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Guidelines For The Management of COVID-19 in Health Facilities
Guidelines For The Management of COVID-19 in Health Facilities
MANAGEMENT OF COVID-19
INFECTION IN HEALTH
FACILITIES
Dubai Health Authority (DHA) is the responsible entity for regulating, licensing and monitoring
health facilities and healthcare professionals in the Emirate of Dubai. The Health Regulation
Sector (HRS) is an integral part of DHA and was founded to fulfil the following overarching
strategic objectives:
Objective #1: Regulate the Health Sector and assure appropriate controls are in place for safe,
Objective #3: Direct resources to ensure happy, healthy and safe environment for Dubai
population.
ACKNOWLEDGMENT
This document is developed for the management of the COVID-19 infection in health facilities, in
collaboration with Preventive Medicine Section (PMS), Public Health Protection Department
(PHPD). The Health Policy and Standards Department (HPSD) would like to acknowledge and
thank these professionals for their dedication toward improving the quality and safety of
healthcare services.
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TABLE OF CONTENTS
EXECUTIVE SUMMARY 5
DEFINITIONS 6
ABBREVIATIONS 7
1. BACKGROUND 8
2. SCOPE 9
3. PURPOSE 9
4. APPLICABILITY 9
REFERENCES 24
APPENDICIES 25
APPENDIX 1b: MANAGEMENT PATHWAY FOR SUSPECTED COVID-19 INFECTED CASES PER
LOCATION 26
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APPENDIX 1c: MANAGEMENT PATHWAY FOR A CONTACT CASES WITH A CONFIRMED
28
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EXECUTIVE SUMMARY
This is the first edition of the Guidelines for Management of Covid-19 infection in health facilities.
This document is based on current knowledge of the situation in China and other countries where
cases of Covid-19 have been identified and is aligned with current international guidelines and
circulars issued by DHA related to the subject. This is to ensure public and patient health
protection and to ensure efficiency and integrity of procedures applied to handle cases of Covid-
19, in all DHA licensed health facilities. DHA will update these recommendations as new
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DEFINITIONS
Healthcare Personnel (HCP): refers to all persons, paid and unpaid, working in healthcare
settings engaged in patient care activities, including: patient assessment for triage, entering
examination rooms or patient rooms to provide care or clean and disinfect the environment,
obtaining clinical specimens, handling soiled medical supplies or equipment and coming in contact
Laboratory diagnosis: at this stage, the laboratory testing for COVID-19 is performed at the
Latifa Hospital Laboratory ONLY. All samples from suspected cases should be send to Dubai
Health Authority (DHA) where laboratory testing is performed to confirm a clinically suspected
Suspected COVID-19: is defines as a Patient present with upper or lower respiratory symptoms
A history of travel to China/ Hong Kong/ South Korea/ Iran/ Japan/ Singapore/ Italy in the
Has cared for/come into contact with an individual or animal known or strongly suspected to
A patient with Severe Acute Respiratory Infections (SARI) with no other lab result that explains
illness.
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ABBREVIATIONS
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1. BACKGROUND
Coronaviruses are a large family of viruses that are common in many different species of
animals including humans. There are four main sub-groupings of coronaviruses, known as
alpha, beta, gamma, and delta. Human coronaviruses were first identified in the mid-1960s.
6. SARS-CoV - beta coronavirus that causes severe acute respiratory syndrome, or (SARS)
7. COVID-19
Globally people are commonly infected with human coronaviruses 229E, NL63, OC43, and
HKU1. These illnesses usually only last for a short period. Symptoms may include runny nose,
headache, cough, sore throat, fever and a general feeling of being unwell.
Sometimes coronaviruses that infect animals can evolve into a new human coronavirus and
infect humans. Three recent examples of this are MERS-CoV, SARS-CoV and COVID-19.
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Recent reports from World Health Organization (WHO) confirmed that COVID-19 is a new
strain of coronavirus that was first identified in a cluster of pneumonia cases in Wuhan City,
Most cases shown respiratory symptoms, fever, shortness of breath and pneumonia.
