HOSPITAL ENTRANCES

ON ARRIVAL
Actionable Yes / No
Security guards at the entrance need to wear a mask
Security to wish every person walking in the hospital to say “namaste”
Security guards that would be doing frisking of baggage to wear gloves too
If valet parking team is there, they need to sanitize their hands after parking/ handing
over the cars and wear mask; ensure ID cards are visible at all times
They should say ,” Sir/Madam I’m Shyam (showing ID card) and allow me to park your
car”

ON ENTRY

Actionable Yes / No
Identify people from front office team who would be available to perform the task (for all shifts)
Similar protocols need to be followed at each entrance
Masks to be worn by them and masks to be made available at the entrance
Pharmacy could arrange desks before the entry point to sell masks and everyone should be
asked to wear a mask
Hand sanitizers available
Thermal scanners available and everybody walking inside the facility should be scanned
Signage on education, wearing mask, hand hygiene and guide to fever clinic to be made visible
at entrances
Staff to say “Namaste”
Staff to guide patients either to fever clinic or inside the hospital to the respective areas-
handholding

Actionable Yes/ No
If patient/ visitor is a suspected case
Fever Clinic:
Space that is identified is rechecked for air conditioning (should not be mixed with other areas
of the hospital)
PPE availability for staff to wear
Appropriate equipment available as mentioned under the fever clinic section
Front desks to have glass partitions made
Staff should always be standing and talking to patients
Digital payment or other methods- information available- display
Hand sanitizers available in reception desk
Reception desks to be clean, organized and should not have unnecessary items kept- Follow 5S
strictly
Waiting areas to have chairs that are cleaned every hour with disinfectant
No reading material to be kept
If television screens are available, then use them for education
Entry doors to be kept open so that visitors/ patients don’t have to touch the door knobs etc
Follow paperless registration process
Housekeeping is trained and wears PPE
PAPERLESS REGISTRATION PROCESS
Actionable Yes/ No
Identify the staff members
Train them- HR & IT to support
Ensure links are saved on systems
Get tablets (if available use the existing ones- AIFS tablets may be)

REGULAR OUT PATIENT SERVICES:

Communicate with patients who have taken appointment and send them instructions on

1. COVID checklist (6 questions)

2. Ask them to bring their own pen
3. Preferred mode of payment is digital
4. Be on time as the scheduled time
5. Wear a mask always
6. Patients should be instructed to come alone unless they need special assistance
7. Attendant (if accompanies) should wear a mask
8. For patients coming alone, advise patients to leave personal belongings in their vehicle or the
waiting room.
9. Preferably empty their bladder while coming to the hospital
10. Maintain social distancing
11. Carry a hand sanitizer/ use sanitizer at the hospital at the entrance
12. Information on online reports if tests are done
13. Avoid touching areas like stair handles, lift buttons, door knobs etc

IF REGULAR OP/ DIAGNOSTICS ETC

Actionable Yes/ No
If patient/ visitor has to visit regular OP
Push for only appointments
 Send emails to your existing customer database on importance of taking appointment
and coming and that we have limited slots for their safety- 4 hours slots may be
 Evening clinics to be active
 Speak to call centre and ensure they also inform customers

For elective visits, consider offering elective visits remotely, via t24/7 if possible, in order to
decrease the OP density of patients, and provide needed care to patients who are less willing
or unable to travel
Speak to the consultants and divide the OP timings into slots and when there is a small OP
space and more consult rooms are there (busy OPs)
DMS office to send a note to all consultants with the OP plan and scheduling.
Staffing in OP to wear mask at all times as per the PPE guidelines
Ensure enough stock is there for masks and hand rubs
Wish every patient by saying ‘Namaste’
Front desks to have glass partitions made
Remove paper as much as possible- paperless registration & online consents
Billing: for collecting money
Credit card payment:
 Cut small pieces of cellophane paper and stick it on the card tapping side on the
screen and on the number input part
 Change after every single individual uses it
 Keep it ready beforehand only enough papers
For cash collection:
Collect cash using the same cellophane paper cut and hand back also using the same
ALL waiting areas, surfaces, entry door knobs (doctor rooms, etc) to be cleaned every 4
hours at least
Digital payment or other methods- information available- display
Hand sanitizers available in reception desk
Reception desks to be clean, organized and should not have unnecessary items kept- Follow
5S strictly
No reading material to be kept
If television screens are available, then use them for education
Social distancing to be followed in all waiting areas and queueing areas – ensure its visible
Patients/attendants should be seated more than 3 feet apart in waiting areas
Every patient’s prescription to be checked when he/she walks out of the doctor’s room
 If OP Persona used, orders can go online
 Else check the prescription and someone should guide the patient to get the
tests/investigations done to support- connect with respective department and make
sure it is done
 Handhold every patient (could get admin people on the ground also to support if
required)

SPECIAL OPDS:
ENT AND DENTAL OPD
 Actionable Yes / No
Patient visiting these OPDs to be screened at the entrance
In case patient found symptomatic with fever shall be advised to get the treatment for fever
first- refer to fever clinic
Patient and attendant to be provided mask and/or encouraged to wear except while being
examined.
Use of N95 mask and face shield to be used by the consultant while examining the patient
always
While operating also doctor will use N95 mask and face shield along with the other PPE as
per operating room protocol

