Managed by RWAs,  AOAs, Companies in their own premises

Mysore/Mysuru: The State Government is establishing COVID Care Centres (CCCs) for isolation and management of asymptomatic and mild symptomatic COVID-19 cases in Government/ private institutions like Ashrams, Exhibition Centres, Bhavans, etc. In this context, a number of Resident Welfare Associations (RWAs)/ Apartments Owners Associations (AOAs) have come forward to facilitate home isolation and management of positive persons in their premises. In this regard the Government has decided to involve the community organisations in the management of COVID-19 positive persons by themselves. Hence, the Commissionerate, Health & Family Welfare Services, has yesterday (July 10) issued the following guidelines for establishing CCCs managed by RWAs, AOAs and Companies in their own premises:

1. Facilities needed

a) Vacant houses, community halls and flats within the apartment(s)/ community. 

b) Separate accommodation for women and children. 

c) Individual occupancy in a room of 10×10 feet preferably with attached bathroom and toilet. 

d) In the absence of individual rooms, 4 to 6 COVID positive persons shall be accommodated in a hall having attached bath and toilet/s.

e) Temporary partitions of either PVC or side screen shall be provided for individual privacy keeping a physical distance of minimum of six feet between the two beds.

f) Beds, mattresses, furnishings and linens, uninterrupted water and power supply shall be available.

g) Homemade food either from the patient’s house or from a common kitchen shall be arranged.

h) Ancillary services like garbage management, sanitation and logistics should be managed exclusively and separately for the COVID block. Especially the biomedical waste shall be treated with 1% hypochlorite solution for a contact period of one hour should be assured before final disposal.

i) If citizens of a group of individual houses in a street or neighbourhood are willing and have an independent unoccupied house or community hall they are encouraged to run CCC facilities akin to RWAs. 

2. Eligibility for admission

All Asymptomatic and mild symptomatic COVID positive persons except the following: a) > 60 years of age. b) With comorbid conditions like hypertension, diabetes, severe obesity, thyroid disease, cancer, kidney diseases include patients on dialysis, heart diseases, stroke, Tuberculosis, People living with HIV, immune-compromised, on steroids and immune-suppressants. c) Pregnant women and lactating mothers. d) Children below 10 years of age. e) Any other serious medical/ psychological condition. 

3. Medical care at CCC

a) Access to public shall be restricted.

b) The RWA / AOA / Company should have a tie up with medical team (or with a doctor residing in the premises) for triaging and regular clinical support of the patients.

c) Nursing staff will conduct temperature measurement and pulse oximetry, monitor other symptoms, record the temperature and SpO2 with fingertip pulse oxymetery thrice a day, and shall have tele consultation with the doctor for any instructions.

d) Linkage with an affiliated private hospital, dedicated COVID-19 health center or hospital for referring the COVID positive person in case of need.

e) Adequate supplies of PPE Kits, N-95 Masks, triple layered surgical masks, gloves, hand sanitisers, thermal scanners, pulse oximeter, glucometer, BP apparatus, stethoscope, medicines like hydroxy chloroquine, vitamin-C, zinc, etc. shall be available.

f) In case of emergency, ambulance services shall be obtained from Government (108)/ private ambulance. 

g) The COVID positive person shall be under the care of RWAs; attending doctor and staff nurses will all be under the supervision of the jurisdictional MOH/ DHO/ HO of City Corporations or THO/ DH&FWO of the Department. 

h) Data entry — the nursing officer shall maintain patient charts and records (for requisite parameters), and the doctor shall officially verify the record data and advise. 

4. Required amenities

a) Support staff for food/ supervision – will be present 24×7, in two or three shifts designated only for the care of patients in the ratio of 1:12 per COVID positive person.

b) Designated security personnel shall supervise CCC.

c) 24×7 Electricity with power back up and water supply.

d) Monitoring facility using CCTV camera installed (optional). e) Facility for disinfection and sterilisation of linen and utensils of COVID positive person.

f) Availability of broadband Internet connectivity with computers and DEOs for providing the COVID-19 patients data. 

5. Daily monitoring and medical supervision

a) Thrice daily temperature and SpO2 recording using fingertip pulse oximeter. 

b) 24×7 monitoring by medical officer.

c) Attending to medical & other complaints.

6. Food and Nutrition

a) Nutritious diet should be provided to the patients using the suggested diet plan as per Government advice (see table below), but catering to the patient’s individual tastes, allergies and dietary requirements. Food will be delivered from the concerned patient’s home to the Centre for the staff to give to the patients. Disposable Plates and cutlery shall be used.

b) Proper food arrangements three times a day along with snacks for the patients and the nursing staff.

7. Ancillary services 

a) Dedicated area of donning and doffing of PPE for health care workers.

b) Garbage Management inside and outside the CCC.

c) To ensure that the biomedical waste generated in the CCC is sent to designate bio-medical processing centre.

d) To ensure complete cleanliness inside & outside CCC.

8. Testing 

COVID-19 Testing for the patients should be done as per the testing guidelines issued by the GoK. Any other test required as per the doctor’s assessment should be made available from the nearest health facility. 

