Ensuring a Covid-19-safe environment for primary healthcare settings

THIS guideline is wri en to offer ideas to general practitioners (GPs) and those working in outpatient clinic se ings (OPD) on what precautionary measures to take to curb the spread of Covid-19 and protect themselves when the relevant government authorities ease our lockdown. It may also be useful for other clinic se ings like speciality clinics, antenatal clinics, dental clinics, etc. We are sharing it with the general public as it may be useful for patients and the community to think through some of these issues.

Although many GPs and primary care clinics have made significant changes in the way they work, we anticipate that as the number of patients increase again and we continue for longer periods, it will become challenging to maintain vigilance. Healthcare professionals cannot go back to the way we were working before and will have to significantly change how we function daily for many months or years.

What we have done with a ‘lockdown’ is just pushing the epidemic further away to give us time to prepare our medical response, change our behaviour, and way of living. It is expected that Covid-19 cases will rebound episodically and we will have to control each wave until it gradually fades over time; this is estimated to be for at least another one year or two.

We have wri en this guideline as some have expressed a need for more detailed ideas. The guideline is meant to protect the patient, the healthcare professional, and the community. We welcome suggestions for improving this guideline.

Note that information provided in this guideline does not take precedence over any guidelines from the Ministry of Health (MoH).

For those of us working in the health sector, we have to assume that every patient and accompanying family member are Covid-19 positive and the majority are likely to be asymptomatic. The key initiative will continue to be safe physical distancing, avoiding touching our face, preventing crowding, limiting physical contact, keeping our hands and surfaces clean at all times, using masks when in close proximity with others, and taking other sensible precautions.

The full guideline is available for download from h ps://bit. ly/2Vy1pAA.

It is imperative that all staff in primary healthcare se ings continue to receive training and periodic retraining to ensure a Covid-19-safe environment (including nonmedical staff like cleaners and administrative staff). The guideline covers the following areas:

1. Strict personal hygiene practices including hand washing/disinfection, use of appropriate personal protective equipment (PPE), masks, face shields, etc.

2. Front-door health checks (triage) and screening procedures, including options to wait in a parked vehicle outside the clinic.

3. Preparing the clinic, waiting area, and clinic rooms including safe distancing measures for the waiting area, clinic rooms, and other areas.

4. Cleaning and disinfection procedures a er every risk patient and at the end of the day.

5. How to train and communicate with all patients and accompanying persons who come to the clinic.

6. Measures to schedule staggered appointments (timeslots) for clinic visits and blood taking electronically to space out clinic visits.

7. Additional suggestions for health staff and clinics regarding meal times, breaks, traveling, home safety, staff meetings, and training.

Attention to detail without getting paranoid, working as a team to prevent exhaustion, and being innovative with protective gear is what will see us through these trying times.

As healthcare professionals that continually support those who are ill and have chronic medical problems, we look to the public to offer their cooperation to make visits to primary care clinics as safe and meaningful as possible.

It is only by working together, to protect and care for each other, that we can last the distance and return some sanity to our lives. As Dr Samin Sedghi Zadeh from Italy said, “Every person who can decide to follow all the rules can be the hero of this time.”

Column was contributed by consultant paediatrician Datuk Dr Amar-Singh HSS, general practitioner Dr Lee Chee Wan, consultant family medicine specialist Dr Paranthaman V, and consultant infectious diseases specialist Dr Timothy William.