Covid 19-quarantine-and-isolation v2

COVID-19:
Quarantine and
Isolation

What will I learn ?
• Differentiate between the need for quarantine and
isolation.
• Recall the guidelines to set up isolation facilities and
quarantine facilities.
• Recall the precautions around PPE and transport of
infectious patients.
• Working at an isolation facility/quarantine facility
• Coming in contact with COVID-19 patients in the
capacity of medical personnel, support staff, or visitors
• Transporting infectious patients for diagnostic or
treatment purposes
Learning Objectives Is this module for me ?
By the end of this lesson, you should be able to:
If you are carrying out any of the following
responsibilities, then this module is for you
This module provides guidelines for setting up quarantine facilities and provides vital information to establish an
isolation facility at the district level (a secondary healthcare facility).

Quarantine and Isolation
Quarantine and isolation are important mainstays of cluster containment. These measures help by breaking the chain of transmission in
the community.
Quarantine
Isolation
▪ Quarantine refers to the
separation of individuals who are
not yet ill, but have been
exposed to COVID-19 (i.e., have
potential to become ill)
▪ There is voluntary home
quarantine of contacts of
suspect/confirmed cases, but
they may also be quarantined in
community-based facilities.
▪ MoHFW’s guideline on home
quarantine
▪ Isolation refers to separation of
individuals who are ill and suspected
or confirmed of COVID-19.
▪ All suspect cases detected in the
containment zones (till a diagnosis is
made), will be hospitalized and kept in
isolation till they test negative.
▪ Persons testing positive for COVID-19
will remain to be hospitalized till 2 of
their samples test negative as per
MoHFW’s discharge policy.

Quarantine in Community-Based Facilities

Understanding Quarantine
Quarantine can be applied to:
The recommended duration of quarantine for COVID-19 is up to 14 days from the time of exposure.
An individual or a
group of persons
exposed at a big
public gathering
Persons believed
exposed on a
conveyance during
international travel
A wider population-
level or geographic
-level basis
Erecting a barrier around a
geographic area (cordon
sanitaire) with strict enforcement
prohibiting movement in and out
The closing of local or
community borders
The purpose of quarantine during the outbreak is to reduce
transmission by:
▪ Separating contacts of COVID-19 patients from community,
▪ Monitoring contacts for development of sign and symptoms
of COVID-19, and
▪ Segregating COVID-19 suspects as early as possible from
among other quarantined persons.

Preparedness Planning: Evaluation of Potential Sites
Requirements for quarantine in a community-based facility must be evaluated on the basis of these points:
Location
▪ Preferably placed in the outskirts of the urban/ city area (can be a hostel/unused health facilities/buildings, etc.)
▪ Away from crowded and populated areas
▪ Well-protected and secured (preferably by security personnel/ army)
▪ Preferably should have better approachability to a tertiary hospital facility having critical care and isolation facility
Access Considerations
▪ Parking space including ambulances etc.
▪ Easy access for delivery of food/medical/other supplies
▪ Differently-abled Friendly facilities (preferably)
▪ Ventilation Capacity: Well ventilated preferably natural

Basic Infrastructure / Functional Requirements
▪ Rooms separated from one another is preferable with in-house capacity of 5-10 beds/room
▪ Each bed separated 1-2 meters (minimum 1 m) from all sides.
▪ Lighting, well-ventilation, heating, electricity, ceiling fan, potable water
▪ Functional telephone system, sanitation, cleaning and housekeeping
▪ Support services: Food, snacks, laundry, recreation
▪ Properly covered bins as per BMW guidelines
Space Requirements for the Facility
▪ Administrative offices- Main control room/clerical room
▪ Logistics areas/Pharmaceutical rooms
▪ Rest rooms- doctors/nurses/supporting staff
▪ Clinical examination room/ nursing station / Sampling area
▪ Laundry facilities (on- or off-site), Meal preparation (on- or off-site)
▪ Holding area for contaminated waste
▪ Wash room/Bathroom/Toilet

