The Dubai Health Authority has approved a plan to restore ENT services in the health sector in the emirate during the Covid 19 pandemic, which includes procedures and measures in clinics, patient priorities, infection control between patients and medical teams, and has identified 6 protocols governing its work.
The authority said that this plan provides guidance with the aim of reducing the risk of airborne transmission, protecting health care professionals, employees, and patients, implementing appropriate infection control measures, and safely managing ENT patients.
She emphasized that these guidelines are binding on all establishments and clinics that provide ENT services in Dubai, and about permissible services, Dubai Health confirmed that health facilities that provide ENT services during the Coved 19 pandemic must comply with a specific range of services until issuing a notice Other from the body and includes 4 types of services: nose and ear throat care for urgent and emergency cases only, such as emergencies, with mandatory admission in emergency cases for inpatients, non-surgical emergencies such as nosebleeds (nose bleeding), trauma and injuries, peritoneal abscess and inflammation Tonsils.
Regarding the protocols, Dubai Health stressed that the ENT clinics have 6 special protocols, namely, the evaluation and screening protocol, scheduling appointments, emergency and urgent patients treatment, follow-up and transportation, protocols to raise awareness and educate the medical staff and patients, and the telemedicine protocol to reduce patient contact and provide advice Self-management, prescribing analgesics or antibiotics, emergency reservation, urgent care or referral, a protocol for patient movement inside and outside the clinic or hospital, a protocol for wearing and removing personal protective equipment, and a protocol for infection control, sterilization, and decontamination-related procedures for Covid 19.
It is also allowed to provide urgent and semi-urgent case services, especially when procedures are not generated by a spray layer (such as urgent head and neck cancers, pediatric airway conditions, biliary tumors, sudden hearing loss, blood discharge, severe vertigo, and Bell's paralysis), and conditions that suffer In it the patient suffers from severe pain or distress, and any other condition is necessary through a telephone screening performed by the doctor for the patient.
The authority stressed to health facilities to offer to visit the clinic if patients are at significant negative risk without an evaluation at their site, and patients who need a comprehensive examination of the head and neck should be seen in person.
All other optional appointments must be managed through telehealth or postponed as a precaution to avoid the transmission of Covid 19, and a preliminary phone consultation on any new signs or symptoms or related to recurring disease or new or pending problems (such as severe dysphagia or airway penetration, Or current symptoms suggestive of Covid 19).
With regard to emergency management and urgent patients, the authority stressed the reservation of emergency and urgent patients an appointment before arrival, examining all patients for Coved 19, maintaining a period of at least (20) minutes between appointments, allowing only one patient per ENT doctor at a time, and examining the degree of Patient temperature upon arrival at the clinic, and to maintain a distance of two meters in the reception and waiting area. Children under the age of (18) years are allowed to attend the clinic accompanied by an adult from the same family.
On infection control measures and health precautions, the Dubai Health Authority emphasized the commitment of the front desk and the medical staff to personal protective equipment, the wearing of face masks and gloves by the staff at the front desk, and the maintenance of two meters when communicating between the patient and the receptionist, protection shields can be used between patients and staff Reception, and ensure that all personnel wear personal protective equipment.
Dubai Health stressed that washing hands when entering the workplace, before and after contact with the patient, after contacting contaminated surfaces or equipment, and after removing personal protective equipment.
The authority stressed that the ENT doctor should wear appropriate personal protective equipment during treatment such as, gloves, gowns, hats, N95 masks and face shield, remove things such as remote control or other common objects in the patient's waiting area, and clean and sanitize seats and tables Regularly in the patient waiting and receiving area.
The authority pointed out that hand sanitizers, gloves and mask should be provided for use by anyone entering the clinic at the entrance or reception desk, and to enhance the etiquette of coughing or sneezing, toilets should be cleaned with disinfectants regularly, disinfecting hand rails and door handles at regular intervals, and use one consulting or treatment room Closed.
