How to prepare an obstetric unit for COVID-19

While the COVID-19 pandemic presents a healthcare complexity not seen in over 100 years, patient care indirectly related to the virus must not be forgotten. One instance of this is how care for pregnant patients must adapt. A review published in The Journal of Maternal-Fetal & Neonatal Medicine illustrates key strategies to implement in obstetric units. The authors note that the importance of implementing these measures as soon as possible before the infection reaches its surge point and healthcare providers and facilities are even more overwhelmed.

Due to unpreparedness on many different fronts, information is still limited, and health care providers and public health officials are learning about COVID-19 as they go. Therefore, it is important to remember that while the measures, based on experiences in the field, appear to help, new information on the virus may mean that these measures need to be adapted so providers must stay up to date.

Virus stability
In regard to virus stability, prior research indicated that viral genomes of coronavirus remained on metal, glass, and plastic surfaces for up to 9 days at room temperature. Furthermore, COVID-19 was specifically detected on surfaces 72 hours after application and in aerosol particles after 1 hour. However, the virus could be inactivated within 1 minute after disinfection with > 62% ethanol, 0.5% hydrogen peroxide or 0.1% sodium hypochlorite. 

Creating a task force
Based on the Chinese model, the key to reducing the spread of infection is to isolate the virus and cases. Testing of suspected or positive people must be carried out at home or outside the hospital (mobile structure) to channel patients directly to the COVID-positive zone. The authors suggest setting up a local task force in the facility to meet regularly to study the resources and share decision making. The taskforce must include an obstetrician, an anesthesiologist, a neonatologist, a midwife or nurse, and a local administrator. It is also important to set up a triage call center for all pregnant women with a toll-free number. Finally, a mobile screening team should be established to care for all pregnant women with suspected COVID-19 infection. The role of this team is to carry out screening and give advice to a patient before she arrives at the hospital. 

Patient care
It is also important to remember to isolate COVID-19-positive and COVID-19-negative patients.  Having a distinct emergency ward, admission, elevator, corridor, labor ward, outpatient clinic, ultrasound department, high-risk pregnancy ward, and operating theater with a clear area defined as “COVID ZONE” can help reduce contamination. Initial triage should also be done outside the hospital. If that is not possible, a specific isolated room should be designated to evaluate patients. The room should be large enough to perform a physical exam and ultrasound and/or cardiotocography test. A cleaning team must also be ready to thoroughly disinfect before and after caring for patients. When possible, telemedicine should be used and physical appointments should be postponed until a 14-day quarantine has been completed.

Hospital preparation
All units of the hospital must have separate tracks for COVID-19-positive and COVID-19-negative patients. This includes an emergency unit, labor ward, operating room, outpatient clinic, high-risk pregnancy ward, and postnatal ward. A COVID-19-positive transportation route must also be established to avoid any interaction with COVID-19-negative patients. 

Personnel precautions
For personnel doing shifts in COVID-19-positive wards, it is important to try to limit shift duration to a maximum of 6 hours. Personnel in these wards must scrub out entirely in order to drink, use the bathroom, etc, as none of these activities may be carried out with personal protective equipment (PPE). It is also vital to create a pre-changing area for personnel entering a COVID-19-positive area. All personnel who come in contact with patients should be equipped with a facial mask (type FFP2 or FFP3) and PPE (disposable gown, gloves, googles or facial screen). Patients should be equipped with surgical masks. The authors offer several tips for how caregivers should be dressed when coming to work:

• Remove all jewelry.

• Beards should be shaved, and long hair should be tied back.

• Avoid using your cell phone or disinfect it.

• Wear eyeglasses instead of contact lenses.

• When you arrive home, leave your shoes outside and your clothes in a decontamination area. Clothes should be washed at 140˚ F.

• Hand washing is not enough while at work and all surfaces need to be disinfected.

Although COVID-19 presents a number of challenges, there are steps providers can take to help limit the infection rate among their patients. However, new information comes out daily, and while these steps can help mitigate risk, they are subject to change and providers need to remain up to date on the latest Centers for Disease Control and Prevention and World Health Organization recommendations.