Monitoring the Health of Contacts and Providing Social Support
▪ Contacts should be monitored at least daily for fever and respiratory symptoms.
▪ Social Support Resources and Recreation activities: Television and radio / Reading materials/
indoor plays
Standard Operating Procedures
Daily monitoring surveillance using the daily reporting format (Annexure 1):
▪ Fever triage/ Isolation
▪ Case and contact monitoring and response
▪ Transfers of suspect/symptomatic to designated hospital (through ambulances)
▪ Public information
Provider information (SOPs):
▪ medical personnel (Annexure 2),
▪ nursing staff (Annexure 3),
▪ movement of health personnel and support staff (Annexure 3), and
▪ security staff (Annexure 4)
(Guidelines for Patient Discharge at Annexure-11)

Quarantine Facility Risk Assessment
Risk refers to how likely it is that someone in the quarantine camp will become infected as a result of movements and
activities in the camp. Risk assessment includes identification of the biohazard risk precaution levels, along with its
associated activities. Areas can segregated and labelled as:
Low-Risk Areas
Areas with less direct contact with evacuee
suspects:
• Control room center,
• Nursing station
• Areas of kitchen where food is cooked.
Moderate-Risk Areas
Areas where infectious aerosols are generated (areas
the suspects inhabit):
• Bed linen, pillows and nearby clothes,
• Areas of low concentration of infectious particles,
• Contaminated surfaces near the quarantine zones.
High-Risk Areas (Containment Quarantine Camp)
Areas directly dealing with suspects:
• medical examination room,
• sample collection areas (high concentration of infectious particles while coughing,
sneezing, gag reflex during nasopharangeal & oropharangeal sample collection),
• toilet and bathroom areas and dining areas,
• areas of bio-waste collections, segregation and disposal.

Security:
▪ Checks main entrance gate of the area and a guard (24×7) with registers for ins and outs
▪ Keeps doors closed at all times.
▪ Manage a double-door entry system with only one door to be opened when required.
▪ Allows only authorized & trained persons or those designated in work areas to permitted
to enter the quarantine areas.
Securing Entry and Exit Points
Designated Nursing Officer:
▪ Checks proper PPE wear at the entrance gate
▪ Keep the international biohazard warning symbol displayed on the doors of the rooms
where suspects are kept, BMW management areas, samples where higher risk groups
are handled.
Control Room: The room where a person entering the quarantined building is given proper
awareness and training on infection control measures

Human Resource Deployment
Chief Medical Officer
appointed as In-charge
/ Nodal Officer for
overall coordination
and supervision of the
quarantine centre
Services of General
Duty (doctors and
specialists) for routine
examination and
clinical care of the
quarantined people
Paramedics
including:
• Staff Nurse
• Lab Technician
• Pharmacist
Public
health
specialist to
monitor
public health
aspects of
facility
Clinical
microbiologist for:
• sample collection,
• packaging,
• infection prevention
• control practices
House-
keeping staff
also need to
be deployed

Training
Training is the most important and critical part to ensure that all activities takes place as per established protocol
and SOPs:
Audience Focus Areas
Medical Officers (Training on SOPs) • Daily examination
• Movements in the facility,
• Infection prevention control measures, and
• Use of the PPE kit
Clinicians, Laboratory Technicians and
Medics
• Appropriate sample collection (nasopharyngeal and
throat)
• Triple-layer packaging with cold chain maintenance
Paramedical Staff i.e., Staff Nurses;
Medics, Pharmacists etc.
• SOPs to be followed at quarantine centres
Staff working in Laundry, Mess/Canteen,
Security and other related staff i.e.,
Drivers, General Duty Staff etc.
• Use of mask, gloves, cleaning and disinfection
procedures
Refresher training for all audiences
Training for all new staff members before being deployed