Dental to follow the following protocols in addition to the ones mentioned above
Actionable Yes / No
Avoid shaking hands with your patients and greet them with “Namaste”
Please remove all the magazines and brochures at patient waiting areas and receptions
Ensure necessary PPE is to be worn while performing a Dental Procedure
Ensure patient Is rinsing with 1% Hydrogen Peroxide solution (diluted) before examination
Ensure Fomites are deep cleaned post every procedure
Use a rubber dam when appropriate to decrease possible exposure to infectious agents.
Autoclave hand-pieces after each patient.
For aerosol procedures, use high-speed evacuation.
Post visual alerts icon (e.g., signs, posters) at the entrance and in strategic places (e.g.,
waiting areas, elevators, cafeterias) to provide patients with instructions (in appropriate
languages) about hand hygiene, respiratory hygiene, and cough etiquette. Instructions
should include how to use tissues to cover nose and mouth when coughing or sneezing, to
dispose of tissues and contaminated items in waste receptacles, and how and when to
perform hand hygiene.
After all cases are over clean the chairs and equipment after every use.
Keep the ventilation system off (if it is working) .Turn the AC Off
If possible, use directional airflow, such as from fans, to ensure that air moves through staff
work areas before patient treatment areas – not the reverse.
Ensure all the electronic equipment has been wiped and covered with a plastic cover
(important to prevent the fogged liquid from going into the machines )
Ensure all surfaces and floors are dry
Check floors for stickiness or wetness to prevent infection from spreading and also foot
slips.
AREAS TO BE CLEANED – Dental chair, Hand rests, spittoons, tray, buttons, head light
switch, door handles to be disinfected with alcohol rub.(Before and after every procedure). -
Hand pieces and burs, diagnostic instruments to be sterilized after every use
In shared spaces or dental rooms try maintain a distance of at least 1metre
Arrange your patient seating areas with a distance of 2-4metres between each chair
Ask patient to keep their hands in their pockets and without touching anywhere to sit on
dental chair
Any treatments generating splatter to be done with complete disposable PPE for all
operating Doctors and assistants along with Rubber dam isolation and preferable
appointments to be kept enough for the day.
Disposal of PPE and Bio-medical waste judiciously
Hand pieces and burs, diagnostic instruments, etc., stringently autoclaved in sealed pouches.
Over looked practices such as scrubbing the hand piece with a disinfectant and working on
the next patient must be avoided under all circumstances. Used burs should be soaked in a
disinfectant prior to autoclaving. Root canal files should be single use and preferably a single
visit under Dam.
For patients coming alone, advise patients to leave personal belongings in their vehicle or
the waiting room. These items should not be brought into the operatory area
Use hand instrumentation versus ultrasonic instruments for periodontal debridement and
scaling procedures
 Use selective plaque and stain removal versus full-mouth coronal polishing
Avoid air-polishing procedures
Do not use the air and water functions on the syringe, together, at the same time
Ask patients to tie their hair and avoid wearing earrings, rings and carrying bags
After every patient remove the Water containers and wash it thoroughly and disinfect with
1% Sodium Hypochlorite / Virex 0.5 & aboveusing clean cotton/gauge piece and then fill it
with fresh 0.01% Sodium Hypochlorite / Virex 0.5 & abovesolution and attach back to the
dental chair
Back-flush the Suction pipe with 1% Sodium Hypochlorite / Virex 0.5 & abovewith the help
of disposable cups for at least 30 seconds
Ensure dental unit waterlines (DUWL) are flushed, disinfected using appropriate organic
disinfectant and drained as per manufacturer’s instructions

OPHTHALMOLOGY

Besides the other important information given above, following should be specifically done for
Ophthalmology:
 1. Disinfect personal items like stethoscope, lenses, indirect and direct ophthalmoscopes, pen, and
torches, and other such items. etc with alcohol arranged in OP areas between patients.
2. To decrease the risk of viral spread, ophthalmologists should inform their patients to refrain from
talking during the slit-lamp examination.
3. To use slit lamp barrier
4. Doctors should wear triple layered mask while handling patient. Hand hygiene with alcohol based
hand rub or hand washing with soap and water in between patient is mandatory. Face shield should
be worn during examination of patient
5. Tonometer tip cleaning: The virus causing COVID-19 is an enveloped virus. 70% alcohol solutions are
effective in disinfecting tonometer tips from SARS-CoV-2. Use single-use, disposable tonometer tips if
available.
6. Multidose eye drops: For diagnostic eye drops required for ophthalmic examinations, multidose eye
drop containers should be kept in cabinets or other closed spaces away from anywhere that could
become contaminated during a patient encounter. As should always be the case, care must be taken
not to touch the eyelashes or ocular surface with the tip of the eye drop bottle, and the examiner’s
hands should be disinfected immediately after touching the patient’s face.
7. Slit-lamp barriers or breath shields: These can be designed indigenously by cutting out a
transparent plastic sheet of an appropriate thickness. The slit lamp touch-contact parts should be
cleaned by alcohol wipes after examining every patient and the barriers should be changed for each
patient. Barriers can be washed with soap water, dried and reused
8. The retinal examination should be done in patients who need it, strictly with an indirect
ophthalmoscope. Avoid direct ophthalmoscopy and contact lens-based fundus examination
9. Gonioscopy and visual field examination should be avoided unless mandatory

OP PHARMACY

Parameters Yes / No
Continuation of social distancing – Foot step signage/any kind of signage on floor

Educational displays to maintain social distancing and cover cough & sneeze

Instructions/ alert stickers pasted on high touch surfaces as “Do Not touch any surface”

Have over the counter system of sale and not walk-in kind of model (if possible), this
reduces the risk factor in terms of people touching and selecting products etc.

Hand sanitizers to be placed in pharmacy for staff and customers

Staff to mandatorily sanitize their hands after handling cash and bills between customers.
Billing: for collecting money
Credit card payment:
 Cut small pieces of cellophane paper and stick it on the card tapping side on the
screen and on the number input part
 Change after every single individual uses it
 Keep it ready beforehand only enough papers

For cash collection:

Collect cash using the same cellophane paper cut and hand back also using the same

Implementing token system to avoid queue

Billing & Dispensing counters redesigning to be considered and shall have glass façade to
prevent droplets.

Masks to be used all the time.

While receiving drugs delivery, the carton boxes to be removed at entry point and only the
contents inside to be brought in to the pharmacy.

Mandatory screening of staff in case of any respiratory illnesses by staff doctor to be done,
and after clearance the staff may join the shift.

Cleaning and disinfection of all the high touch surfaces to be done periodically- at least every
4 hours

EMERGENCY
Actionable Yes / No
ER must have a separate entrance.
Mandatory screening of all patients and attendants as per the current guidelines and
declaration form to be taken.
Triage of patients to be carried out by qualified and trained personnel.
In case a patient is having any respiratory syndromes and fever at screening/triage: give
patient a triple layer surgical mask and direct patient to separate area (an isolation room if
available).
Any ER case with respiratory and fever signs to be admitted in an isolated area and sample
to be send for Covid 19. If it turns positive case, patient is to be as per existing Covid-19
guidelines by local government. If negative, based on the current clinical status the patient
to be shifted in other ICU or ward.
Keep at least 2 meter distance between suspected patients and other patients. Follow cough
etiquette.
Staff safety: staff has to wear complete PPE at all times. Full cover-up and N95 masks at all
times.
ER should not have central air conditioning.
Appropriate precautions to be followed during aerosol generating procedures (Intubation,
CPR, Bronchoscopy, Open suction etc) – Full cover-up and N95 masks and protocols as given
in red book
Follow revised BLS, ACLS, NALS, PALS, ATLS protocols as defined by competent authorities
as given in red book
Holding the patients in ER to be minimized to the extent possible. The holding duration
should not be more than 4 hours in any case even if it is in the middle of the night or on a
weekend/holiday.
ER reception, billing etc protocols to be the same
Disinfection in ER- including beds, equipment door knobs, toilets etc to be done after every
patient use

CHECKLIST FOR RADIOLOGY

Actionable Yes / No
Greet every patient saying “Namaste”
Scheduling:

 Scheduling to be done in Medmantra module compulsorily

 Check schedules and post In patients either before 8 am or after 4 pm (exceptions
emergency)
 NO OUT PATIENT should be given a later date appointment. On a priority their tests
should be done