Currently, there is no known treatment or vaccine available for either people or animals.
Intensive supportive care with the treatment of symptoms is the main approach to manage
the infection in people. People with cardiopulmonary disease, immune-deficient, infants and
2. SCOPE
2.1. Provide directions to Dubai Health Authority (DHA) licensed Health Facilities and
infection.
3. PURPOSE
3.1. Identify and isolate COVID-19 infected patients and inform DHA.
4. APPLICABILITY
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5. RECOMMENDATION ONE: CASE DEFINITION FOR COVID-19
5.1.2. A patient with Severe Acute Respiratory Infections (SARI) with no other lab result
5.2. A case is a confirmed case of a suspected case with laboratory confirmation of COVID-
5.3. For the management of suspected COVID-19 infection case as per location, refer to
Appendix 1b.
5.4. For the management of contact cases with a confirmed case of COVID-19 infection,
5.5. For the management of confirmed COVID-19 infected case, refer to Appendix 1d.
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6. RECOMMENDATION TWO: ADMINISTRATIVE MEASURES
6.3. Ensure patients with symptoms of any respiratory infection (e.g. cough, runny nose,
fever) inform the front desk/reception on arrival and immediately take appropriate
preventive measures (e.g. patients and people accompanying wear a surgical mask upon
6.4.2. Ensure adequate supplies of Personal Protective Equipment (PPE) e.g. surgical
masks, N95 masks, gloves etc. and other infection prevention and control
supplies (e.g. hand hygiene supplies) are available for Healthcare Personnel
individuals e.g. physical barriers or partitions to guide patients through triage areas,
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6.6. Establish a well-equipped triage station at the entrance of health facility, supported by
trained staff.
6.7. Ensure access to prompt laboratory testing for identification of the etiologic agent.
6.9. Ensure isolation rooms with negative pressure with separate bathrooms are available
and functioning correctly and are appropriately monitored for airflow and exhaust
handling.
6.10. Ensure availability of adequately ventilated single rooms with attached bathrooms in
6.11. Have contingency plans if the demand for PPE or other infection control materials
6.12. Post signs in public areas reminding symptomatic patients to alert healthcare
professionals.
6.13. Limit visitor access and movement within the health facility.
6.15. Provide adequate education and refresher training for Healthcare professionals
PPE use, triage procedures including patient placement, how and to whom COVID-19
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(i.e., not wearing recommended PPE) to suspected COVID-19 infected patients at the
health facility.
6.16. Establish a surveillance process for acute respiratory infections potentially caused by
6.17. Ensure that Healthcare professionals and the public understand the importance of
6.18. Ensure that specific persons have been designated within the health facility who are
6.19. Ensure safe waste management, proper linen cleaning and utilization, environmental
7.1. Be up to date on the latest information about signs and symptoms, diagnostic testing
7.2. Adhere to standard contact and airborne precautions including the use of eye
protection.
7.3. Implement preventative measures before patient arrival, upon arrival and throughout
7.4. Be alert for patients who meet the criteria for suspected cases or confirmed cases.
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7.5. Ensure rapid triage and isolation of patients with symptoms of suspected COVID-19
7.6. Admit suspected cases of COVID-19 infected cases in negative pressure room
(s)/implement strict standard, contact and airborne. If negative pressure room not
available, place patients in adequately ventilated single rooms with separate bathroom.
7.7. In case of no inpatient service, transfer the patient with suspected COVID-19 infection
7.8. Apply the WHO-5 Moments for Hand Hygiene approach before touching a patient,
before any clean or aseptic procedure is performed, after exposure to body fluid, after
7.9. Source, control measures for suspected patients (e.g. surgical masks for suspect
patients).
7.10. Remain at home and notify the health facility, if the healthcare professionals
clinical suspicion.
mentioned below:
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8.2.1. All patients should cover their nose and mouth with a tissue or elbow when
coughing or sneezing.
8.2.3. Proper Hand hygiene techniques, include either cleansing hands with soap and
b. Wash hands with soap and water when they are visibly soiled.