The commission asked to maintain the level of staff in the consulting or treatment room to the minimum required, reduce the papers in the consulting or treatment room, cover the computer keyboard with a flexible, disposable transparent barrier (such as a plastic wrap) and change it between patients, and disinfect and sterilize the treatment chair and its tools Before and after each patient.
Dubai Health Authority emphasized the use of disposable consumables to avoid contamination, cleaning and disinfecting all surfaces in the consulting or treatment room after each patient wears gloves, mask and face protector, and if the surfaces are dirty, they must be cleaned with soap and water before disinfection, and get rid of surface barriers After each patient, frequent cleaning and sterilization of public places, including elevator door handles, lighting switches, chairs, desks and bathrooms, provision of napkins, alcohol and soap on the basins and trash cans.
The authority stated that the room pressure should be maintained according to the settings (usually ENT rooms are positively pressed), and that negative pressure rooms are not required unless there are procedures for generating aerosols or expecting these procedures, and the treatment rooms that are designated to manage Cases of infectious diseases and non-proliferation in other rooms passively, and HEPA filters must be used according to the manufacturing guidelines, and make sure to dispose of all medical waste according to the requirements of Dubai Municipality, and take advantage of Dubai Municipality approved providers for sterilization and disinfection if the clinic is unable to do so.
Regarding treatment precautions, Dubai Health confirmed a laparoscopic examination of the mucous membrane of the head and neck, with endoscopic examinations of the nose, sinuses, lower pharynx, pharynx and larynx considered to be spray-generating procedures, and examinations should be limited to patients who have a clear and urgent emergency and need, Awake patients, appropriate topical preparation can be used but sprays should be avoided, and carefully developed pledges should be used to provide decongestants and anesthetics.
She stressed the local anesthesia procedure for any intervention of the throat under the direction of the laryngoscope, or laryngoscope through the application of a spray and is considered a high risk, therefore, biopsy, injection, laser or other procedures in the clinic should be delayed if possible, and if there is a video screen available for the examination, It should be used to separate the patient’s face and health care professionals, and disposable endoscopes can be used after the examination is completed, and the endoscope must be handled appropriately, since endoscopes should not be removed from the examination room without a protective covering.
Regarding the intubation and tube removal procedures, the authority indicated that it is advisable during the intubation that all unnecessary employees leave the room and return only after securing the airway, and all non-essential staff must leave the room during the removal of the tube, taking into account that the jet ventilation procedures pose a significant risk In particular, it should not be carried out except in the case of extreme necessity and with appropriate personal protective equipment, preferably in a room with negative pressure.
Endoscopic rhinoplasty, including sinus surgery and intravenous pituitary gland surgery, are very risky procedures. In general, these procedures should be delayed in patients with Covid 19, or those who cannot be tested.
Regarding thyroid and neck eradication procedures, the body pointed out that procedures that do not reveal mucous surfaces are less dangerous, while warning that the use of energy devices can lead to the virus flying out of the bloodstream or other intestinal secretions.
She pointed to the controls of ear surgery, as digging through the mastoid leads to the formation of drops and aerosols in large clouds that may cause injury to everyone in the operating room environment if the virus is present, since the contaminated fog contains a virus that is viable for several hours, especially in places Closed, caution is required, so mastectomy is a high-risk procedure, and ideally, any patient undergoes any ear surgery before COFED 19 before surgery, and if the patient is positive, the surgery must be postponed until the patient has recovered.
On dealing with trauma to the face, the body emphasized the treatment of tears involving the mucous surfaces as high risk, and for injuries that require surgical intervention such as fracture reduction surgery, the patient's condition must be confirmed first and then the final treatment started if possible.
Dubai Health noted that in areas where there is a severe shortage of medical capabilities and health workers, non-surgical methods should be considered medically acceptable, emphasizing avoiding or delaying most of the tracheal puncture procedures, due to the high infectious risks of the procedure and subsequent care until the time passes It has the acute stage of infection for Covid 19 patients, when the probability of a cure is high.