Waiting areas

 Re-organize waiting areas

 Social distancing between seating arrangement
 DO NOT USE PPRINT OUTS/ PAPER/ tapes etc to label chairs/ benches for social
distancing. You could use laminated sheets that could be cleaned easily as well
(samples given below)
 Hand wash/rub facility must be made available in diagnostic waiting areas
 No reading material to be available- if required give handouts only to concerned
patients for their relevant tests- SEND THEM EMAILS/WATSAPP
 Display instructions about the tests on screens
 Any old age patient, patient with respiratory syndromes should be given priority for
investigation

Follow token system in diagnostic areas – if online system not available create a PPT format
and update after every patient so that patients don’t wander around and they have a clear
update on the time it will take. EXAMPLE:

X RAY ROOM 1 ULTRASOUND DOPPLER

IN PROGRESS IN PROGRESS IN PROGRESS
TOKEN 11 TOKEN 6 TOKEN 10
CT MRI X RAY ROOM 2
IN PROGRESS IN PROGRESS IN PROGRESS
TOKEN 15 TOKEN 13 TOKEN 12
Open the door for every patient while patient is coming in or going out so that they avoid
touching surfaces
Staff to wear PPE AS per the policy
Route for patient transfer to radiology and other diagnostics from various patient care areas
to be worked out in such a way that the transportation route and time as well as mixing up
patient with other traffic is minimum.
Patient may be given a mask if patient is coughing or having any respiratory illness. Have
stock of masks, do not waste.
The equipment and console rooms are sanitized, especially the contact surfaces (i.e.,
operating consoles, switches, handles once a shift etc. All surfaces are cleaned with 1%
sodium hypochlorite.
Radiology departments should contact their equipment vendors to find the safest
disinfectant for each piece of equipment in use.
All stretchers and places where patient would lie should be swiped clean after every patient
by the technician
For ultrasound and Doppler, have a transparent sheet or curtain that is in between patient
and the doctor. Space for his/her hand to be made available so that they could perform the
test. The sheet could be cleaned at regular intervals.
All the personal belongings of the patients must be removed and handed over to attendant
before the patient is entered in any diagnostic areas by the patient himself.
Portable radiographic or other diagnostic equipment should be used wherever and
whenever possible to limit the transportation of patients especially for in patient after
cleaning perfectly between every patient including the wheels.
Educate patients about their reports being made available on prism and that they could
connect on …. (number) if they face any issues

The softcopy of the investigation report is dispatched to all the concerned, to minimize the
human traffic for report collection. X ray and films could be given in CD rather than prints

SAMPLE COLLECTION- REGULAR

Actionable Yes / No
Greet every patient saying “Namaste”
Staff should explain the process clearly
PPE Usage – as per the policy
Reception desk should follow similar protocols as described before
The division between different counters for sample collection to be covered with glass
partitions
Social Distancing signage marked and followed
Waiting areas protocols remain the same as described before
Token system to be followed- if it is not there, use in house developed one as described
before
Disinfection protocols to be followed after every 4 hours

BLOOD BANK

Actionable Yes / No
PPE Usage – Especially Three Layered Surgical Mask & N95
Social Distancing signages marked and followed.
14 days follow up for all the donors regarding the Covid 19 Signs and Symptoms.
Outside Camps not to be done and on call donor list should be used including stronger tie
ups with other blood banks
Maintain adequate plasma and other blood and blood products including SDP for the need.
Other protocols related to screening, registration, billing, PPE etc remain the same as
mentioned above.

PHYSIOTHERAPY

Actionable Yes / No
All Physiotherapist to use appropriate PPEs; Respiratory therapist to use PPE
accordingly.
COVID 19 Negative reports are to be must for any respiratory therapy patients or use full
PPE set for suspected patients
Respiratory therapy should be given in close rooms not preferred in common sharing
areas.
As Social Distancing is difficult to implement, Appropriate PPEs are needed for
protections.
Equipment need to be disinfected after every patient use

ENDOSCOPY & BRONCHOSCOPY **In addition to critical points mentioned before

 Only essential personnel should be present during procedures

  For patients defined as suspected, probable or confirmed COVID-19, enhanced PPE should be
practiced during endoscopy, including the use of a N95 mask; isolation gown with water resistance;
head cover; eye protection and face shield. The procedure should be conducted in negative pressure
room.
 For patients who are tested negative COVID – 19, healthcare providers should perform endoscopy
with PPE, including a face mask; isolation gown with water resistance; eye protection.
 All specimen from patients with COVID-19 should be handled with extra precaution and with
appropriate protective equipment.
 Standard room disinfection should be conducted at the end of the session in rooms where non-COVID
or low-risk patients had endoscopy. All surface areas, shall be cleaned with 1% Hypo.
 The disinfection and reprocessing of the endoscope and instruments used for a patient with COVID-19
will be similar to those used in standard practice.

Actionable Yes / No
Greet every patient saying “Namaste”
Reception/ front office/ registration processes remain the same as mentioned above
Covid 19 testing is mandatory for all Endoscopy and Bronchoscopy procedures.
Documented triage to be done based on the checklist provided to assess risk of patients with
suspected or confirmed COVID-19 before endoscopy/ bronchoscopy is essential. Vitals
including temperature is important to be recorded.
The endoscopies are divided into: Urgent endoscopy / Semi-urgent endoscopy (to be
discussed on a case by case basis)
Urgent endoscopies should be performed by strategically assigned staff to minimize
concomitant exposure. Where urgent endoscopies are necessary, it is recommended to keep
the number of staff to a minimum, with preferably one experienced endoscopist and two
nurses for each endoscopy room. Ample time should be allowed for infection control
measures before and after endoscopy. The same team of endoscopy staff should serve the
same room for the whole session.
Resource reallocation for staff and medical equipment is recommended to prepare for a
surge in healthcare demand.
Regular monitoring of supply and use of personal protective equipment (PPE) is necessary
to adjust endoscopy service and uphold morale of staff.
The recommended PPE for all endoscopies is Head cover, Visor/ Face shield, N 95 mask,
Surgical gown, Impermeable gown, Surgical gloves, Nitryl gloves , Shoe cover.
For confirmed negative cases, the following PPE could be used: N 95 mask, Goggles, Surgical
gown, Surgical gloves.
Extra precautions to be taken during colonoscopies as prolonged faecal shedding of SARS-
CoV-2 can occur.
Endoscopies should be performed with strict isolation precautions in suspected or
confirmed cases of COVID-19.
Suspected or confirmed cases should be posted at the end of the list.
Central air conditioning if there to be switched off or covered while doing such procedures.
Disinfection policy for endoscopy rooms and reprocessing of instruments should be
enhanced.
Protective measures against infectious aerosols include use of N 95 masks, respiratory
protection, negative pressure rooms where feasible and avoidance of devices that
 purposefully produce aerosols including nebulizers or atomizers which can be contaminated
with virus after a cough or sneeze with subsequent aerosolization.
Bronchoscopy room need go have negative pressure