9. Daily reporting

The CCC will ensure daily reporting of the admissions, release from isolation and medical condition of patients in the software recommended by the State Government/ report to District Surveillance Officer (DSO) 

10. Others

The CCC facility will be used by the local RWA/ AOA residents only. The COVID positive persons shall be allowed to use their laptop, mobile, tablet, books and other reading materials, etc. 

11. Discharge/ Release from isolation:

To be followed as per GoK guidelines in consultation with treating doctor. 

Standard Operating Procedure on running CCCs

1. Different places which can be identified as COVID Care Centres (CCCs):

Institutions like community halls, community hostels, school or college premises, malls, stadiums, marriage/ party halls, camp sites, exhibition grounds, hotels and others as deemed appropriate and identified by the authorities can be CCCs. 

2. Human resources requirements:

• Doctors – one per 100 persons for 8 hrs shift (to be provided by the Health/ Medical Education Dept. in case of Government managed CCC)

• Staff nurses – one per 50 persons for 8 hrs shift. (to be provided by the Health/ Medical Education Dept. in case of Government managed CCC)

• Support staff for food/ supervision – one per 100 persons for 8 hrs shift. 

• Staff for cleaning – one per 50 persons for 12 hrs shift. 

• Data entry operator – one per centre for 12 hrs shift. 

• Security personnel and marshals – one per 50 persons for 12 hrs shift. 

The staff should stay at CCC only in a separate wing. They will work for two weeks at CCC and then go home after testing negative for COVID-19 for period of one week. 

3. Required amenities:

Any CCC needs to: 

• Have restricted access to general public.

• Have beds 1 meter apart with side locker and charging point for mobile/ laptop etc. 

• Have a separate section/ ward for male and female patients.

• Has 24×7 electricity with power back up and water supply.

• Have a nursing staff and doctor at station for 24×7 care facility in case of emergency. 

• Shall have adequate supplies of PPE Kits, N-95 Masks, triple layered surgical masks, gloves, hand sanitizers, thermal scanners, pulse oximeters, glucometer, BP apparatus, stethoscopes, medicines like hydroxy chloroquine and others including emergency drugs, dressing material and first aid kit, oxygen cylinder with tubing/ oxygen concentrator, nebuliser, portable ECG machine. (The requirements of supplies is given in the Annexure-1)

• Have adequate toilet facilities (1 toilet for 10 persons).

• Have adequate ventilation and lighting facility.

• Have monitoring facility using CCTV camera installed (optional).

• Have 24×7 ambulance service to shift patients whenever necessary

• Have a linkage with dedicated COVID-19 Health Centre or dedicated COVID Hospital.

• Facility for disinfection and sterilisation of patient linen and equipment – Mechanized Laundry. 

• Availability of broadband Internet connectivity with computers and DEOs for providing the COVID-19 patients data.

• Garbage Management inside and outside the CCC.

• To ensure that the biomedical waste generated in the CCC is sent to designate bio-medical processing Centre. 

4. Patient monitoring

a) A common facility for thermal scanning and pulse oximetry can be set up for temperature and oxygen saturation check.

b) A staff nurse/ trained health worker can record everybody’s temperature and pulse oximeter reading twice a day.

c) Anybody with new symptoms or fever ( >38°C or >100.4° F) or oxygen saturation <94% needs to be immediately referred to the nearest appropriate linked COVID facility. 

5. Discharge of the patient

As per discharge policy issued by the State Government from time to time. 

6. Management of Logistics at CCC:

a) Supply of equipments and medicines to Government managed CCC – The Karnataka State Drugs Logistics and Warehousing Society (KSDLWS) will provide the necessary equipments and medicines to Government managed CCCs. In greater BBMP area the nodal officer for CCC will send the requirement for 15 days to Additional Director, KSDLWS. In districts, DCs will manage this from the pool of equipments and medicines available with                                               them for COVID-19.

b) Supply of food – The BBMP/ District Administration will make arrangement for supply of food for patients (as per diet chart) and to the staff. 

c) Cleaning – The BBMP/ District Administration will make arrangement for the cleaning and sanitisation of the place. In case the CCC has existing staff for sanitation and cleaning the same should be used.

d) Transportation – The patients should be shifted from CCC to other medical facilities using pool of dedicated ambulances available with CCC management team of BBMP/ District. 

e) Testing – COVID-19 Testing for the patients should be done as per the testing guidelines issued by the Government from time to time. 

For the staff after two weeks of work RT-PCR/ CBNAAT/ True-NAT test should be done before giving one week off. Any other test required as per the doctor’s assessment should be made available from the nearest DCHC.

f) Daily reporting – The CCC will ensure daily reporting of the admissions, discharges, medical condition of patients in the software recommended by the State Government.

g) Private facilities taken over by Government as CCC – In case the private facilities are taken over by Government as CCC under Epidemic Diseases Act 1897, then the available staff and the ancillary facilities should be put to use.

h) CCC in-charge officer – BBMP/ District Administration shall appoint a Group-A officer as centre incharge who should manage the HR and logistics of the centre.