Prevention of Corona in pediatrician

🩺💉💊 *TIPS FOR PAEDIATRICIAN IN CORONA PANDEMIC* 💊💉🩺

*Compilation, written and drafting by*

*By Dr Gyanendra Singh*
*MBBS,MD*
*New Hansraj Hospital*
*Naroda, Ahmedabad*
*98795 79055*

*By Dr Krunal Mistry*
*Orthopedic Surgeon*
*M.S. (ORTHO)*
*Gokul Hospital*
*Rajkot*
*Darshi Orthopedic Hospital*
*Jasdan*
*94295 64466*
*93741 42789*

*Editor*
*_Dr Jigar Bhutwala_*
M.D.(Anaesthesia)
Surat.

As we are now witnessing that there is a constant rise of number of paeditricians affected with Covid 19 infection.
With much pain and grief, we have to admit that many of them who were infected with Covid succumb to the illness.

This made us think about  doing study on following questions.

*(1)*
Why is it so common in paeditricians ?
*(2)*
How does it spread among Paediatricians.
*(3)*
What could be done to prevent it ?

*So in first half*,  we have pointed out probable caused of spread of COVID infection in paeditricians. This will help them all about *focusing over areas of precautions what they need to take.*

In *second part*, we will make *suggestions to let that infection not to catch you.*

*First part*

*(1)*

*Feeling of false security*

This is because of a false belief that children are very less prone to get infected with Covid 19.
It was said that to have very low incidence of this  infection.
*This false belief was based upon one fact that symptoms in Covid in children are entirely same as any other cough, cold and diarrhea.*
So it is very difficult to suspect.
So paeditricians often take these symptoms lightly and get  infection.

*(2)*
*Why children are worrysome*

It is seen that infected children are either asymptomatic , mildly symptomatic or having atypical symptoms. So paeditricians become less careful in protection or may have complacent attitude.
*It is also seen that children have high viral load (10-100 times) in their naso pharynx as compared to adults.*

*(3)*
*Buy one get one scheme*
Children are the patients who are closely accompanied by their care taker.
So many times, accompanying person, his/her father or mother or both could be spreaders. So when they are in your chamber for consultation, you have *buy one, get one* scheme applicable and you become more prone to catch infection.

*(4)*

*Difficulty in examination of children faced by  paeditricians.*

*(a)*
For examining a paedia patients, a paeditricians has to examine them very closely.
*(b)*
Moreover, children are continuously busy with coughing and crying. So more droplet production.
*(c)*
Third one, children are seen very less comfortable with masks. So
most of time keep their face uncovered.
Sum total of these three factors cause a great rise in possibility of a paeditricians getting infected.

*(5)*
*Paeditricians can indirectly get infected from the child*

When children are in consulting chamber, paeditricians give their
PEN,
STETHOSCOPE,
TOY KEPT ON TABLE,
to patient to play while they are examining them.
So indirect contact with corona virus in the affected area can takes place.

*(6)*
*Some other factors*

*(a)*
Each child needs weighing. So fomite.
*(b)*
History of positive case in family not revealed.

*Now in next coming session*, we will *throw light over precautions and measures for prevention* to be taken by paeditricians to make themselves safe*

*It is always told that prevention is better than cure.*
So following this old proven fact, we are aimed at suggesting some steps that may help to prevent spread of infection to paeditricians.

So based upon close observations, we have identified two areas from where paeditricians can easily get infected.

*(1)*
*Paeditricians own OPD set up*
(2)
*During LSCS call at an Obs&Gyenc Hospital*

So discussing about OPD area, we have come with a suggestion to separate paedia patients into following main 3 groups and accordingly management should also be carried out.
They are respectively
*(1)*
*Vaccination OPD*
*(2)*
*Well baby OPD*
*(3)*
*Sick baby OPD*

So now discussing each OPD separately.

*(1)*
*Vaccination* These pts come to the hospital for sole purpose of vaccination.
These babies are having almost zero percent possibility of spreading infection to paeditricians.
So this type of patients should be separated from other two groups.

*(2)*
*Well baby*
This is the class of patients who are
Afebrile,
Routine follow up pts or pts
Without any respiratory symptoms.

*(3)*
*Sick baby*
This class includes all other patients apart from the above mentioned class and with symptoms like
Fever,
Cough, cold( respiratory symptoms)
Or any serous illness.

Moreover, OPD timings for these three class of patients should also be separated.
Preferably,
*Vaccination in morning sessions*

*Well baby after finish of vaccination with an interval of half an hour.*

*Sick baby should be called in afternoon session.*

So after finishing OPD, in late evening or late night, you can clean OPD area and leave it overnight. So preparing healthy for next day vaccination babies.

*(b)*
*Mask etiquette*

*For children above 2 years age.*

This group, children should be encouraged to put on mask.In market many colourful padiatric mask are available with pictures of their favourite cartoon character on them which the child will love to wear.This will help in developing mask etiquette in the children for future also.

Apart from this, there is a common problem with almost all babies that they don't keep their nose and mouth covered.
You can make children above 3-4 years to put mask properly.

*For children below 2 years age*

Unmonitored use of Masks is not recommended in this age group due to risk of choking,but at the same time use of mask under supervision of parents or the pediatrician can be recommended even in this age group for a brief period say during close examination.
*So you can make them put on a mask, or a face shield which comes with hat.*

This will not only make them happy but also relieve stress of accompanying person.

*(2)*
*Precautions during LSCS at Obs &Gynec Hospital*

In OT during LSCS

If mother is COVID POSITIVE, then we should wear full PPE KIT.

if COVID STATUS is unknown even then also, we have to be careful and ideally need to wear PPE
Paeditricians have tendency to go very near to mother to recieve baby from gynaecologist and chances of spillage of amniotic fluid is there better to recieve baby in other room
Avoid going near to mother

Need to be very careful in OT as most of us are under impression that neonates dont spread and we are protected but we can get infection from mother or relatives

Ideally, obstetrician should be encouraged to get the Covid test of the pregnent patient done within 24 hours of planned LSCS.

For emergency LSCS atleast rapid antigen test should be done prior to surgery,

Paeditricians should avoid to go to OT,
Near the pregnent lady,
And avoid directly recieving the baby because amniotic fluid can have high amount of virus if the patient is having Covid.
Ideally, only receive the baby in separate room from hospital staff.
All above measures will minimise the risk of infection to the Paediatricians but *_Don't forget the importance of_ *Universal Precautions*
* Use of Appropriate Mask and optimal PPE.
*Hand hygiene
*Physical distensing
*Visitors restriction
*Cough etiquette
*Importance of sanitisation & disinfection.

*We are very much thankful to following paeditricians for helping us.*

*(1)*
*_Dr Chitra Prakashkar_*
M.D. (Paediatrics)
Ahmedabad

*(2)*
*_Dr Mehul Gosai_*
M.D. (Paediatrics)
Bhavnagar

*(3)*
*_Dr Rajeev Arora_*
M.D.(Paediatrics)
New Delhi