CHEMOTHERAPY **In addition to critical points mentioned before

Actionable Yes / No
Greet every patient saying “Namaste”
Covid 19 testing is mandatory WEEKLY if allowed by the state governments.
Mandatory routine blood tests and high-resolution computed tomography (CT) scans of the
lungs to be performed. Possibility of coronavirus must be considered and evaluated at every
admission based on doctor’s advice.
Documented triage to be done based on the checklist provided to assess risk of patients with
suspected or confirmed COVID-19 before endoscopy/ bronchoscopy is essential. Vitals
including temperature is important to be recorded.
Speak to enrolled patients a day before their scheduled session and reiterate the protocols
to be followed and educate
ASSESSMENT FORMS TO INCLUDE:
For patients who are preparing to be admitted, hospitals shall record for symptoms
potentially associated with COVID-19, such as fever and cough, at the time of screening as
well as during history and physical by the doctor.
Special attention should be considered in case of recent new symptoms such as:
 Fever
 Coughing
 Sore throat
 Difficulty breathing
 Muscle pain
 Tiredness
 Anosmia
 Dysgeusia

Admitted patients must also take essential personal protective measures laid out by our
hospital, such as wearing a mask and regular hand wash.
Patients should be informed regarding the cough etiquettes, trained in proper handwashing,
hygiene, and how to minimize exposure to sick contacts and large crowds.
Clinical staff responsible for the care of patients to be trained and wear PPE.
Ensure that guidelines are given as clear as possible and sent on emails as well so that
papers could be avoided

RADIOTHERAPY

Actionable Yes / No
Greet every patient saying “Namaste”
Patient screening: All patients receiving radiotherapy must be screened at the entrance.
Patients’ tested negative shall be directed to Radiotherapy to receive the treatment.
Covid 19 testing is mandatory WEEKLY if allowed by the state governments.
Mandatory routine blood tests and high-resolution computed tomography (CT) scans of the
lungs to be performed. Possibility of coronavirus must be considered and evaluated at every
admission based on doctor’s advice.
Radiation Planning:
Patient pays for the treatment in the billing counter and this payment is entered in the CT
simulation form- paperless and other billing procedures remain the same as described
above
Scheduling
 Scheduling to be done compulsorily
 Check schedules and post In patients either before 8 am or after 4 pm (exceptions
emergency)
 NO OUT PATIENT should be given a later date appointment. On a priority their tests
should be done
Waiting areas
 Re-organize waiting areas
 Social distancing between seating arrangement
 Hand wash/rub facility must be made available in diagnostic waiting areas
 No reading material to be available- if required give handouts only to concerned
patients for their relevant tests
 Display instructions about the tests on screens and send them on emails
Any old age patient, patient with respiratory syndromes should be given priority for
investigation
Staff training: Regular training to staff on the protection level of their corresponding role,
the appropriate personal protection equipment (PPE) for the role (a radiation therapist
wearing PPE during treatment delivery, a nurse during assessment and post procedure care
etc), as well as the dons and doffs.
Cleaning and disinfection - Treatment couch and mould is cleaned after each treatment
with 1% Hypo. Console room, monitors, mould storage cupboard is cleaned with 1%
Hypochlorite three times a day. Regular hand washing by doctors, staff, patient and
attendants. Posters displayed as a reminder for hand washing and social distancing. Social
distancing protocol to be adhered at the waiting time.

DIALYSIS CHECKLIST

Actionable Yes / No
Greet every patient saying “Namaste”
Covid 19 testing is mandatory WEEKLY if allowed by the state governments.
All existing dialysis patients to be medically screened (including location history, and
exposure) before every session when they report for treatment.
Any patient fulfilling the clinical criteria of the ICMR guidelines either to be managed in-
house as per revised clinical guidelines with appropriate precautions or referred to the
approved Covid 19 center for further management.
Full PPE for the dialysis staff is mandatory. Dialysis personnel, should wear a three-layer
surgical facemask. Standard precautions are adhered to at all times.
Any new patient for dialysis must be thoroughly assessed by nephrologist and should be
screened whenever patient comes for dialysis.
No attender to be allowed with patient in dialysis area. Patient’s attender is sent back home
and asked to come back at the end of dialysis. Alternatively, he/she can wait down in the
waiting area. Social distancing to be followed at all times.
Full clinical assessment of all dialysis patients at least once in a week by nephrologist.
Communicate more effectively
Weekly schedules to be prepared and work in more shifts if required- Do NOT clutter
dialysis department
Patients are educated to strictly follow the schedule.
Send them the instructions at least a day in advance- email
Distance between beds/chairs is crucial at least 2 meters with adequate space between
patient and technician/nurse
All the patients on dialysis are advised to wear three layered mask all the times from the
time they start from home.
Patients are asked to disinfect their hands before entering department.
After the dialysis, internal and external disinfection of the machine should be done. External
disinfection of Machine is done with 1% hypochlorite.
Clean and disinfect frequently touched surfaces after the dialysis between each patient with
1% hypochlorite. Monitors and trolleys are disinfected with Bacillol 25. This includes
bedside tables and lockers, dialysis machines, door knobs, light switches, counter tops,
handles, desks, phones, keyboards, toilets, faucets, and sinks etc.
Dialysis for any positive/suspected case has to be done either in a negative pressure room
or in a separate area with no central air conditioning
Staff to wear proper PPE
Machine disinfection is critical
Waste segregation is also to be looked into
Donning and doffing of PPE
CONCIERGE SERVICES

Actionable Yes / No
Set up a concierge desk for patients to be picked up and dropped for surgery
Patient SPOC/ navigator could connect based on patient’s preference and requirement
Travel & transport team to ensure patient is picked up as confirmed
The vehicle is clean and disinfected after every use

BEDSIDE ADMISSION / BILLING CHECKLIST

Actionable Yes / No
Hospitals to identify admission navigators and form the pool of team members
HR needs to ensure the staff is trained
For the first few days until the patient load is less, they could work as observers
Process training needs to be done to all
Mock drills to be conducted where every identified staff member acts as a navigator and takes through the
process in three stages:
1. First interaction- meeting the patient from OP, explaining the process, booking his bed, getting him
the estimate & instructions related to documentation & other information
2. Second: Call a day before explaining instructions and confirming
3. Third: On the day, receive him, take him to room, hand over to nurse and ensure that formalities are
completed
COVID test is done for all before the surgery is planned based on government guidelines
COVID test is done for one attendant who is identified for every admitted patient (check state government’s
guideline)
Surgery planned and a date is given
Doctor fills up the request for admission form
After the consultation, patient shall get a COST estimate. This cost estimate shall be given to the patient in written
with preferred room category
Check the bed availability on the portal one-day prior
The portal must show an overview of the potential and actual discharges
The admission desk books the room / bed by the patient name
Instruction to the patient before admission (sample pointers)- EMAIL & CALL
 Identification (driver's license, photo ID) and emergency contacts (relatives and friend’s names and phone
numbers)
 Please carry all your current investigation reports, previous medical history, reports if any
 List of all current medications (name, strength, frequency), if any
 At the time of admission, you are required to make a deposit based on package (at least X% of the bill), which
would be adjusted against your final bill
 Bring all cards pertaining to insurance coverage
 Minimum admission is for a day. Hospital follows a single discharge time at 11.00 a.m.
 In the interest of your Patient's safety food from outside is not permitted in the Hospital
 Do not bring your valuables. Leave jewellery and any other valuables at home
 Wear a mask at all times & follow hand hygiene
 Please ensure maximum one attendant accompanies you and is aware of your medical condition; medications;
infection prevention protocols to be followed and is healthy
One-day prior of admission (at least before 8 Hours), navigator shall call up the patient / attendant on the
registered number to inform what time to report at the hospital on day of admission based on the room

