SOP For Fever Clinic Work Process

SOP for Fever clinic Process
Steps
1. Provide visual alerts and respiratory etiquette awareness at the entrance to hospital while maintaining
social distance.
2. Assist to wear mask and hand rub.
3. Do Visual Triage assessment including thermal screening for a patient with history of fever and acute
respiratory symptoms and document visual triage assessment form.
4. Help the patient to do registration for Suspected cases and send the patient directly to the fever clinic.
5. Do Surveillance of suspected covid-19 inside fever clinic using surveillance form.
Case determination criteria.
a. Clinical presentation of acute respiratory illness (sudden onset of at least one of the
following:
 Fever or recent history of fever, cough or shortness of breath) AND in the 14 days prior
to symptom onset (or)
 Had contact with a confirmed COVID-19 case (or)
 Lived in or worked in a facility known to be experiencing an outbreak of COVID-19.
b. Adult patient with severe acute respiratory illness (ICU admission, ARDS or CURB-65
score3 ≥ 3 points) AND all the following conditions fulfilled
c. (CURB-65 severity score: Score 1 point for each of following features that are present:
Confusion (mental test score 8 new disorientation in person, place or time) BUN > 20 mg/dL
Respiratory rate 30 breaths/min Blood pressure (systolic <90 mm Hg, or diastolic 60 mm Hg)
Age 65 years)
6. Examine, diagnose and Provide appropriate treatment by Limiting the patient’s movement within the
assigned area and carry out the doctor’s order by coordinating portable Xray, laboratory, pharmacy and
nursing personnel.
7. Follow GCH covid 19 treatment protocol
8. Provide Nutritional advise
 Eat fresh and unprocessed foods every day
 Eat a variety of fresh and unprocessed foods every day to get the vitamins, minerals, dietary
fibre, protein and antioxidants as body needs to improve immunity.
 Drink enough water.
 Avoid sugar, fat and salt to significantly lower your risk of overweight, obesity, heart disease,
stroke, diabetes and certain types of cancer
 Eat moderate amounts of fat and oil
 Avoid eating out
 Counselling and psychosocial support
9. Report suspected cases immediately through Health Electronic Surveillance Network (HESN).
10. Do Follow up for community and contact management by risk communication team using public health
considerations guidelines.
 Household and Community Contacts Management, Quarantine and medical advise.
i. Contact tracing- anyone with any of the following exposures to a confirmed COVID-19 case
from 2 days before the case’s onset of symptoms
 Being within 2 meters of a confirmed COVID-19 case for >15 minutes;
 Direct physical contact with a confirmed case
 Providing direct care
 Living in the household with a confirmed case;
 Sharing a room, meal, or other space with a confirmed COVID-19 case;
 Sitting within 2 rows of a confirmed COVID-19 case for >15 minutes and any crew in direct
contact
ii. listing, daily follow up looking for symptoms (fever or respiratory symptoms) among originally
asymptomatic, and clinical assessment for those who develop symptoms
iii. Contacts are categorized by the presence or absence of suggestive symptoms at the first
assessment
iv. Contacts without suggestive symptoms should be listed for follow up on daily bases by phone or
face-to face if feasible.
v. A nasopharyngeal swab should be collected and sent for testing for all symptomatic contacts
vi. Ensuring the contact being informed about infection prevention procedures and respiratory
etiquette.
vii. Environmental assessment of the contact's house is needed to determine its suitability for home
isolation
viii. Use Quarantine form for quarantine management.
11. Admission criteria
a) Mild to moderate - If the patient has mild symptoms and no risk factors for poor outcome provide
home isolation.
b) Mild cases with risk factors for poor outcomes outcome -must be admitted to hospital for isolation
for 14 days.
c) Severe- Patient with Symptoms ≥ 1 of the following: - Respiratory rate ≥30/min (adults); ≥40/min
(children < 5) - Blood oxygen saturation ≤93% - PaO2/FiO2 ratio <300 - Lung infiltration >50% of
the lung field within 24-48 hours -must be admitted to hospital for isolation for 14 days
d) Recommended suspected case for Admission
 Clinical or radiological evidence of pneumonia.
 Age >65 years.
 Low oxygen saturation SpO2 < 94% on room air.
 Acute respiratory distress syndrome (ARDS).
 Chronic pulmonary disease.
 Chronic kidney disease.
 History of comorbidities Diabetes Mellitus or/and hypertension.
 History of cardiovascular disease.
 Obesity (BMI ≥40).
 Use of biological (immunosuppressants) medications (e.g., TNF inhibitors, interleukin
inhibitors, anti-B cell agents).
 History of organ transplant or another immunosuppression disease.
 History of active malignancy.
 Other Co-illness that requires admission
12. Criteria for Recovery and Discontinuing Isolation
Confirmed Cases
▪ For symptomatic confirmed patients
 At least 3 days have passed since recovery (cough and SOB) AND followed by 2 negative
respiratory samples ≥ 24 hours apart.
 Or If PCR test not feasible, resolution of the fever without using fever reducing medication and
respiratory symptom resolution for at least 3 days AND at least 10 days have passed since
symptom first
• For asymptomatic laboratory-confirmed patients
 In order to discontinue designated facility isolation precautions, 2 negative respiratory
samples 24 hours apart to be done 72 hours from the date of collection the respiratory sample
with first positive PCR result.
 Or If PCR test not feasible, 10 days have passed since the date of collection of the respiratory
sample with the first positive PCR result
• Suspected Cases
 All suspected cases must be tested with COVID-19 RT-PCR.
 If clinically unstable, the suspected case must be isolated in a hospital until the result becomes
available and/or the case is clinically stable for discharge.
 If a suspected case is clinically stable, home isolation may be considered based on the
assessment of public health team and CCC until the result becomes available.
13. Follow Standard, Contact, and Airborne Precautions, including the use of eye protection
14. Restrict Visitors and guide with precautionary measures.
15. Source control measures for patients (e.g., put facemask on suspect patients)
16. Strictly follow infection control precautions performing aerosol generating procedures
17. One supporting staff should clean the fever clinic including instruments, door handles, chairs, beds,
floors daily basis before and after the clinic and instructing patients to wear face masks and to do hand
washing, supporting transportation of patients and disposal of medical clinic waste.
Fever clinic work flow process.
Visual alert Appropriate Followup and

Surveillance
and visualt Send patient treatment in community
Registrtion of suspected Reporting
triage to fever clinic assigned area contact
covid-19
assessment of fever clinic. management
Prepared By: Ms. SHOBANA, (Acting Director quality risk and patient safety
Signature ……………….
Reviewed By : Dr. Hasan (Medical Director) - Signature …………………..
Approved By: Eng. Mr. Sarry, (President and CEO) Signature ……………………..

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Visual alert Appropriate Followup and

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