COVID-19: Govt issues detailed advisory for safe ENT practice

New Delhi, June 04: The Ministry of Health Affairs has issued guidelines for safe ENT practise in the wake of COVID-19.

The Health Ministry says that tele consultation would be preferable. Prior tele consultation can be done to identify patients requiring physical examination, the guidelines also say.

Appointment system:

• One patient at a time in examination room, if possible, without attendant
• Sufficient time should be given for patient evaluation and for time in-between

patients

Walk-in patients without appointment should be discouraged

Screening:

All patients entering ENT OPD should be screened using screening

proforma and thermal screening. The objective of screening is to minimise exposure to staff and to patients. Screening is to be done to pre-screen all patients before entry and to minimise entry to the OPD premises. Patients having symptoms suggestive of Covid 19 ( Whether ENT Symptoms or Respiratory Symptoms) should be seen in a separate "Covid-19 screening Clinic" and not in the ENT OPD. This is so that other patients in the ENTOPD are safe. Also, personnel manning the Covid- 19 Screening Clinic will have a different level of PPE.

Entry point:

Regulate entry of patients and ensure use of mask, hand hygiene and social

distancing, as per the standard protocols advocated by the Health Ministry.

Within the OPD room:

• ENT OPD room should be well-ventilated.
• ENT doctors should wear Level I PPE kit (N95 mask, gown, gloves, goggles/ face shield) in OPD chamber.
• Avoid performing endoscopy (Nasal endoscopy, 90 rigid or flexible endoscopy for

larynx) in routine OPD.

If endoscopy has to be performed, it should preferably be performed in a separate

demarcated area with Level II PPE kit(Cover-all gown, N-95 mask, gloves and goggles).

Doctor should change gloves if they get soiled and refrain from eating/drinking during OPD timings.

Doctor should encourage patients and their attendant to follow-up with tele-

consultation based upon his/her assessment.

Endoscopy and biopsy:

Because of risk of aerosol generation during biopsies and endoscopies, all HCP(doctor,

nursing staff and technical assistant) need to wear Level II kit (Cover-all gown, N-95

mask, gloves and goggles) during these procedures.

It is preferable to have separate donning and doffing area with a supervisor for both

procedures.

Protocol for ENT, head and neck surgery ward:

COVID 19 suspect patients should be treated in a separate ward for COVID 19 patients, and

should be shifted to ENT ward only after confirmation of COVID negative status.

Ensure that suspected and confirmed cases of COVID-19 patients are kept separately.

Patients should be screened for COVID 19 before admission (refer to Annexure I)

Only one patient's care-taker should be allowed at a time who is also screened like above.

They should comply to strict precaution for COVID 19 like wearing of mask, frequent hand

washing and social distancing.

Ensure that appropriate hand washing facilities and hand-hygiene supplies are available.

Hand sanitisation and social distancing posters must be displayed in multiple areas of ward.

Keep the patient's personal belongings to a minimum.

Examination instruments should be properly sterilized as per standard sterilisation protocol after every use .

Ward should be with minimum furniture for proper cleaning and disinfection.

Visitors should not be allowed.

Corridors and rooms should be well-ventilated.

Scheme for the ENT and head and neck surgery ward:

• Distancing of at least 2 meters in between patient beds is mandatory. Additional distance if feasible is desirable as care taker may also be accompanying patients.
• Ward should be demarcated into separate areas for patients with high aerosol generating potential (e.g. Tracheostomized patients) and for patients with ENT patients
• If possible, patients in the ward can be segregated depending on the time from admission.