17 | P a g e
 availability (review, discharges, admissions, room type requested for, room TAT) and send exact time when room
will be ready for this patient
On day of admission, patient upon reaching the hospital shall the navigator who will then escort the patient
directly to the room and handover to the assigned nurse.
All the admission formalities shall be done in the room including billing.
Information to be given to the Patient at the time of admission in the room (sample here)
 Room amenities and charges for the same
 A copy of the In-Patient Guide
 Number of attendant who will be allowed to stay with the patient and arrangement for the attendant
 Visitors timings and rules related to visiting patients
 Payment timings and mode of payments (In case of insurance patient details related to insurance payments)
 General Consent for admission
Billing related guidelines and handling of credit cards and cash has to be the same

DOCTOR ROUNDS

Actionable Yes / No
Doctor rounds have to be at fixed timings so that we don’t mix up activities and there is
clarity among staff and patients and they remain prepared
Medical heads to speak to doctors and look at their schedules for:
 OPD
 Surgery
 IP rounds
This need to be divided into slots also so that the IP staff doesn’t have to run around
much
The above information should be communicated to the concerned hospital teams
Patients/ families to be informed about doctor IP visit timings to avoid attendants moving to
OP areas or doctor clinics.

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WARDS CHECKLIST

Actionable Yes / No
Open up wards in a phased manner based on the inpatient census (to prevent duplication of
staff and use of resources like electricity, water, manpower (housekeeping) etc.
Screening is done before admission, and if the patient is negative in screening, then only
admitted in the ward, otherwise in suspected COVID ward. Check local government policy
All staff in the Wards need to wear protective gear in the form of: Three ply mask and
surgical gloves.
All patients are given triple ply surgical masks.
All droplet borne and contact precautions are taken.
Visitor restriction is carried- 1 visitor once in the morning, to avoid overcrowding and
chance of infection transmission.
Sanitization is carried out with 1% Sodium Hypochlorite at least thrice a day.
If any patient develops symptoms of COVID 19 despite initial / Virex 0.5 & above negative
screening, he/she is promptly referred to ID consultant, and transferred to COVID ward if
required.
Other disinfection, ward management protocols, use of PPE etc to be followed as in general.
Ward huddles to happen from 9:00-9:15 am with the complete staff to understand the
current status and concerns (format used could be the one used for ward as a unit)

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 ICU / HDU CHECKLIST Yes / No
Actionable
As per the current protocols, all patients are taken as COVID 19 positive unless proven
otherwise. They have to be screened as per hospital protocol before admission. Only Non
COVID (no suspicion/ confirmed negative) patients are admitted in the ICU/HDU.

COVID19 test to be done for all patients (if government permits)

All the staff in ICU & HDU need to wear protective gear in the form of: N95 mask, surgical
gown, surgical gloves.
For suspected/ high risk cases, the following are to be worn: Head cover, N 95 mask, Surgical
gown, Impermeable gown, Surgical gloves, Shoe cover.
For procedures, Visor/ Face shield is required.
Patients have to be grouped together as those with the same etiological diagnosis.
When providing care in close contact with a patient with respiratory symptoms (e.g.
coughing or sneezing), eye protection is used (goggles / visors), because sprays of secretions
may occur.
Apply contact precautions at all times
If equipment needs to be shared among patients, clean and disinfect between each patient
use.
Ensure that health care workers refrain from touching their eyes, nose, and mouth with
potentially contaminated gloved or ungloved hands.
Avoid contaminating environmental surfaces that are not directly related to patient care
(e.g. door handles and light switches).
Ensure adequate room ventilation. Avoid movement of patients or transport. Perform hand
hygiene.
Apply airborne precautions when performing an aerosol generating procedure
Avoid the presence of unnecessary individuals in the room.
Care for the patient in the same bed after mechanical ventilation commences
If any patient develops symptoms of COVID 19 during the stay, urgent referral to the ID
consultant is done and is transferred to COVID ICU if required.
Sanitization in the ICU is carried out with 1% Sodium Hypochlorite / Virex 0.5 & aboveat
least thrice a day

CSSD

Actionable Yes / No
CSSD staff to use PPE as recommended in guidelines (set with shoe cover, face mask, cap,
gum boots, eye google/face shield, hand gloves, heavy duty glove at wash area)
ICN to visit CSSD at least every alternate day to oversee the compliance
All items going for sterilization should go through disinfection process
Other all policy as per current practice shall continue.

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CATH LAB

Actionable Yes / No
Before any procedure, COVID 19 RTPCR test is to be conducted and decisions taken
accordingly (follow government policy)
Postponing of procedures in patients may have adverse effects and therefore individualized
decisions should be made, weighing the risk of COVID-19 exposure vs. risk of delay in
diagnosis or therapy.
Risk of exposure to infection of personnel is increased with procedures as intubation,
suction and active CPR (due to aerosolization of respiratory secretions). Intubation of
(suspected) infected patients should be done prior to arrival at the catheterization lab. Other
suggestions include use of closed circuit BIPAP machines, close coordination with critical
care, ID and anesthesia teams to prevent spread of infection.
Cases of (suspected) COVID-19 should be done at the end of working day when considering
the requirement for terminal cleaning. Or one lab should be designated for COVID-19
patients (if more than one lab is there).
Appropriate complete PPE would be used during the Cath Lab procedures.

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OTHER SUPPORT FUNCTIONS:
Basics related to the use of PPE, signage, social distancing, hand hygiene remains standard for all areas.

