AL KHAFJI NATIONAL HOSPITAL

Evidence Based Clinical Practice

Guidelines for the Management of
COVID-19
A Clinical Practice Guidelines Adopted from CPG Source:
Ministry of Health, Kingdom of Saudi Arabia
 Prevalence
At the end of 2019, a novel coronavirus was identified as the cause of a
cluster of pneumonia cases in Wuhan, a city in the Hubei Province of China. It
rapidly spread, resulting in an epidemic throughout China, followed by a
global pandemic. In February 2020, the World Health Organization designated
the disease COVID-19, which stands for coronavirus disease 2019. The virus
that causes COVID-19 is designated severe acute respiratory syndrome
coronavirus 2 (SARS-CoV2); previously, it was referred to as 2019-nCoV.

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Prevalence and Severity of COVID-19
The complications, including ARDS risk, ranged from 5.6–13.2 %, with the
pooled estimate of ARDS risk at 9.4 %, ACI at 5.8 % (95CI 0.7–10.8 %), AKI
at 2.1 % (95CI 0.6–3.7 %), and shock at 4.7 % (95CI 0.9–8.6 %). The risks of
severity and mortality ranged from 12.6 to 23.5% and from 2.0 to 4.4 %,
with pooled estimates at 18.0 and 3.2 %, respectively. The percentage of
critical cases in diabetes and hypertension was 44.5 % (95CI 27.0–61.9 %)
and 41.7 % (95CI 26.4–56.9 %), respectively. (Virol, 2020)

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 Based on the Prioritization of CPG Subcommittee they selected to work on this
guidelines based on the criteria stipulated below and they prioritized it to come
up with and adopted best practice and guidelines.

CRITERIA COVID-19
High Risk Impact of Disease/Condition 4
Disease/Condition has Hight Individual Cost 4
High Volume of Cases 4
Priority Areas in Morbidity and Mortality 4

Availability of High Volume of Evidences 4

SUM 4

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 Objectives in Adapting a CPG for
COVID-19
To look for an evidence based CPG to effectively management
suspected and confirmed COVID-19 patients to;
 Standardize the management
 Improve clinical results and patient outcomes.
 Improve Utilization by improving length of hospital stay, decreasing overall
cost, etc.

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 KNH INSTITUTIONAL
PROTOCOL BASED ON
THE ADOPTED CPG

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 Case Definitions
DEFINITION OF COVID-19 SUSPECTED CASES
 Patient with acute respiratory illness (sudden onset of at least one of the following: fever1
(measured or by history),cough, or shortness of breath
 Patient with sudden onset of at least one of the following: headache, sore throat,
rhinorrhea, nausea, diarrhea or loss of smell or taste. AND in the 14 days prior to symptom
onset, met at least one of the following criteria.
 Any admitted adult patient with unexplained sever acute respiratory infection (SARI), either
Community Acquired Pneumonia (CAP) or Hospital Acquired Pneumonia (HAP).

DEFINITION OF COVID-19 SUSPECTED CASES

 A person who meets the suspected case definition with laboratory confirmation of COVID-19
infection (PCR).

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 Management/Treatment
SUSPICIOUS CASE
MILD TO MODERATE:  Treat Symptoms
 NO shortness of Breath
MILD TO MODERATE:  Treat Symptoms
 NO shortness of Breath in High Risk Patient  Consult Infectious Disease Specialist
MILD TO MODERATE:
 WITH shortness of Breath in High Risk Patient

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 Management/Treatment
PCR CONFIRMED CASES
ASYMPTOMATIC  Treat symptoms

MILD TO MODERATE: No oxygen requirements/no evidence of

Pneumonia

SEVERE: Symptoms ≥ 1 of the following:  Treat symptoms

 Respiratory rate ≥30/min (adults); ≥40/min (children < 5 years)
 Blood oxygen saturation ≤93%
 PaO2/FiO2 ratio <300
 Lung infiltrates >50% of the lung field within 24-48 hours
 ICU admission, decision by ICU treating team
 The initiation of hydroxychloroquine in patients in the ICU needs
the approval of ID and Intensivist
 Antibiotics and antifungals according to local antibiogram and
institutional pneumonia management guidelines/pathways.

CRITICAL− Symptoms ≥ 1 of the following:  Treat symptoms

 ARDS;Sepsis;Altered consciousness;Multi-organ failure
 Patient with cytokine release syndrome consider starting Tocilizumab
 Criteria for patients at high-risk for developing cytokine storm (1 or
more of the following):
 Serum IL-6 ≥3x upper normal limit
 Ferritin >300 ug/L (or surrogate) with doubling within 24 hours
 Ferritin >600 ug/L at presentation and LDH >250
 Elevated D-dimer (>1 mcg/mL)
 ICU admission, decision by ICU treating team
 The initiation of hydroxychloroquine in patients in the ICU needs
the approval of ID and Intensivist
 Antibiotics and antifungals according to local antibiogram and
institutional pneumonia management guidelines/ pathways

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 Implementation Strategies
 Orientation to disseminate information
 Multidisciplinary meeting with other health
professionals (nurses, laboratory technicians)
 Continuous Compliance Verification

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 Compliance Audit with the
Prescribed Protocol/Guidelines
Patient record conform to KNH standards

Relevant checklist /form completed & attached to the file

Patient progress during episode of care documented in the file timely & signed

Required medication given according to protocol /Guideline& documented in medication sheet with: date, dosage, frequency & duration

Required laboratory and/or other diagnostics (initial &subsequent)

Patient assessment done within time frame according to protocol/Guideline

Identification information

0 20 40 60 80 100 120

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 Performance Measure
of the Guidelines
IN SITU PULMONARY THROMBOSIS
INCIDENCE OF IN SITU PULMONARY THROMBOSIS AMONG
25

COVID-19 PATIENTS
20
Rationale: To measure the precise percentage of complication incidence
& compare it to the regional/global incidence proportion.
15

Target: <20%
10
Based on the aggregated case file data it has shown that COVID-19 in
situ pulmonary thrombosis incidence is within the national incidence
5 percentage. Large number of patient didn’t develop such complication
which significantly affects the outcome of admitted patients in KNH.
0
Jan to June July to December

Percentage Target

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 Performance Measure
of the Guidelines
MORTALITY FROM COVID-19 AT KNH
2020 2021
9
8
8
MORTALITY RATE OF ADMITTED COVID-19 PATIENTS
7
6 Rationale: To show the fatality rate of contracting Covid-19, and more
accurately measures enhancements in medical treatment, and
5
corresponding danger to patients.
4 3.65
3
2
1
0
MORTALITY

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