An Initiative by Indian Association of Palliative Care

In Collaboration with Hyderabad Centre for Palliative Care and TWCC Canada.

Topic: Staying Safe in Health Interactions and Health Environment for Palliative Care Providers.

Session 3 held on 16th April, 2020 from 6:30 AM to 7:30 AM.

While talking on the topic, ”Staying Safe in Health Interactions and Health Environment for Palliative Care Providers – a rapid review on evidence”, Dr. Naveen Salins, Head of the department, Palliative Medicine, Kasturba Medical College, Mangalore, stressed on the need to focus on personal protection rather than on Personal Protection Equipment. According to him PPEs to be used appropriately (but not always), considering the environment where the health care provider is working. He explained this with the help of the inverted pyramid model of personal protection where PPE is in the lowest part of the pyramid. PPEs to be preferred for protection if the health care provider is working in an environment like ICU, in providing direct care or working in close contact with suspected or confirmed COVID 19 infected patients, or doing aerosol generating procedures. But in other settings, elimination (physical distancing), replacing the hazard, isolating, and changing the way people work are more effective.

Face Mask

According to the evidence based studies shared by Dr. Naveen, face mask provides mild to moderate protection at community level against casual community contact. In a home environment it provides mild to moderate protection if both infected and uninfected wear mask.

When to use a surgical face mask?

Dr. Naveen explained this based on the reviews. According to him a surgical face mask to be used:

  1. In coherted area (but no patient contact). Ex: while cleaning the room of the patient / cleaning equipment etc. Cleaning staff should wear surgical mask along with other designated PPE.
  2. Close patient contact – within one metre: For example- Providing patient care, Home visit, diagnostic imaging, physiotherapy etc . In such situations along with surgical face mask, apron, gloves, and eye protection should be used.

When to use an FFP3 respirator?

Based on the studies reviewed, Dr. Naveen said that FFP3 respirator should be used:

  1. When carrying out aerosol generating procedures on a patient with possible or confirmed COVID 19

Based on evidence based studies cited by Dr. Naveen, respiratory masks are recommended for protection during aerosol generating environment. Standard surgical masks are as effective as respiratory masks (eg: N95, FFP2, FFP3) for preventing infection for health care workers in outbreak of viral respiratory illnesses. But, “No head to head studies of these masks in COVID 19 has yet been published, and neither types of masks prevents all infection”, he explained.

Prof. Manju Sengar, of Tata Memorial Hospital, Mumbai presented the topic – Protective Measures to Continue Safe Services in an Institution during the Pandemic. She explained the measures taken by Tata Memorial Hospital, Mumbai.

Measures are being taken to avoid overcrowding, screening facility set up outside the building, training provided to staff, transportation and accommodation facility provided to staff for their safety etc are the important measures taken. Pateints are contacted over phone, and if there is no urgent need to visit hospital, they are directed to stay home.

Dr. Reena Sharma of Cansupport Delhi and Dr. Vivek S N of Cipla Palliative Care and Training Centre, Pune shared their efforts to provide care to the needy during the health care emergency. They emphasized the need to train their staff for practicing proper personal protection and to reduce anxiety and panic. Hospice Care is being continued in Cipla with all protective measures taken by Staff to avoid any infection while Home visits are restricted only to manage emergency situation. Cansupport is also depending on virtual care for caring patients by tele-consultation and direct home visits are being provided only for emergency cases.

Next Session in ECHO Series to be held on 23rd April, 2020 (Thursday) from 6:30 am to 7:30 am.
Topic: To be announced later.

Those who are interested can join with us and participate in next session by filling up the form here

Contact: ppcecho@gmail.com

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