1) Don't panic:
- contagiousness of 2019-nCoV is 5 times less (R0 from 2 to 4) than measles virus (R0 from 12 to 18);
- in China, where there are thousands of patients, only isolated cases of infection of health workers are reported. 2) Prepare:
- review stocks of personal protective equipment (PPE) (disposable gowns, gloves, masks, eye protection and respirators (N95 or FFP3), hand hygiene products, general purpose disinfectants and universal disinfectants);
- Buy in advance what is missing. Don't wait for something to be given and brought to you - the patient can be brought earlier;
- the usual medical mask gives less reliable protection, than respirators;
- if possible, do a Fit-test (tightness test) of respirators to make sure they are effective https://www.youtube.com/watch?v=mwQitIYA-Fc
- in the absence of respirators, a mask is better than nothing;
- instruct and train your staff: everyone should clearly know where the PPE is, how to use them properly, how to act in an emergency;
- decide where you can isolate the patient and contacts if necessary;
- print out and put in a prominent place the necessary regulations (Order of the Ministry of Health of Ukraine from 24.01.2020 № 185 https://moz.gov.ua/uplo…/3/18478-dn_20200124_185_dod_rek.pdf
and others) and contacts of responsible persons and governing bodies that you may need: Public Health Center: firstname.lastname@example.org, email@example.com tel. (044) 294 64 85, hotline of the Ministry of Health of Ukraine: 0-800-505-201 3) Diagnose:
- symptoms of influenza-like illness (MANDATORY THERMOMETRY!) in a patient who traveled to China in the last 14 days OR had contact with confirmed cases of 2019-nCoV;
- pay special attention to the manifestations of respiratory failure - shortness of breath, cyanosis (if possible, do PULSE OXYMETRY);
- There are NO characteristic signs of this disease, so pay special attention to the HISTORY: when and how the disease, what are the first symptoms, travel outside Ukraine for the last 14 days, contact (living together, meetings, etc.) with those who came from China and traveled outside Ukraine;
4) If you are examining a patient with flu-like illness who has traveled to China in the last 14 days:
1) immediately ask the patient to put on a mask;
2) leave the room if you touched the patient - wash your hands immediately with soap;
3) if other people (staff, relatives) are present during the examination - ask them to leave immediately;
4) wear personal protective equipment (PPE) - a disposable bathrobe, gloves, respirator or mask and eye protection;
5) it is desirable to leave the patient in the room (office) where you examined him;
6) if you can not isolate the patient in this place - take him to a separate isolated room (in the infectious department - in the box);
7) in the room where the patient is, close the doors, windows, turn off ventilation (air conditioning);
8) warn that no one enters this room without PPE;
inform by phone the senior on shift (responsible duty officer), the head. department, the chief physician and wait for further instructions;
9) if the general condition of the patient is satisfactory, explain to him the need to stay in your hospital until all the circumstances are clarified and further instructions are received;
10) record information about all those who contacted the patient (family members, roommates, etc.) - name and other passport data, address of ACTUAL residence, telephone, degree and circumstances of contact;
11) QUALITATIVELY collect anamnesis (history of travel, dates, cities, hotels, circumstances), when ill, the first symptoms, the dynamics of their development, contacts over the past 14 days;
12) if the patient refuses further medical examination and hospitalization - warn about the possible consequences for his health and the health of others and BE SURE to record all his contact information (name and other passport data, address of ACTUAL residence, phone);
13) recommend the patient to stay at home and avoid contact with other people (do not go to work, study, visit, do not invite guests, do not use public transport, taxi), when communicating with other people - wear a medical mask, in case worsening of the condition - IMMEDIATELY call your doctor or call 103;
14) recommend contact persons to refrain from contact with other people as much as possible, when communicating - wear a mask, and in case of any symptoms of illness - IMMEDIATELY call your doctor or by phone 103.
15) if the patient is in serious condition and needs urgent intensive care - decide how your medical institution can provide isolation and respiratory support.
You must be convinced that you can provide all the necessary care to this patient and prevent the infection of others.
Transporting a patient to another hospital is sometimes necessary, but can cause deterioration and ALWAYS increases the number of contacts and the possibility of spreading the infection.
Be smart and healthy! ;)
These recommendations are not official, and cannot replace the approved regulations!
We wish you good health, but we do not take responsibility for all possible consequences of using these recommendations.
You are free to discuss, copy, distribute these recommendations at your own discretion, assuming all risks and all responsibility for their use.
The following guidelines were used in the preparation:World Health Organization https://www.who.intEuropean Centre for Disease Prevention and Control https://www.ecdc.europa.eu/en/homeDepartment of Health and Social Care and Public Health England https://www.gov.uk/gove…/collections/wuhan-novel-coronavirusCenters for Disease Control and Prevention https://www.cdc.govChinese Center for Disease Control and Prevention(China CDC) http://www.chinacdc.cn/en/
In the near future we will publish more detailed recommendations for the diagnosis and treatment of new coronavirus infection.
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