BIOMEDICAL AND ENGINEERING

Actionable Yes / No
Follow every precaution on management and maintenance of equipment keeping in mind
infection control measures.
Staff involved in the process to use PPE optimally and ensure adequate surface cleaning
with 1% dilution of sodium hypochlorite.
Precautions to be taken at crowded places such as workshops, maintenance & repair site
and ongoing civil work areas etc.
Equipment used on one patient to go through the disinfection process first before using on
to the another patient
HODs along with the training team to focus more on staff training and compliance.
Do rounds in patient areas (wearing PPE) to ensure compliance of the equipment cleaning
and appropriate usage practices
 

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KITCHEN

Actionable Yes / No
Maintain at least 1 meter distance from the delivery personnel while receiving goods.
All perishable goods to be disinfected
All goods received in package to be sanitized with disinfectant spray
Gloves and Masks to be used while handling.
Leafy vegetables to be procured on a day-on-day basis as these cannot be washed and
preserved for longer time.
Crates, Pallets, Storing Racks, Contact surfaces must be sanitized daily
Equipment’s, Machines must be sanitized.
Vegetables, fruits to be stored in cold room after sanitization.
PPE is required & Hands must be sanitized before and after the preparation is completed.
Equipment’s like kitchen knives, cutting boards, utensils, machines and the pre-preparation
area must be sanitized
Vegetables, fruits, meat, poultry etc. must be washed and disinfected.
All surfaces shall be sanitized periodically
Jewelry, rings, wrist watches should not be worn during shift
Service trolleys should not be wheeled into isolation areas, the food may be handed over to
the staff working in the area.
Stewards while servicing & clearance shall use mask and gloves.
Utility staff shall wear appropriate PPE’s which shall include eye wears.
Mandatory screening of staff in case of any respiratory illnesses by staff doctor to be done,
and after clearance the staff may join the shift.
Cleaning and disinfection of all the high touch surfaces to be done periodically
Staff to greet the patient by saying “namaste”

CANTEEN/ FOOD COURTS

Actionable Yes / No
All staff in such areas to be trained and supervised to follow the infection control protocols
and wear PPE
Surfaces and table tops, counters to be cleaned regularly
Billing process to be followed as explained above
Hospital should place a menu that should have the list of all food items and room delivery
numbers
Try as much as possible to do room delivery of food; in disposable containers
Any sit down areas to follow social distancing & disinfection protocols at all times

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SECURITY

Actionable Yes / No
Social Distance is the way of life – now onwards. 3 feet (1 meter) to be followed in all the
interactions with the Patient.
All Security Guards to be given Mask with Hand Sanitizer to handle the Patient. Mainly for
ER, Respiratory OPD, Medicine OPD and other high risk Transmission areas.
Security Guards – (Responsible for Frisking) to be given PPE appropriately.
ER Entrance Gate, knobs and handles must be considered as high risk of transmission and
appropriate actions to be taken to reduce the infection rates.
If Mortuary, is under Security. COVID 19 protocols to be followed even after COVID 19 is
over.

HOSPITAL VISITOR POLICY

Actionable Yes / No
A strict visitor policy with rare exceptions.
No children below 16 years to be allowed in the Hospital premises as an attendant.
Only one attendant per patient to be allowed in the hospital.
Attendant need to protect himself by wearing a mask at all times and follow hand hygiene
Attendant should restrict their movement while in the hospital
Attendant should report his medical condition to the doctor/ nurse if he/she is not feeling
well at any point of time during the stay
If the patient is in ICU/OT etc and the attendant has to wait in the waiting area then they
need to follow social distancing guidelines strictly
Attendants need to sign the consent form.

HUMAN RESOURCES

Actionable Yes / No
Regular Staff Screening to identify any COVID suspect case
Providing adequate PPE to all staffs as per the job role
Regular monitoring of staffs who are suffering from health issues 
Separated isolation rooms in the hostel are arranged for our staffs who are suffering for
health issue (Fever, Cold etc) are regularly monitored by Unit Head, Nursing Head & HR
Evaluate the dining areas food section for staff food
Ensure protein diet is added & food serving and preparation section is clean

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 Dining areas to be sanitized daily

IT

Actionable Yes / No
Help the hospital teams to implement the following fully:
Token system for radiology & sample collection
Paperless registration
Reports available on prism/ watsapp and information to patients

ADMINISTRATION DEPARTMENTS

Parameters Yes / No
Administrative Dept. should be separated from Clinical Dept. (as much as feasible).
Seating arrangements of all Meeting Rooms must be planned with concept of social
distancing (more than 3 feet distance between 2 chairs).
Acceptable Definition of personal space to be changed from 1.5 feet to 3 feet.
In person meeting to be discouraged, Microsoft Teams and Its features to be explored.
Relook at all work spaces and reorganize seating
Staff members are responsible to ensure they :
 Follow 5S strictly and removing unnecessary stuff
 Organize the work spaces
 Ensure desks ae cleaned everyday morning before starting work
 Discard unnecessary papers
All Training and Auditoriums to be used with social distancing. Like alternate seats will be
filled first for entire auditorium.
Apart from Approval needed papers, no print outs to be taken.
All Data collection sheets, reports, information should be done on soft copy, preferably
utility and/or software.
Seating capacity- Maximum Staff/ Employee Person allowed in specific
areas/unit/wards/training center/OPDs/ Conference Room/Dept. to be defined and to be
displayed there to ensure easy follow up.
Hand Shakes to be extremely discouraged and only Namaste to be used.
Meeting with external company persons to be limited, preplanned and time bound like fix
time in the day. Do video calls as much as possible.
If any interview have to be taken, go digital.
For payments, go digital. Communicate to the payors in advance so at they don’t have to visit
the office.
We must control the Number of persons in our premises, it is public place but social
distancing must not be compromised for the same.
Not More than 1 hour of Visiting time to be permitted with limited person access. We also
can explore the possibility of putting in house our control tabs only accessed by our network
and system.

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GENERAL LIST OF CHECK POINTS

Actionable Yes / No
Units to discuss & agree with their local corporations/ health authorities about restarting
operations- check local law also
Basis that approval, units to draw up a plan of OP services (timings, COE’s, Consultant ROTA,
Number of appointments per day per Dr, other services like billing, lab sample collection,
radiology, etc.)
Basis the identified Dr’s who are going to come, the patient list to be drawn up for
consultation (in discussion with the consultant). We have to be close to 100% by
appointment only to begin with. Use 24/7 for physical consultation appointment booking &
promote them in social media.
Basis the patient load, staff & area of operations should be finalized.
Zero Waiting Time, Zero Queue & Social distancing norms to be followed
Protocols for all Dr’s, Nurses and Staff to be shared which has to be vetted by ID team
(centrally with unit level inputs factored in)
COVID testing for all IP & surgical patients to be done (based on government guidelines).
Consent forms to include COVID testing related aspects
PPE protocols for staff to be standardized.
Units to take ID clearance their reopening plan.
Divide hospital paths/ routes into clean patients, confirmed patients, suspected cases (clean
and dirty routes)

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ISOLATION ROOM – NEGATIVE PRESSURE ROOM

Rooms: which are clearly demarcated from regular patient rooms with good ventilation with separate AC/
ventilation
Toilet: The toilet should have a negative pressure facility and should not be connected to any exhaust/air
conditioning/ ventilation that leads to general ventilation of the hospital or should have adequate ventilation.
ICU: Demarcated ICU beds, preferable separate AC
Separate Donning and Doffing room – Ante room/area

Staff:
 Dedicated doctors
 Senior nurses (nursing care and sample collection when required)
 HK staff for cleaning
 Security
 Biomedical staff
 Waste collection
 Radiology
 The staffing is separate for suspected and confirmed areas. The staff entering the Confirmed or
Suspect Isolation area has to don full PPE.
 Facilities for the treating staff would be free food and free healthcare in this period as per government
directives. The treating staff are to be quarantined if they develop respiratory symptoms.
Equipment/ Products:
 Monitors
 Thermometer
 NIBP- for BP measurement
 Stethoscope
 Drug boxes & Emergency carts
 Defibrillators
 Oxygen, Suction, Air ports
 ICU equipment - as per normal protocol