8.2.4. Offer surgical masks to patients with suspected COVID-19 infection while they
8.2.5. Appropriate and consistent use of PPE to reduce the spread of pathogens. Refer
8.2.6. Ensure that environmental cleaning and disinfection procedures are followed
water and detergent and applying commonly used hospital level disinfectants
are effective.
8.2.7. Medical devices and equipment, laundry, food service utensils and medical
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airborne precautions before entering the room where suspected or confirmed
8.3.2. Patient should be placed in an isolation room with negative pressure (if
8.3.4. Healthcare professionals should wear fit-tested N95 mask, eye protection,
8.3.5. The use of boots and coverall is not required during routine care.
8.3.6. After patient care, appropriate doffing and disposal of all PPE's and hand
disinfect with ethyl alcohol 70%, it between use for each patient.
8.3.10. Healthcare professionals should refrain from touching eyes, nose or mouth with
8.3.11. Avoid moving and transporting patients out of their room or area unless
medically necessary.
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8.3.12. Use designated portable X-ray equipment and/or other designated diagnostic
equipment.
exposure for staff, other patients and visitors, and have patients use a surgical
masks.
8.3.14. Ensure that HCP who are transporting patients perform hand hygiene and wear
appropriate PPE.
8.3.15. Notify the area receiving the patient of any necessary precautions as early as
8.3.16. Routinely clean and disinfect surfaces, which is contacted by the patient.
8.3.17. Limit the number of healthcare professionals, family members and visitors who
8.3.18. Maintain a record of all persons entering the patient’s room, including all staff
and visitors.
following:
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pressure rooms with at least twelve (12) air changes per hour and
apron/gown.
d. Limit the number of HCP present in the room to the absolute minimum
9.2. Coordinate for sample transportation to DHA with Microbiology & Infection Control
9.3. Currently, the laboratory testing for COVID-19 is performed at the Latifa Hospital
laboratory ONLY. All samples from suspected cases should be sent to DHA laboratories
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where testing is performed to confirm a clinically suspected case and to screen
contacts.
9.4. All samples sent to the laboratory shall only be taken from individuals who meet the
9.5. All specimens collected for laboratory investigations should be regarded as potentially
infectious.
9.6. Healthcare professionals who collect, handle or transport any clinical specimens should
9.6.1. Ensure that Healthcare Professionals who collect specimens use appropriate
PPE (i.e. Wear fit-tested N95 masks, eye protection, gloves and impermeable
apron/gown).
9.6.3. Ensure that all personnel who transport specimens are trained in safe handling
9.6.4. Place specimens for transport in leak-proof specimen bags (i.e., secondary
containers) that have a separate sealable pocket for the specimen (i.e., a plastic
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biohazard specimen bag), with the patient’s label on the specimen container
(i.e., the primary container) and a clearly written laboratory request form.
handled.
transport specimens.
9.7. Fill the Patient Under Investigation (PUI) form and submit it to Latifa Hospital with
the specimen.
Note: Latifa Hospital Laboratory will not accept the specimen without the completed
PUI form.
10.1. All outpatient facilities with the following specialties shall provide an emergency room
to isolate patients upon receiving suspected cases, till the case is transferred to a
hospital:
10.1.3. ENT
10.1.4. Pediatrics
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10.2. In case of a suspected case at a DHA licensed Outpatient Facility, the health facility
management shall coordinate with Dubai Ambulance for the patient to be transferred
to a nearby Hospital.
11.1. Health Facilities have to report any suspected and confirmed cases of COVID-19
infected case based on case definition immediately to the Preventive Medicine Section,
a. +971562253800
b. +971562256769
11.1.3. Fill the Patient Under Investigation (PUI) form Appendix 5, scan and send it
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11.2. Healthcare professionals should immediately notify both infection control personnel at
their health facility and DHA in the event of a PUI for COVID-19.
