands with Soap and Water. Install a washbasin at entry point, just after the lockdown opens (area identified, and feasibility done). Currently using a tap at the garage for the handwashing purpose

·         Hand sanitizer to every visitor at the gate provided by the guard and assistant

·         Special consent (about the risk of COVID infection) and Undertaking (about travel history, symptoms, and need to inform us immediately if turn out to be COVID positive in the near future of 2 weeks) to be taken from every visitor (patient and attendant)

·         No walk-in patients, patients seen only with appointments. If a walk-in comes, tell him to first talk on the phone, come only after appointment has given (preferably payment taken) and history taken on the phone

·         OPD and IPD patients told firmly to maintain punctuality. This would help us in our planning and to manage the crowds better

·         No tea/coffee service to the patients or staff

·         Disposable glasses for water / Consider selling plastic bottles of water

·         No magazines/ newspapers in the waiting room

·         Social distancing in the center for staff and patients to be followed strictly. Make a senior staff responsible for ensuring the same

·         Mark the spaces with appropriate distances for standing and sitting

·         Barriers in front of counters of reception, pharmacy to maintain distance

·         No Optical shop activities

·         Discourage TPA and cashless cases, to minimize patient stay and paperwork. When we start, take papers on email/WhatsApp.

·         Encourage non-cash payments. If taking cash, educate the cashier to sanitize hands regularly

·         Minimize Lift use by patients, No lift use by staff

·         Minimize patient waiting and provide seats only to very needy patients

·         Screening area to be made at the entrance floor in open parking lot hall

·         History of patient and checking of previous records to be done before the patient arrives. This is done when the patient books appointment on the phone. Previous documents received on email/WhatsApp

·         Keep limited plastic chairs in the screening area for vulnerable patients. Chairs to be washed with soap and water daily.

·         Check vision (patient standing) unaided, with glasses and with pinhole.

·         Pinhole: Use disposable pinhole (A cardboard with a hole) and dispose after use. Don’t use trial frame for pinhole vision

·         Screening person checks the AC depth, pupils with a torch and then decides if dilatation is required. If required, dilate in screening area

·         Send to OPD floor, only once the patient is ready for checkup

·         No NCT, no non-urgent refraction

·         Proper cleaning of the trial frame after refraction

·         Explore the option of standing AR and Refraction

·         Slit-lamp Guard installed for the safety of the doctor and patient

·         Open door policy. Keep all the door open, so as to minimize the need for touching the doorknobs/handles. In OT, the doors to be opened by OT staff only and not by the patients. Regular cleaning of OT and Bathroom door handles, locks.

·         No white coats for staff or doctors. To wear freshly laundered shirts

·         Cough and sneeze etiquette, Handwashing taught to the staff and to be re-inforced regularly

·         Faceguard issued to every staff. All staff to wear it all the time along with the surgical masks. They should clean the face guard with soap and water daily, or whenever soiled

·         No biometric attendance for staff

·         Avoid cases under General Anesthesia as far as possible. Avoid sick patients for surgeries as far as possible.

·         No Fluorescein Angiography, unless urgently indicated

·         Modified CPR guidelines during Corona epidemic (from British Resuscitation Council) shared with staff and anesthetist team

The Workflow would be like this:

·         FOE confirms the need for a visit, discourages patients with non-urgent minor problems. Briefly confirms that he is not suffering with COVID (fever, cough, breathless, contact with COVID or foreign travel in the past 4 weeks)

·         Gives tentative appointment and notes phone no (mobile) and email

·         Sends Payment link, the Registration form (for new patients), Instructions to patients, COVID declaration and COVID consent forms by WhatsApp and/or email. Would try to get this process automated through our EMR systems.

·         Once the patient has made the payment and sent the filled forms by email or WhatsApp, patient registered into the system, transferred to Optom login

·         Senior Optom/doctor calls the patient on phone, takes the relevant history, gets previous documents on WhatsApp or email and attaches these to patient’s digital records in the EMR software

·         Decides and defines the tentative plan of action on the day of visit (need for refraction, need for dilatation, need for any investigations need for surgery/injection)

·         At the time of the visit, the patient comes with the pre-signed printouts of the registration form, declaration form, COVID consent form. He/she shows these forms and then drops them in a collection tray (to be collected and filed at the end of the day). If he/she comes without a printout, the forms are filled at the center (using his own or gifted pen) and dropped in the collection tray

·         If required, video conferencing facility used (mobile with camera kept near the staircase on entry floor) to discuss the history with the doctor/optom who is sitting in the OPD floor above (use Counselor’s room for this)

·         Every patient gets a vision test in the parking area with vision charts and cardboard disposable pinhole. A torchlight exam to rule out shallow AC, any other contraindication to dilatation done by assistant (Optom)

·         Keep a few socially distanced plastic chairs for elderly/vulnerable patients or those getting dilated

·         Make two vision testing stations at the screening area

·         Those who need dilatation, are dilated (they buy the fresh dilating drop)

·         Keep a laptop with software in the screening area to register the patient and to enter vision findings

·         Optometrists in screening area do not touch patients or papers. Sanitise hands immediately if need to touch.

·         Patients requiring refraction AR, Refraction (clean trial frame after use with sterilium). Consider the option of standing AR/Refraction

·         Doctor’s room: Avoid direct ophthalmoscopy, do indirect ophthalmoscopy, slit-lamp only if required (or else torch and indirect ophthalmoscope)

·         Fundus photo and OCT and Retinal laser and YAG laser is ok with precautions

·         Avoid Syringing, Refraction, FFA, and HFA if not urgent

·         Maintain good sterilization practices for contact probes/lenses like A scan, Laser lenses

·         Counseling for surgery to be done by a doctor, decides the package. Then the booking form etc. sent to the patient by email/WhatsApp

·         No surgery booking without advance payment

·         Avoid TPA/credit Panel cases

·         Discontinue charitable OPD. For emergency cases of poor patients, can see them free at the discretion of screening Optom/doctor

·         OT timing: 9 am reporting of patients. 10 am to 11 am OT time.

·         OPD time: give appointments from 11 am to 6 pm. 4 OPD appointments per hour

We understand that these changes would cause some inconvenience to the doctors, staff and patients. It would also slightly compromise the quality of care. But we have to strike a fine balance between the safety from Corona infection and efficacy of our systems to ensure that we continue to serve our patients to best of our abilities. We all have to work together. We are going to rely on the great Synergy in efforts of our management, doctors, staff and patients. I would appreciate any suggestions. Please email me your inputs at [email protected]g

Together we shall all come out stronger.

Stay Safe, Stay Healthy.

Dr. Vinay Garodia

Director,

Synergy Visitech Eye Centre

www.visitech.org