PPE: Hand rub, Medical Face masks, Gloves, Caps, gowns, shoe covers

Surface Disinfectants 1 % Sodium Hypo chlorite

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ISOLATION ROOM CHECKLIST

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 Isolation Room check points Y N Remarks
1 COVID-19 patients should be housed in single rooms.
If sufficient single rooms are not available, beds could be put with a spatial
separation of at least 2 meter (6 feet) from one another (only positive cases
together)
2 If room is air-conditioned, ensure 12 air changes/ hour and filtering of exhaust
air
3 A negative pressure in isolation room for patient requiring aerosolization
procedures (intubation, suction nebulisation)
*not be a part of the central air-conditioning
4 The isolation ward to have a separate toilet with proper cleaning and supplies
(Even the toilet should have a negative pressure facility and should not be
connected to any exhaust/air conditioning/ ventilation that leads to general
ventilation of the hospital)
5 Avoid curtains inside the room
6 Isolation ward to have a separate entry/exit
(Not be co-located with post-surgical wards/dialysis unit/ labour room)
7 Double door entry to changing room and nursing station
8 Signage on the door indicating that the space is an isolation area.
9 Remove all non-essential furniture and ensure that the remaining furniture is
easy to clean
10 Keep the patient’s personal belongings to a minimum
11 Keep water pitchers and cups, tissue wipes, and all items necessary for attending
to personal hygiene within the patient’s reach
12 Non-critical patient-care equipment (e.g. stethoscope, thermometer, blood
pressure cuff, and sphygmomanometer) dedicated for the patient
13 Any patient-care equipment that is required for use by other patients to be
thoroughly cleaned and disinfected before use
14 Dedicated Portable X-ray and portable ultrasound equipment for Isolation area
15 Place an appropriate container with a lid outside the door for equipment that
requires disinfection or sterilization
16 Alcohol-based hand rub, near the point of care and the room door
17 Storage of minimum imprest stock medicines as per the Red Book
PPE & Waste Disposal
18 Staff assigned in isolation area to be trained on donning and doffing of PPE
19 Separate Donning and Doffing room – Ante room/area
20 Availability of enough PPE in the changing room
21 Used PPEs are disposed as per the BMWM guidelines in a touch-free bin
22 Used (i.e. dirty) bins remain inside the isolation rooms
23 Puncture-proof container for sharps disposal inside the isolation room/area
24 Inside the Suspect and Confirmed Isolation areas, separate toilets would be
demarcated for patients and staff
Hand hygiene and Cleaning
25 Appropriate hand washing facilities and hand-hygiene supplies are available
26 Sink area is stocked with suitable supplies for hand washing
27 Ensure regular cleaning and proper disinfection of common areas, and adequate
hand hygiene by patients, visitors
28 Corridors with frequent patient transport to be well-ventilated
Access control to Isolation Area
29 The access to isolation ward is through dedicated lift/guarded stairs
30 Visitors to the isolation facility should be restricted /disallowed
31 For unavoidable entries, they should use PPE according to the hospital guidance,
and should be instructed on its proper use and in hand hygiene practices prior to
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e into the isolation room/area
32 Maintain a Visitor record to the isolation area
Staff management in Isolation
33 Keep a roster of all staff working in the isolation areas, for possible outbreak
investigation and contact tracing
34 Dedicated Doctors, nurses and paramedics posted to isolation facility (not
allowed to work in other patient-care areas)
Communication
35 Set up a telephone or other method of communication in the isolation room or
area to enable patients to communicate with families and care givers
Categories of staffing to be strictly avoided for postings in COVID / Suspected area
 Pregnant women
 Staff with a history of comorbid conditions like anemia, diabetes, symptomatics seasonal flu etc
** health assessment/ history taking to be done for all staff and should be certified fit for handling
such patients by a physician

Working hours & post duty

Nurses Doctors Housekeeping Other staff

6 hour- 6 hour- 12 hour 10 days continuous 6 hours- 6 hours- 12 Fixed staff
shift (3 shifts) Then 4 days off hours
1:4 for suspected/ After a month- 5 days 1 housekeeping per Should not be
stable confirmed cases off 5 rooms rotated
1:1 for ventilated
positive cases
5 days continuous work
then 2 days off
After three weeks- 5
days off
Post duty- all staff
Staff to take shower in the building after finishing up the duty
Change the scrubs
Scrubs need to be washed separately by hospital
Washroom to be cleaned after every staff usage
Staff need to be staying in the hospital premises or in a quarantined/
separate section/ floor in the hostels (not mix with other staff
These areas need to be supervised and cleaned thoroughly continuously

Diet/ Food for staff

 Dieticians to supervise the food for the staff (doctors, nurses, housekeeping) who are stationed in
these areas
 Staff to be given a high protein diet and other important nutrients
 They should not be dehydrated at any point

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PATIENT MEDICAL RECORD CHECKLIST
 
Actionable Yes / No
Ward/ICU
The Medical Record of patient must not be taken to the bedside of the patient unless it is
mandatory for obtaining signatures of the patient/attendant.
The record must be stored at designated area at nursing station all the time.
All staff handling the medical records must ensure that they perform hand-hygiene before
and after touching the Medical Records.
Signatures of the patient wherever mandatory should be taken ensuring that the patient is
wearing mask and gloves. The contact time of record with the patient must be minimized. As
stated above, signature of attendant, if required will be taken outside the Ward/ICU. Ensure
even the attendant wear gloves and mask.
MRD Staff in all shifts must ensure that the scanned copies of all the records are uploaded
into system for easy access
All the computers/printers used throughout the hospital should be disinfected regularly or
at least at each shift
Pens used by staff during documentation to be sanitized after every use.
All the registers/forms/notepads used in the hospital to be away from the patient/patient
care areas.
If needed only the medication chart can be carried to the bed side.
The forms or reports once given to Patient/Family should not be collected back at any given
time.
The racks where Patient medical records are stored to be sanitized at each shift by the nurse
taking care of those patients
On Discharge/Death of positive patient
Discharge/Death Summary to be handed over to Patient/Attendant in the ziploc packet. The
Medical record of the patient has be retained in the Isolation Area for a period of at least 6
days before dispatching the record to MRD as the viability period of virus on paper is said to
be 5 days as per the literature review.
The Ziploc packets with patient file inside must carry patient label on it.
The Ziploc packs must be disinfected with 1% Hypochlorite before packing these in Yellow
Polybags.
Declaration/ Consent form for Home Quarantine post discharge
Undertaking on Home Isolation is filled as per MoHFW guideline
Discharge advice / instructions are given along with discharge summary for COVID patients
at the time of discharge
Transport and Storage of Files in MRD
The file to be transported by staff wearing mask and gloves on a designated trolley for
carrying the record.
Trolley used for shifting of record to be disinfected with 1% Sodium Hypochlorite.