Daily Clinical Examination and Referrals, Coordination
Daily Clinical Examination and Referrals
• All quarantined people to be examined twice (morning & evening) daily
• The same applies to daily census of the people (e.g., Morning 8 am and evening 6 pm)
• Referrals for related symptoms of COVID-19 (fever, cough, sore throat, breathlessness etc.) – Refer to a designated
hospital directly in an ambulance with due precautions as per referral SOP.
• Ambulances necessary in the facility on standby, including advanced lifesaving ambulances.
Chief Medical Officer: Supervises and coordinates with various organizations working with the facility.
Separate teams constituted for various purposes - Supervisory, admin, logistics, referrals, medicine /
equipment, and hygiene sanitation teams.
Daily review meetings are conducted under the chairmanship of Chief Medical Officer to discuss day-to-
day affairs and sort out any issues.
A 24×7 Control Room are established at the facility with CCTV cameras and speakers at each floor for
routine communication providing instructions to quarantined people.
Coordination

Reporting and Monitoring
Recording and Reporting Mechanisms
Monitoring and Supervision
▪ Public health officers conduct daily monitoring visits inside quarantine facility and
outside the facility (campus) and gaps noted.
▪ Necessary corrective and preventive actions taken by the Nodal Officer.
▪ Visits are also made by senior officers for regular review.
To ensure standardized reporting, daily reporting format has been designed to record:
(1) suspected cases with symptoms related to coronavirus,
(2) the number of cases requiring referral,
(3) sample collection status (As per Annexure-1)
The report needs to be sent to relevant higher authorities daily.

Establishment of Infection Prevention Control (IPC) measures
As per risk assessment undertaken, a special map of the facility needs to be prepared to outline the details of
movement of health care and other personnel around the quarantine area and in the building. The movement of
healthcare staff and other personnel should take place as per the designed map to prevent and control infections:
Trained security personnel deployed around the campus on 24×7 rotation
Monitor the facility and to avoid entry of undesired persons/animals inside.
All healthcare personnel properly trained use to use PPE, and assisted during wearing
• Separate areas earmarked for PPE donning and doffing.
• Compliance ensured by Nodal Officer.
Build a fence to prevent entry of animals
Especially dogs, monkeys, and even birds if possible
1
2
3

Establishment of Infection Prevention Control (IPC) measures
Disinfect the facility daily with freshly prepared 1% hypochlorite, detergent solution
• Including mopping of floor, bathrooms, toilets, under side of beds, other items placed in
quarantined people’s rooms.
• For decontamination, refer to infection prevention control (IPC) guidelines.
Separate cubicle for people developing mild symptoms for temporary observation (Transit Room)
Early isolation of any symptomatic person helps prevent transmission to other groups.
Assign well-informed and trained nursing officers regulate staff movement in the facility
• Nursing officer sees that every person enters their details in the register;
• Ensures that all are labelled for identification by security staff; and
• Ensures two entry doors to avoid mixing of quarantined people with healthcare staff.
4
5
6

Lodging, Catering, Laundry and Other Related Activities
Before laundering, all the
washable items needs to be
placed in 1% hypochlorite
up to 30 minutes and later
washed in detergent..
Disposable and pre-
packed food to be
needs to be served to
quarantined people.
All quarantined people must
be on separate beds with 1-
2 meters distance, no bed
facing another.
All beds must have
a disposable bed
sheet that should
be changed daily.
Personal toiletries/ towel/
blanket/ pillow with covers/
electric kettle, room heater
and water dispenser may
be provided to each person
depending on availability.
A separate room needs to be
assigned to perform laundry
services for cleaning of all
the clothes and other
washing related activities.

Biomedical Waste (BMW) Management
▪ Separate yellow, red /black bags, foot operating dustbins need to be kept at
each floor and outside the facility.
▪ Doffing takes place in the designated area with all the PPE kit including mask,
gloves is properly placed in yellow bags.
▪ Healthcare workers collecting the possible infectious material such as food
items, PPE kits from yellow bags should also wear PPE and follow the IPC
measures.
Steps in the management of biomedical waste include generation, accumulation, handling, storage, treatment,
transport and disposal.
All officials concerned with the administration and all other health care workers including medical, paramedical, nursing
officers, and waste handlers such as safai-karmacharis, sanitation and other attendants need to properly know how to
handle and manage general and biomedical waste generated at the facility, such as:

Biomedical Waste (BMW) Management
▪ Designated place outside the building for collection of yellow and black
bags, which should be collected at least twice daily by biomedical waste
management vehicle / any other local established practice.
▪ Site of collection of biomedical waste should be regularly disinfected with
freshly prepared 1% hypochlorite solution.
▪ All the generated waste from quarantine facility should be treated as isolation
waste and its disinfection /treatment is strictly monitored by specialists in the
health authorities.
▪ Continuous training, monitoring & supervision to monitor the implementation to
be done on daily basis to manage compliance-related issues.

