Training module for doctors to protect against Covid-19

Sanjeet Bagcchi | Updated on April 17, 2020 Published on April 17, 2020

Safe hands WHO says infections among health workers may be under-reported image courtesy: dr shantanu panja   -  image courtesy: dr shantanu panja

A Kolkata doctor-duo has put together a video outlining safety guidelines for medicos battling Covid-19 cases

Two medics from Kolkata have developed a training module to help doctors protect themselves while treating patients during the ongoing Covid-19 pandemic. Available as a free-of-cost online programme (45 minutes) and a brief written document, the “five-step” strategy recommended by Dr Shantanu Panja, an ENT and head and neck surgeon, and Dr Saikat Sengupta, an anesthesiologist, is meant to complement the guidelines formulated by various state governments and the use of personal protection equipment (PPE), including surgical face masks and goggles.

The idea of this training programme is to bring “clarity in chaos”, says Dr Panja. A doctor in India typically has to deal with a large volume of patients and complex situations, and personal protection often takes a backseat, he notes.

Against the World Health Organization (WHO)-recommended doctor-patient ratio of 1:1,000, India fares poorly at 1:1,445. Hence, the withdrawal of doctors from the Covid-19 treatment pool — thanks to their own viral infection — will not only jeopardise the containment efforts but also end up quarantining the entire medical team associated with the infected doctors.

As an April 7 article in the Journal of the American Medical Association (JAMA) puts it, “Maintaining an adequate health care workforce in this crisis requires not only an adequate number of physicians, nurses, advanced practice clinicians, pharmacists, respiratory therapists, and other clinicians, but also maximising the ability of each clinician to care for a high volume of patients.”

The WHO, however, worries that infections among healthcare workers may be under-reported currently. Its Covid-19 Situation Report-82 states that, as of April 8, there were 22,073 Covid-19 cases reported among healthcare workers in 52 countries, but believes that this under-represents the true number in the absence of systematic reporting. India has reported cases of Covid-19 infection among doctors and other healthcare staff, but there is no verified figure yet.

Five steps to greater safety

The first step in the safety module devised by Dr Panja and Dr Sengupta involves screening all patients arriving at the hospital for Covid-19 infection, and referring positive cases to the Covid-19 care facility. The second step covers doctor-patient interaction — emphasis is on verbal communication, to help doctors better understand the nature of the disease. The third step involves the use of protective gear, including face masks for patients and PPE for the healthcare staff. The fourth step revolves around precautions related to anaesthesia and surgery — for instance, the equipment and monitors used for anaesthesia should have transparent plastic covers; and the presence of minimum staff during surgery, among other measures.

Step five is all about doctors’ self-care in the hospital and includes a discussion on the appropriate use of PPE.

“We have seen that there is widespread confusion among doctors regarding the right use of PPE and how to work within the available means,” says Dr Panja, adding that “this training is aimed to make [doctors] wiser, confident and instil safe surgical practices.”

“This is a carefully considered training module,” says Dr Ismail Jatoi, a professor and chief of the division of surgical oncology and endocrine surgery at the University of Texas Health Science Center in San Antonio, US. “Doctors should exercise the precautions outlined when caring for potential [Covid-19] patients.”

While most Covid-19 treatment centres have developed their own modules, this programme sets out a uniform standard approach for healthcare workers, says Dr Ahsan Ahmed, a critical-care specialist from Kolkata who is affiliated to the KPC Medical College and Hospital. “In a pandemic situation, we have to consider every patient as Covid-19 positive until proved otherwise, and a universal precaution [should] be taken,” he explains.

However, Dr Debashis Ghosh, a leading cancer surgeon in London who’s heading the Covid-19 strategy for cancer and is part of the strategic committee dealing with Covid-19 in north London, points out that any training module or guideline should be adapted according to the existing infrastructure of a healthcare set-up, category of patients, and threat of viral exposure for the doctors.

“Doctors’ protective measures at a small nursing home in India should be more intensified — thanks to more chances of viral exposure due to the small room size, etc — as compared with measures adopted by doctors working at a large private or government hospital,” says Dr Ghosh, who is affiliated to the Royal Free London Hospital and UCL Medical School, London. He explains that doctors working in close proximity to a Covid-19 patient, such as a specialist in critical care or endoscopic procedures, should be extra-cautious.

Dr Sengupta flags yet another area of worry — any breach in the PPE can lead to infection. “Unfortunately, it is during removal of PPE that many healthcare workers [are] infected... they need to be monitored during this process,” he says. A few doctors have also acquired the disease outside the hospital, he notes.

“Therefore, the basics of social distancing, good handwashing habits, not touching the face, and covering the face and nose with appropriate face masks are also very important [for doctors],” he stresses.

Sanjeet Bagcchi is a physician and an independent writer based in Kolkata

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Published on April 17, 2020
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