COVID-19: Government guidelines for isolation wards

The isolation wards in a district should have at least 10 beds to facilitate infected patients whereas this capacity should increase to 50 beds at the state level. These are the guidelines which are needed to be fulfiled while setting up an isolation ward:

• All the COVID-19 patients should be kept in separate single rooms. If single rooms are not available, beds can be placed in a room while maintaining a distance of at least 1 meter (3 feet) from one another. You may require a minimum space of 2000 sq. feet in order to accommodate 10 beds while maintaining the required distance.
• All the doors should have a signboard pasted on them which would indicate that it is an isolation area.
• Keep minimal furniture in the isolation wards. Also, ensure that the remaining furniture is easy to clean and does not allow dirt or moisture to retain.
• The isolation wards should have a separate entry and exit from the rest of the hospital departments. It should not be close to recovery wards, post-surgical, dialysis department, neonatal ICU or labour room. 
• The isolation wards should be in a segregated area which is not visited by outsiders.
• The Personal Protective Equipment (PPE) should be stocked in a changing room just outside the isolation wards. There should be enough supply of PPE available in the changing rooms for both doctors and the nursing staff. The changing rooms and the nursing stations should have double door entries for better passage.
• Biomedical waste disposal bins should be present in every changing rooms for the disposal of used PPE.  
• Puncture resistant bins should be kept inside the isolation wards for proper disposal of sharp instruments. The bins should be touch-free and should be emptied on a regular basis.
• The infected patient should have all the necessary items like water pitchers, cups, tissue wipes, and other personal hygiene items within reach. 
• If possible, try getting separate diagnostic tools such as a stethoscope, thermometer and sphygmomanometer for every patient. If that is not possible, disinfect and clean the equipment thoroughly before using it for another patient.
• Isolation wards should have portable X-rays and Ultrasound machines for infected patients.
• The isolation area should have enough water supply and hand-hygiene supplies. There should be enough handwashes, paper towels and alcohol-based handrubs (sanitizers) available in that area. The alcohol rubs should be available near every patient bed and at the room door. 
• The isolation ward should have proper ventilation. If the isolation wards are air-conditioned, ensure that it replaces the air of the room at least 12 times in an hour (12 air changes per hour) and filters the exhaust air. This ensures that the isolation wards have a negative pressure which is essential for the patients who require aerosolization procedures such as intubation and suction nebulisation.
• Isolation wards should not have centralised air-conditioning.
• If the isolation wards do not have air-conditioners, negative pressure would be created using 3-4 exhaust fans which would throw the air out of the room. Natural ventilation can also be provided in those isolation wards which have large windows on opposite walls of the isolation ward allowing a natural unidirectional flow and air changes.
• The isolation ward should have separate toilets for patients as well as the medical staff. The toilets should be cleaned on a regular basis with the help of a potent disinfectant.
• The isolation wards should be cleaned twice daily by damp dusting and floor mopping with phenolic disinfectants and cleaning of surfaces with sodium hypochlorite solution.

There are some guidelines for the family members of the infected patients and also for the doctors who are involved in treating the COVID-19 patients in the isolation area:

• No family members or visitors would be allowed to meet the infected patients. If in case, the entry of the visitor is permitted, they will have to use the PPE before entering the isolation ward. They will have to follow proper hand hygiene before and after entering the isolation ward.
• The infected patients would be given telephones to communicate with their family members or visitors. The medical staff would also be given phones to communicate with each other to reduce the unnecessary donning (wearing) of the PPE enter the isolated area.
• The medical authority of the isolation ward would keep all the information about everyone who enters the isolation ward, including the medical staff. This is done to trace contacts in the case of a possible outbreak.
• The doctors, nurses and paramedics posted in the isolation facility would not be allowed to work in other patient-care areas to prevent any chance of disease outbreak.
• All the medical staff working in the isolated area should be well trained in the use of PPE.

There are certain items listed below that should be present in an isolation facility for both the patients as well as the doctors:

• Personal Protective Equipment: Shoe covers, hood or head caps for the head, single-use long-sleeved fluid-resistant gown or drape, N-95 or FFP2 respirator (mask), face sheild or eye protective goggles and surgical gloves
• Reusable vinyl or rubber gloves for cleaning of the isolation ward and other areas
• Single-use latex gloves when dealing with patient related stuff
• Plastic aprons while dealing with instruments or things involved with the patient
• Alcohol-based handrub
• Liquid soap
• Clean, single-use paper towels
• Sharps containers for the disposal of sharp instruments
• Biomedical waste bags
• Large plastic bags for the disposal of PPEs
• Linen bags to dispose of the bedsheets and dirty laundry of the patient
• Sterilizable container for disinfecting the used instruments
• Disinfecting cleaning solutions for cleaning the isolation wards, instruments and other equipment. 

The Ministry of Health and Family Welfare of the Government of India has laid down the above mentioned guidelines for hospitals and other medical facilities to follow when dealing with patients suffering from COVID-19. The guidelines include how many isolation wards hospitals should have in a district or a big state, the dimensions of the isolation wards and instructions on the facilities each isolation ward must be provided with.

Healthcare professionals, doctors and nurses must follow the set of rules and regulations for their own safety as well as other staff as well as patients in the hospital, to prevent the spread of the disease and avoid an outbreak of any kind within the facility.