Logistics and IEC
Logistics Management
▪ All logistical materials to be used in quarantine facility (i.e., PPE , medical equipment such
as thermal thermometer, stethoscope, BP machines; office logistics; sample collection
and packaging material) need to purchased in advance.
▪ Performa needs to be prepared for daily consumption of PPE, triple-layer mask, gloves,
etc. and monitored by the logistics team on a daily basis.
Information, Education & Communication (IEC)
Quarantined people need to be informed and educated about:
• Universal infection control measures,
• Personal protective measures,
• Do’s and don’ts in the quarantine zone (written) to contain and avoid infection spread,
• The importance of frequent hand-washing, especially after touching surfaces like door
handles, stair railings, and bed railings.

Psychosocial Support
• Quarantined people to be counselled by clinicians regarding day-to-day queries.
• If needed, referrals can be made to the psychiatrist/psychologist team.
On arrival (and after), there might be a sense of psychological fear and panic among the quarantined
people and some of the involved stakeholders, like healthcare staff. Such steps may be followed for
psychosocial support:
Interpersonal communication needs to made by the psychiatrist team to all
persons in groups initially, and later on with individual counselling sessions.

Sample Collection and Packaging
▪ For baseline testing, samples (Nasopharyngeal swab and throat swabs) need
to be collected and sent with triple-layer packaging maintained in a cold chain
(2-8° C) to designated laboratory.
▪ Safe collection and handling of specimens in the quarantine camp needs to be
performed in identified locations as per the SOP.
▪ Specimen containers generally used are viral transport medium (VTM vials
containing 3 ml medium) with falcon tubes (50 ml) as a secondary layer of triple-
layer packaging system.
▪ Containers need to be correctly labelled to facilitate proper identification.
Specimen request or specification forms to be placed in separate waterproof
zip pouch envelopes with locking facility and pasted on the outside walls of the
sample transport containers.
▪ Just before the end of the 14 days quarantine period, resampling of
nasopharyngeal swabs needs to be done.

Discharging Quarantined People from the Facility
▪ The quarantined people need to be discharged at the end of 14-day incubation
period, provided the samples are negative on resampling.
▪ Written instructions should be provided individually to patients to self-monitor
their health at their home (home quarantine) for the next 14 days and
immediately report it to their District Surveillance Officer (DSO) in case
symptoms suggestive of COVID-19 develop.
▪ The District and State Surveillance Units should be given contact details of the
quarantined people to conduct active surveillance for the next 14 days and
intimate it to the Central Surveillance Unit, IDSP (NCDC).

Terminal Disinfection and Decontamination Procedures
1. All textiles (e.g. pillow linens, curtains, etc.) should be first treated with 1% hypochlorite spray
2. Then, they should be packed and sent to get washed in laundry using a hot-water cycle (90°C) using
detergent.
1. Spray mattresses / pillows with 1% hypochlorite
2. After that, they should be put to dry (both sides) in bright sunlight for up to 3 hrs each.
Cleaning/decontamination needs to be performed using the proper PPE and adopting the three-bucket system:
One with plain water, one with detergent solution, and one for sodium hypochlorite (Refer Annexure-9)
1. First mop the accessible surfaces with warm water and detergent solution. After mopping, clean the mop
in plain water (Change the water when dirty).
2. After drying, mop the area using 1% sodium hypochlorite working solution (dilution 1:4 from an initial
concentration of 4%), protecting electrical points/appliances.
3. This needs to be followed by cleaning with a neutral detergent for removing the traces of the hypochlorite
solution.
▪ While cleaning, windows need to be open in order to protect the health of cleaning personnel.
▪ 1% hypochlorite solution should also sprayed in the PPE doffing and discard area twice every day.
Surfaces
Textiles