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SPECIAL RECOMMENDATIONS FOR PREGNANT WOMEN

Reduce access of pregnant women to prenatal care, limiting only to high-risk cases. There is no evidence of an
increased risk of unfavourable maternal or foetal outcomes in the case of COVID-19. Infants born to mothers
with confirmed COVID-19 should be considered as suspects. As such, these infants should be isolated from
others. Separation (i.e. in an individual room) of the infant from the mother with COVID-19 confirmed or
suspected, until the precautions based on the transmission risk of the mother are suspended. The decision
should be discussed carefully between the caring team and the mother, evaluating risk and benefits of this
choice, including the protective potential of colostrum, breast milk and feeding time.

The discharge of mothers after childbirth must follow the recommendations for discharge of COVID-19 or
suspected patients. In the case of a woman with suspected SARS-CoV-2 infection or with COVID-19, according
to her clinical conditions and desire, breastfeeding should be started and / or maintained directly on the
breast or with squeezed breast milk. If mother and child must be temporarily separated because of mother
clinical conditions, one should help the mother to maintain milk production through manual or
mechanical/electric squeezing. In a limited series reported to date, the presence of the virus in the breast
milk of infected women has not been reported, but anti-SARS-cov2 antibodies have been found. So breast
milk would be protective.

A mother with confirmed COVID-19 or ongoing swab samples because symptomatic should take all possible
precautions to avoid spreading the virus to the baby, including washing hands before touching the baby and
wearing a face mask, if possible during breastfeeding. If using a manual or electric breast pump, the mother
must wash her hands before touching the breast pump or parts of the bottle. If possible, have another person
administer the milk to the baby.

It is not yet known whether COVID-19 can be transmitted through breast milk. At present, the main concern
is not whether the virus can be transmitted through breast milk, but rather whether an infected mother can
transmit the virus through respiratory droplets during breastfeeding.

For assisting the delivery of women with confirmed or suspected COVID-19, staff must use the safety
precautions provided for non-pregnant patients.

Pregnant women with suspected or confirmed SARS-COV2 infection should be treated with supportive
therapies, however taking into account the physiological characteristics of pregnancy.

The use of experimental therapeutic agents outside of a research study should be guided by an individual
risk-benefit analysis based on the potential benefit to the mother and the safety of the foetus, with the
consultation of an obstetrician specialist and an ethics committee.

The decision to proceed to a pre-term birth is based on many factors: gestational age, maternal conditions
and foetal stability and requires a collegial evaluation by obstetric, neonatal and intensive care specialists
(depending on the mother's condition).

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Positivity in itself to Coronavirus is not an indication for a caesarean section which in these patients should
only be performed based on other obstetric or medical indications. In COVID-19 pregnant women, it is useful
to be very cautious in inducing maturity of the lung by means of corticosteroids, since these drugs seem to
worsen the course of the infection. If possible, evaluate each case with a neonatologist.

OPERATION THEATRE (OT)

Actionable Yes / No
Patient to be given instructions a day in advance on preparation, arrival time, date, whom
to bring along, and the SPOC details (navigator)
As soon as patient arrives in the room or in day care, admission formalities to be
completed
COVID test to be done before, if government policies permit- positive/ suspected patients
to be referred to the ID consultant
Medical team to inform In-charge of Lab about the required number of kits needed for
next day.
It is also possible that all patients required for pre-operative COVID testing may not be
accommodated on the next day because of lack of available screening beds. The hospital
should try to accommodate them on the next to next day, after discussing with the
Consultant in-charge.
Consultants admitting for pre op. testing, should inform the patient & relatives that this
COVID testing + Pre OP Ward bed charge, may not be covered by insurance.

REQUISITE TO BE FULFILLED TO AVOID UNKNOWN COVID TRANSMISSION IN HOSPITAL

1. Health care workers to wear triple layered mask all the time while handling patient or coming in
contact with patient within 3 feet.
2. Other non-health care workers like dietician, F and B staff, security talk at a distance of more than 3
feet away from the patients.
3. Hand hygiene after touching the patient and follow 5 moments of hand hygiene.
4. Patients with fever, cough, coryza, sore throat, dyspnoea, myalgia, GI symptoms. Conjunctivitis, loss of
taste or smell, myo/pericarditis. Any febrile illness > 72 hrs without clinically overt localization to be
admitted in a private ward or keep more than 6 feet distance between each bed.
5. Provide the above mentioned patient with triple layered mask.
6. Disinfection of all rooms with 1% Sodium Hypochlorite / Virex 0.5 & abovesolution.
7. Patient who is suspected to be at high risk (History, clinic radiological procedure) should be shifted to
COVID isolation ward.
8. Patient who is suspected to be at low risk to be isolated in single rooms.
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 9. Sample collection in a private room only with appropriate PPE.
10. Risk stratification if there was a contact.
11. Ask staff continuously - How they did they travel to work
12. In emergency, every patient has to be treated as a suspect case so staff has to wear complete PPE at all
times and patient should wear mask unless it’s not possible.
13. Chest x ray to be imp for every admission.
14. For admission: Any Patient should not be admitted in sharing rooms- single rooms only (if required-
upgrade)- also keeping in mind that we are not opening unnecessary ward/floors/ ICUs.
15. Suspected cases cannot be kept in rooms where central air conditioning is there.
16. ICU cases to be kept at least 10 feet away from each other (preferably as much far away as possible)
with adequate and 24/7 supervision.
17. Housekeeping staff to wear mask and gloves at all times and the mask should not be hanging around
their necks.
18. F&B staff should not enter patient rooms and nurses should hand over the food.
19. Patient attendants when in the hospital should wear a mask at all times- strict adherence and
compliance to all infection prevention protocols needs to be done- patient/family education.
20. Every patient should identify only ONE attendant who should be available at all times.
21. Screening of attendants should be done like visitors daily.
22. CODE GREEN (SUGGESTED AS A GOOD PRACTICE):
 Call XX and announce CODE GREEN IN 15 MINUTES OR 30 MINUTES (please note that this is not
an emergency code like CODE BLUE. The 15-30 minutes is to ensure that patients who are in
transit or getting some investigation done will finish and will be shifted back to their rooms
before the area is cordoned off for green corridor)
 After 15 or 30 minutes, please call XX again and announce CODE GREEN STARTING FROM AREA 1
TO AREA 2 (eg CODE GREEN starting now from ER to Level 5) and then start the green corridor
process for movement of suspect patient. (All members of the team in this chain from ER to Level
5 should be positioned and do the needful. Unnecessary crowding of people and blocking of
normal activities should be refrained)
 Once the desired activity is completed, normal activities can be resumed. CODE GREEN
COMPLETED can be announced
 Lifts and other areas of patient movement to be cleaned as per protocol

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