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COVID-19 guidelines from Italy

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Posted: Wednesday, March 18, 2020

General recommendations to protect Staff and Patients from COVID-19, based on lessons learned in Italy

Kindly provided by Lucio Buratto

First and Foremost – Coronavirus infection will persist for months and, therefore, one must get used to the idea of the precautions mentioned below. Be patient and observe them very precisely.

Personal hygiene is the best prevention – avoid touching your face (especially mucous membranes: eyes, nose, mouth).

In case of sneezing or coughing, always use disposable paper tissues.

The virus may also be transmitted by contact with infected surfaces. Therefore clean all surfaces where patients place their hands with sterilising products regularly.

Masks and gloves are only protective if used consistently and correctly – do not forget to disinfect your hands after removing masks and gloves.

Exercise an affectionate and kind surveillance over work colleagues and patients so that they follow the safety rules, for their benefit and for the benefit of all others.

Depending on the circumstances, it may be advisable to measure your own temperature (standard contact devices) daily.

Preventive measures even before any patient – staff contact

– Stop all elective surgeries and patient visits – provide only emergency care. This is necessary to limit the potential transmission of the virus in the office / hospital setting, both to protect patients AND staff.

– Install – if not already in place – some kind of physical barrier for reception / front desk, e.g. a Plexiglas shield. This physical barrier between staff and patients serves for greater protection of both.

– In the waiting rooms, the chairs should be moved away from each other to keep adequate distance between people (>1m).

– If necessary, appointments should be phased to avoid too many people being resent at the same time.

– Numerous dispensers of detergent-sterilising substances for the hands should be positioned inside the offices (they provide disinfection against viruses and bacteria).

Useful tips at the Call Centre

– During calls to make appointments, ask if the patient has a cold, flu symptoms, fever, cough or conjunctivitis, in which case, invite them to wait for the visit or instead recommend they go to the hospital (outpatients service, not emergency room).

– If possible, also ask if the patient has recently been in contact with people with COVID-19 infection or comes from infected areas. If the answer is yes, again recommend to wait for the visit or to go to the hospital (outpatients service, not emergency room).

Actions upon arriving of the patient at the front desk

– Upon entering the office, all patients and accompanying persons should be asked to wash their hands or disinfect them, ideally using non-contact dispensers present at the entrance.

– Each patient who enters the office should be asked if they have a cold, flu symptoms, fever cough, or conjunctivitis, in which case they should be invited to go to hospital outpatients service (not to the emergency room).

General Recommendations at the front desk / at the office

– Inform patients that all necessary precautions for patient and staff safety will be used during the visit.

– Kindly remind your patients that these actions are both to protect the patient and the staff from infection, to ensure continuous medical care!

– Patients should be asked not to be accompanied by family members (or friends) during tests performed by technicians; their presence may, however, be allowed during the final interview with the doctor.

– All patients and accompanying persons should be asked to wash their hands or disinfect them, ideally using non-contact dispensers present at the entrance.

– All patients should wear and keep a mask during their entire stay in the office and during the various examinations (the mask must cover the mouth and nose well). The masks may not stop the virus but are intended to prevent droplets (emitted in speaking, sneezing, and breathing) from reaching nearby persons – thus reducing the risk of transmission of the virus.

– Remind patients to keep a distance of one meter or more between people and to avoid touching the various parts of the face (nose, eyes, mouth) as well as various surfaces in the office.

– Patients should be reminded not to shake hands with the staff of the practice and avoid kisses, hugs and, as far as possible, physical contacts.

– Numerous dispensers of detergent-sterilising substances for the hands should be positioned inside the offices, and patients should be invited to use them frequently.

– Non-contact temperature measurements are not reliable and are therefore of only limited use for screening of patients in the office.

Preventive measures for staff in contact with patients

– Always wear masks and touch them as little as possible. When you remove them, do so by taking the rubber bands from the back. Remember: The mask does not claim to protect from the virus but prevents droplets from spreading.

– All staff should wear protective glasses for their own protection during clinical examinations and in general within the office (please note that the first case of Coronavirus infection occurred to a Chinese ophthalmologist).

– All exams performed during the visit should be done without physical contact. If contact is necessary, the healthcare professional should wear protective gloves, which should be replaced after each patient. After removing the gloves, staff should disinfect their hands.

– Remember: The virus may also be transmitted by contact with infected surfaces. Staff should clean all parts of the instruments and surfaces that come into contact with the patient with disinfectant liquids between visits to protect the next patient.

– Clean the surfaces, handles, switches and any object that comes into contact with the hands or face of patients and staff (i.e. also door handles, computer keyboard and mouse, telephone etc) frequently with detergent, sterilising solution; always use disposable gloves when doing so and disinfect your hands afterwards.

– Always clean all the chin guards and borders of instruments and test glasses with which patients come into contact and all parts of the instruments touched by the patient: always do this at the beginning of the examination, in the presence of the patient, so that they see that it is done.

– Clean and sterilise all instruments that come into contact with the patient’s eye: use disposable contact tonometers whenever possible. Whenever possible, avoid the use of contact lenses (3-mirror, gonioscope) and preferably use Volk-type lenses, or if available use single-use contact lenses.

– Limit as much as possible touching of the eyelids, eyes, nose and mouth of the patients and if necessary, do so with gloves. The same is true for one’s own eyes and face; remember that the eyes, and in particular the conjunctiva, are a direct gateway for the virus.

– Avoid using multi-dose eye drops that can be sources of contamination if they touch the eyelids and conjunctiva of patients (and through the non-sterilised hands of healthcare professionals). Whenever possible, use single-dose products. If you need to use multiple doses, avoid any contact of the regulator or your hands with parts of the patient’s face.

– Avoid handling contact lenses of patients or applying them.

– Avoid non-contact tonometry (air-puff tonometry). In patients with COVID-19 associated conjunctivitis, virus DNA was found. Air puff tonometry in such patients may produce a significant amount of virus-loaded aerosol in the local area, thus effectively spreading the virus.

Recommendations for staff

– During staff breaks avoid that there are several people together – keep at least 1m distance, avoid staying in the same room for more than 15 (better 10) minutes to reduce the risk of virus transmission.

– Always wear the mask even in the presence of colleagues and other staff members.

– Preferably use paper plates and cups and disposable cutlery.

– All staff are invited to observe personal protection rules in addition to those of patients, avoiding shaking hands, kisses, hugs and physical contacts with other people.

– Use alcohol disinfectant gel frequently; in this way, the risk of infection is greatly reduced.

Last not least

– The toilets should be cleaned frequently, including door handles and taps. If water taps are not controlled by a photocell but must be touched to run water, they should also be cleaned frequently.