Background
General measures
I. Establish simplified purpose-designed governance and coordination mechanisms | |
II. Identify context-relevant essential services | |
III. Optimize service delivery settings and platforms | |
IV. Establish effective patient flow (screening, triage, and targeted referral) at all levels | |
V. Rapid re-distribution of health workforce capacity, including re-assignment of tasks | |
VI. Identify mechanisms to maintain the availability of essential equipment and supplies |
Establish simplified purpose-designed governance and coordination mechanisms
- Establish a COVID-19 Incident Management Team and designate a focal point.
- Consideration for the reallocation of human, financial and material resources, and mobilizing additional resources are essential.
- Managers must inform staff not to report to work if they feel unwell or have any suspicion of having COVID-19 symptoms.
- Facilities must ensure that the waiting area has access to handwashing facilities and that hand sanitizers, tissue boxes, and masks are within reach so that patients can follow basic hygiene practices. The waiting areas need to be organized in such a way that it provides space for patients to sit at a distance from each other to reduce the risk of transmission.
- It is essential to ensure strict hand hygiene, maintaining at least 1 m (3 ft) distance [5] in all patient/staff interactions when possible, avoiding crowding at the workplace, etc.
- Implementation of cleaning and disinfecting procedures for equipment and accessories including camera gantries, patient beds, blood pressure cuffs, workstations, mouse, keyboards, and any other items of daily use.
- Develop a contingency and business continuity plan if one of the staff becomes sick with COVID-19.
Identify context-relevant essential services
Optimize service delivery settings and platforms
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Use of communication technologies must be a primary consideration.
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Teleconsulting with patients prior to scheduling and the day before attending the nuclear medicine center must be established, in order to identify patients who may have COVID-19 symptoms.
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Patients should be instructed to attend their appointments alone, if their condition allows. In case assistance is required, only one accompanied person, ideally without risk factors, should be permitted. The risk factors should be stated during the phone appointment.
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Remote reporting should be considered, when possible, provided that national or local rules are followed.
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Teleconsultation with patients after radionuclide therapies is strongly encouraged.
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Establish virtual multidisciplinary meetings.
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Establish remote communication channels with referring physicians.
Establish effective patient flow (screening, triage, and targeted referral) at all levels
Patient arrival, waiting area
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Reception staff to be sited behind a glass or plastic screen if not already in place. Upon arrival, patients are asked to declare if they have been in contact with patients with COVID-19 or if they have any symptoms.
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It is useful to display information announcements at the reception, indicating possible symptoms and asking patients to inform staff if they have symptoms.
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Display posters to promote handwashing and proper respiratory hygiene measures.
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Consideration should be given to implement temperature control using electronic skin contact systems.
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Be vigilant in identifying patients with symptoms of COVID-19.
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Consider that there are asymptomatic patients and apply all protective and hygiene measures.
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When patients with COVID-19 are identified, they should be placed in a separate waiting area, and if available, appropriate consultation with the infectious diseases team should be sought.
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COVID-19 patients should wear a surgical mask to minimize the risk of transmission.
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Consider providing surgical masks to all patients and chaperones, to wear at all times while in the NM center. Remember that local or national regulations must be followed.
During the injection and scan
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Use all aseptic and antiseptic techniques
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Apply all standard radiation protection and optimisation principles;
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Use the appropriate PPE
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Place special attention when removing the gloves and other protective elements
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Disinfect the devices used during patient preparation and injection
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Thoroughly sanitize hands after each procedure
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Dispose the used protective elements in a container for biosafety waste
During the scan
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Apply all standard radiation protection and optimisation principles
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Use the appropriate PPE
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Use disposable protective elements for the scanners
When the patient is scanned and goes home
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After scanning a COVID-19 patient, scanners and room surfaces should be disinfected to prevent possible spread of infection. If available, local recommendations and guidelines should be followed, e.g., Public Health England has released a guide for disinfecting scanners and clinic rooms with solutions containing 1000 ppm available chlorine, and appropriate training for environmental maintenance personnel is recommended.
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Before the patient is released, if the hybrid study involves a CT of the chest, it is imperative to look for incidental COVID-19 findings that might suggest COVID-19 infection.
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If incidental COVID-19 findings are detected in the lungs, it must be reported immediately to the referring clinician, and the patient triaged for the appropriate care pathway.
Rapid re-distribution of health workforce capacity, including re-assignment of tasks
- The same precautions and screening tests that apply to patients upon arrival should be implemented for the nuclear medicine staff.
- Simple measures, such as staying home if you are not feeling well, are essential to reducing the risk of infection and transmission to the team.
- Consider segregating staff into teams to reduce the possibility of virus transmission between health care providers which could result in the inability of the department to function.
- Consider re-training of staff to cover other positions within the department.
- All required personal protective equipment (PPE) should be made available for staff at all times and all working sites. It is recommended to follow guidelines of the WHO–Rational use of personal PPE for coronavirus disease (COVID-19) [10].
- Consider providing staff transportation and, if necessary, staff accommodation.
- Environmental services staff members who clean all departmental areas during, and out of, working hours must be specifically trained for professional cleaning of potentially contaminated surfaces after each contact with a high-risk patient.
- Establish periodic virtual staff meetings to update on the local status of the pandemic and enquire about their well-being.
- Psychological consultation for staff should be available.
Identify mechanisms to maintain the availability of essential equipment and supplies
- List of required supplies
- List of all possible suppliers and distribution channels
- Maintain a detailed inventory and to coordinate the redistribution of supplies
Conclusion
The robust screening process for patients and staff | |
Identification of cases promptly | |
Social distancing | |
Training of staff members | |
Posters to promote handwashing and proper respiratory hygiene | |
Cleaning and disinfection of equipment and accessories | |
Hand sanitizing dispensers | |
Stay at home or working from home guidelines for staff | |
Develop a contingency and business continuity plan |