Isolation Facility / Ward: Guidelines

Setting Up A District Isolation Ward
➢ At State level, a minimum of a 50-bed isolation ward should be established.
➢ At District level, a minimum of a 10-bed isolation ward should be established.
(For 10 beds, a minimum space of 2000 sq. feet area clearly segregated from other patient-care areas is required.)
• Patients housed in single rooms.
• If single rooms not available, beds put at a distance of at least 1 meter (3 feet)
• Keep patient’s personal belongings to a minimum.
• Adequate room ventilation: If air-conditioned, 12 air changes per hour + filtering of exhaust air.
• If air-conditioning not available, negative pressure created through 3-4 exhaust fans to drive air out.
• If sufficient room space, have natural ventilation - large windows on opposite walls allowing unidirectional flow and air changes.
• Negative pressure in room for patients requiring aerosolization procedures (intubation, suction nebulisation). Such rooms must
and must not be a part of central air-conditioning (standalone AC required)
• Telephone or other communication method in the room to enable visitors to talk with healthcare workers to reduce the number
of times the workers need to don PPE to enter the isolation area.
COVID-19 Patient Care

• Post signages indicating the isolation area.
• Ward in a segregated area - not frequented by outsiders
• Accessed through a dedicated lift / guarded stairs.
• Double-door entry with changing room and nursing station.
• Separate entry/exit, not co-located with vulnerable wards (e.g., post-surgical, labour room, dialysis unit, etc.)
• Visitors to the isolation facility restricted /disallowed.
• For unavoidable entries, visitors use PPE with hospital guidance prior to entry.
• Visitors must consult the health-care worker in charge (who keeps a visitor record) before being allowed into the isolation area.
• Keep a roster of working staff in the isolation areas for possible outbreak investigation and contact tracing.
• Doctors, nurses and paramedics posted to isolation facility need to be dedicated and not allowed to work in other patient-care
areas.
• Under no circumstances should suspect cases and COVID-19 patients be placed in the same ward.
Access to Ward

• Stock PPE supply and linen outside the isolation area (e.g., change room, trolley outside).
• Avoid sharing of equipment - If unavoidable, ensure it is thoroughly cleaned and disinfected before use for another patient.
• Place container with a lid outside door for equipment needing disinfection or sterilization.
• All health staff involved in patient care should be well trained in use of PPE.
• At all times, those working in the clinical areas wear three-layered surgical mask and gloves
• Support staff engaged in cleaning and disinfection also wear full PPE.
• Patients may progress to multi organ failure, and may require critical care. Consider having designated portable equipment,
including ventilator management, dialysis facility, ECMO facility, etc.
• If such facilities are not available in the containment zone, the nearest tertiary care facility in Government / private sector needs
to be identified.
• Medical personnel working in isolation and critical care facilities will wear full complement of PPE (including N95 masks).
Patient-Care Equipment

• Waste bags in a touch-free bin
• Keep inside the isolation area:
• Used (i.e. dirty) bins
• Puncture-proof container for sharps disposal
• Manage biomedical waste as per BMWM guidelines.
• All items necessary for personal hygiene within the patient’s reach.
• Hand-hygiene supplies are available and stocked at sink, alcohol-based hand rub near the point of care and room
door.
• Ward has a separate toilet with proper cleaning and supplies
• Ensure regular cleaning and disinfection of common areas, and adequate hand hygiene by patients, visitors and care
givers.
• Remove all non-essential furniture, keep easy-to-clean ones that don’t conceal or retain dirt or moisture within or
around it.
• Environmental cleaning done twice daily, with damp dusting and floor mopping with phenolic disinfectants, and
cleaning of surfaces with sodium hypochlorite solution.
Hygiene

Checklist for Isolation Rooms
✓ Eye protection (visor or goggles)
✓ Face shield (provides eye, nose and mouth protection)
✓ Gloves
✓ Reusable vinyl or rubber gloves for environmental cleaning
✓ Latex single-use gloves for clinical care
✓ Hair covers
✓ Particulate respirators (N95, FFP2, or equivalent)
✓ Medical (surgical or procedure) masks
✓ Gowns and aprons
✓ Single-use long-sleeved fluid-resistant or reusable non-fluid-
resistant gowns plastic aprons (for use over non-fluid-resistant
gowns if splashing is anticipated and if fluid-resistant gowns are not
available)
✓ Alcohol-based hand rub
✓ Plain soap (liquid if possible, for washing hands in clean water)
✓ Clean single-use towels (e.g. paper towels)
✓ Sharps containers

