Setting Up Triage & Isolation Wards v2

Setting up Triage & Isolation wards in SHCOs
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Key Principles In Managing Ill Patients:
Use clinical triage in health care

1. Timely and
effective triage
2. Admit facilities for early identification of
patients to
and infection
dedicated area patients with acute respiratory infection
control
(ARI) to prevent the transmission of
4. Safe 3. Specific case pathogens to health care workers and
transport and and clinical
discharge management other patients
home protocols
Key Concepts:
Screening Triage
Why?? What?
Evaluate each patient to Identifying patients who require immediate
identify any suspected case. medical intervention, patients who can
safely wait, or patients who may need to be
How??
transported to a specific facility based upon
Using screening questionnaire
their condition.
Key Concepts (2):
Isolation Quarantine
Why?? The quarantine of persons is the

Isolation refers to separation of individuals who restriction of activities of or the
are ill and suspected or confirmed of COVID-19 separation of persons who are not
ill but who may been exposed to
How?? an infectious agent or disease, with
Mild and moderate patients may be isolated the objective of monitoring their
either in health facility, community facilities symptoms and ensuring the early
detection of cases.
Definition of ‘Suspect:’
Who is ‘Suspect’? Steps to be followed:
A patient with fever & at least a sign of Step-1: Clinical samples of suspected cases
respiratory disease- cough, shortness of breath to be sent to labs for confirmation
Also have a history of travel to an area reporting
transmission Step-2: Suspect to be kept in Isolation at
OR health facility till the time of receipt of lab
A patient/healthcare worker with acute respiratory results & given symptomatic treatment as
illness & having contact with a confirmed case in per guidelines.
last 14 days prior to onset of symptoms.
OR Step-3: If lab results are negative, the
A patient with severe acute respiratory infection decision to discharge will be governed by
or a case for whom testing is inconclusive treating physician. However, the
discharged patients are recommended to
continue isolation for 14 days or kept in
quarantine centre.
Hospital Readiness
Ensure readiness by:
• Assess available resources

• Availability of PPE, sanitizers, disinfectants, Biomedical equipment
• Facilities for seriously ill patients or referral protocol.
• Assess testing & lab capacity
• Develop staffing plans to identify and appropriately supervise staff
• Strengthen measures for protection of occupational health, safety, and security of health
workers
• Strengthen infection prevention and control (IPC) measures
• Setting up triage area to control patient movement
• Setting up isolation facility/ward
Key Considerations In Setting Triage Area
• Prevent overcrowding.
• Conduct rapid triage.
• Place ARI patients in dedicated waiting areas with adequate ventilation.
• In addition to standard precautions, implement droplet precautions and contact
precautions
• Ask patients to perform hand hygiene, wear a mask and perform respiratory
hygiene
• Ensure adequate space for triage (maintain at least 1 m distance between staff
screening and patient/staff entering)
• Waiting room chairs for patients should be 1m apart
• Maintain a one way flow for patients and for staff
Setting Up Triage Area
Set up triage area at entrance. The triage or screening area requires the following
equipment:
• Screening questionnaire
• Algorithm for triage
• Documentation papers
• PPE
• Hand hygiene equipment and posters
• Infrared thermometer
• Waste bins and access to cleaning/disinfection
• Post signage in public areas with syndromic
screening questions to instruct patients to
alert health care worker (HWC).
Setting Up Triage Area
Screening Questionnaire
Ask Every Patient:
• Do you have fever more than 100.4 deg. F in past 14 days?
• Do you have new onset of cough or shortness of breath in past 14

days?
• Have you travelled to country/place with transmission of COVID-

19 or in contact with someone who travelled there?
• Have you had contact with someone experiencing respiratory

symptoms in the past 14 days?
Setting Up Isolation Rooms:
• Direct entry from triage area to isolation ward.
•
• Signage of Isolation room to be displayed
• For isolation rooms, separate entrance and exit should be

there. Access to ward through dedicated lift/stairs.
• Remove all non-essential furniture and ensure that the

remaining furniture is easy to clean, and does not
conceal or retain dirt or moisture within or around it.
• COVID-19 patients should be housed in single rooms.
• If sufficient single rooms are not available, beds could

be put with a spatial separation of at least 1 meter (3
feet) from one another
• Stock the PPE supply and linen outside the isolation

room or area.
• Double door entry with changing room and nursing

station.
• Maintain one-way flow of patients and the staff

• Ensure 12 air changes/ hour and filtering of exhaust air for negative pressure. If air-
conditioning is not available negative pressure could also be created through putting up
3-4 exhaust fans driving air out of the room. Cut off centralized air supply to room.
• Provision of hand washing facility with liquid soap (if not, alcohol-based hand rub)
and masks.
• Attendants of patients should wait outside the triage area to avoid overcrowding
Protocols For Isolation Rooms:
• The isolation ward should have a separate toilet with proper cleaning and supplies
• Reusable equipment is appropriately disinfected between patients
• Visitors to the isolation facility should be restricted /disallowed
• Set up a telephone in the isolation room to enable patients, family members or visitors
to communicate with health-care workers
• Place a puncture-proof container for sharps disposal inside the isolation room
• Physical barriers (e.g., glass or plastic screens) at reception areas may also be
considered.
• Dedicated staff for isolation wards.

Resources:
• WHO Coronavirus Homepage
https://www.who.int/emergencies/diseases/novel-coronavirus-2019
• All coronavirus (COVID-19) technical guidance documents

https://www.who.int/emergencies/diseases/novel-
coronavirus-2019/technical-guidance
• IPC documents
https://www.who.int/emergencies/diseases/novel-
coronavirus-2019/technical-guidance/infection-prevention- and-control
• Principles for Infection Prevention and control-COVID 19 Patients/ Version-

NHSRC/QI/00-30/3/2020
• Guidelines for Setting up Isolation Facility/Ward/GOI-MOHFW

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Setting Up Triage & Isolation Wards v2

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Setting up Triage & Isolation wards in SHCOs

Cascade Sharing By:

Use clinical triage in health care

Why?? The quarantine of persons is the

• Assess available resources

• Do you have fever more than 100.4 deg. F in past 14 days?

• Do you have new onset of cough or shortness of breath in past 14

• Have you travelled to country/place with transmission of COVID-

• Have you had contact with someone experiencing respiratory

• For isolation rooms, separate entrance and exit should be

• Remove all non-essential furniture and ensure that the

• If sufficient single rooms are not available, beds could

• Stock the PPE supply and linen outside the isolation

• Double door entry with changing room and nursing

• Maintain one-way flow of patients and the staff

• Reusable equipment is appropriately disinfected between patients

• Visitors to the isolation facility should be restricted /disallowed

• Dedicated staff for isolation wards.

• All coronavirus (COVID-19) technical guidance documents

• Principles for Infection Prevention and control-COVID 19 Patients/ Version-

• Guidelines for Setting up Isolation Facility/Ward/GOI-MOHFW

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