Wearing and Removing PPE
Before entering the isolation room / area:
Collect all the
personal protection
equipment needed.
1.
Perform hand hygiene with an
alcohol-based hand rub
(preferably when hands are not
visibly soiled) or soap and water.
2. Hand HygieneCollect PPE 3. Wear PPE
Put on PPE in the order ensuring adequate placement of
items that prevents self-contamination and self-inoculation
while using and taking it off (e.g., gown > mask or
respirator > eye protection > gloves)
Leaving the isolation room / area:
Either remove PPE in the anteroom or, if there is no
anteroom, make sure that the PPE will not contaminate
either the environment outside the isolation room or
area, or other people.
Note: If the gown is disposable, gloves can be peeled off
together with gown upon removal.
Gloves ➔ Hand Hygiene ➔ Gown ➔
Eye Protection ➔ Mask ➔ Hand Hygiene

Wearing and Removing PPE
Leaving the isolation room / area:
You also need to prevent self-contamination or self-inoculation with contaminated PPE or hands.
Follow this sequence for removing the PPE:
1. Remove the most contaminated PPE items first;
2. Perform hand hygiene immediately after removing gloves;
3. Remove the mask or particulate respirator last (by grasping
the ties and discarding in a rubbish bin);
4. Discard disposable items in a closed rubbish bin;
5. Put reusable items in a dry (e.g. without any disinfectant
solution) closed container;
6. Perform hand hygiene with an alcohol-based hand rub
(preferably) or soap and water whenever un-gloved hands
touch contaminated PPE items.

Transport of Infectious Patients: Precautionary Measures
Infected or colonised areas of the patient’s body are covered
• Mask, gown, and body covered in sheets
• Transfer to Standard Pressure/ Negative Pressure Isolation Room
• Quarantine cases: Fully enclosed transport cell, filtered air supply and
exhaust; accommodated in a high-level quarantine isolation suite.
Transport personnel remove existing PPE, cleanse hands and
transport patient on a wheelchair, bed or trolley
• Apply clean PPE on patient during transport and when handling patient
at the destination
• Gown-up and gown-down rooms at the entry to assist the staff to enter
and exit the facility according to the infection control protocols.

Destination unit contacted and
notified prior to the transfer to
ensure suitable accommodation
on arrival
Patients are preferably transported through staff and
service corridors, not public access corridors
• During planning stages design can assist transfer of infectious
patients in strategically placed lifts (separated from other lifts).
• The lift should be isolated from public and staff transit by
access control measures and cleaned after transit of the
infectious patient.

Designated floor for horizontal bed
transfers of infectious patients away
from busy clinical areas
The designated floor may be located at
mid-level in the hospital.
A combination of nominated lifts,
corridors and a bed transfer floor
This would assist in the movement of
infectious patients through the hospital and
minimise the risk of spread of infection.

Glossary
BMW: Bio-medical Waste
ECMO: Extra Corporeal Membrane Oxygenator
IDSP: Integrated Disease Surveillance Programme
IEC: Information, Education & Communication
IPC: Infection Prevention Control
MoHFW: Ministry of Health and Family Welfare
NCDC: National Centre for Disease Control
SOP: Standard Operating Procedure

Covid 19-quarantine-and-isolation v2

Empfohlen

Empfohlen

Weitere ähnliche Inhalte

Was ist angesagt?

Was ist angesagt? (20)

Ähnlich wie Covid 19-quarantine-and-isolation v2

Ähnlich wie Covid 19-quarantine-and-isolation v2 (20)

Mehr von Kailash Nagar

Mehr von Kailash Nagar (20)

Kürzlich hochgeladen

Kürzlich hochgeladen (20)

Covid 19-quarantine-and-isolation v2