11.3. Specimens should be collected as soon as possible once a PUI is identified regardless
collect and test multiple clinical specimens from different sites, including all three-
12.1. To avoid getting infected and spreading the coronavirus, it is important to abide by the
following:
a. Hand Hygiene- Wash your hands often with soap and water for a minimum
of twenty (20) seconds. If soap and water are not available, use an alcohol-
b. Coughing Etiquettes - Cover your cough or sneeze with a tissue, then throw
12.1.2. Avoid touching your eyes, nose and mouth with unwashed hands.
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12.1.6. Social Distancing–in advanced crisis, stay away from crowded places like
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REFERENCES
2. Centers of Disease Control and Prevention (2019). 2019 Novel Coronavirus, Wuhan, China
04/02/2020).
3. WHO (2020). Infection prevention and control during health care when novel coronavirus
https://apps.who.int/iris/bitstream/handle/10665/330375/WHO-2019-nCoV-IPC-
https://www.who.int/csr/resources/publications/ebola/ppe-steps/en/ (accessed
02/02/2020).
https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance
(accessed 03/02/2020).
6. WHO (2020), Novel Coronavirus (2019-nCoV) advice for the public: When and how to use
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APPENDICIES
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APPENDIX 1b: MANAGEMENT PATHWAY FOR SUSPECTED COVID-19 INFECTED CASES PER LOCATION
APPENDIX 1c: MANAGEMENT PATHWAY FOR A CONTACT CASES WITH A
CASE
APPENDIX 2: HOSPITAL PREPAREDNESS CHECKLIST FOR COVID-19
Location: ______________________________________________________________________
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9. Review plans for implementation of surge capacity procedures and
crisis standards of care. This includes collaboration with DHA Public
Health and Protection Department and Public Hospitals.
10. Procedures for laboratory submission of specimens for COVID-19
testing.
11. Assess effectiveness of environmental cleaning procedures. Provide
education/refresher training for environmental services personnel
regarding COVID-191 coronavirus.
12. Policies and procedures for monitoring and managing HCP with
potential for exposure to COVID-19 coronavirus, including ensuring
that HCP have ready access for medical consultation.
13. Provide education and refresher training to Healthcare Professionals
for Diagnosis of COVID-19 infection, obtaining specimen for testing,
appropriate PPE use, triage procedures; including patient placement
and COVID-19 infection case reporting and procedures following
unprotected exposure to suspected COVID-19 infected patients at the
health facility.
14. Procedure in place for a HCP or healthcare professional who is a
contact of a confirmed case.
15. Dedicated assigned trained Healthcare Professional Team to handle
suspected/positive cases.
16. Plans for visitor access and movement within the health facility.
17. Record of all persons entering the patients room including all staff and
visitors
18. Proper disposal of infectious medical waste.
19. Appropriate handling of contaminated linen.
20. Ensure that specific individuals have been designated to
communication with Public Health and Protection Department and
dissemination information to other Healthcare Professionals at the
Health Facility.
1
All trainings should be properly documented
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APPENDIX 3: WHO- 5 MOMENTS FOR HAND HYGIENE
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APPENDIX 4: APPROPRIATE USE OF MASKS
Replace the mask with a new one as soon as it is damp and do not re-use single-use masks.
To remove the mask: remove it from behind (do not touch the front of mask); discard
immediately in a closed bin; clean hands with alcohol-based hand rub or soap and water.
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APPENDIX 5: INTERIM COVID-19 PATIENT UNDER INVESTIGATION (PUI) FORM
As soon as possible, notify and send completed form to Preventive Medicine Section
NOTIFIER INFORMATION
Health Facility Name: __________________________________________________________
Date of Notification: ______/______/________
Interviewer’s Name: ____________________ Phone: _______________E-mail: _____________
Physician’s Name: _____________________Phone: ________________E-mail: _____________
PATIENT INFORMATION
Patient Name: ________________________________________________________________
Patient Emirate ID/Passport No. :__________________________________________________
Patient Health Record Number/MRN: ______________________________________________
Sex: Male ☐ Female ☐
Date of Birth: ____/____/_____
Residency: ☐ UAE resident ☐ Non-UAE
Nationality: __________________________ Mobile No.:_______________________________
Patient address: ______________________________________________________________
Medical History
Date of onset: ____/____/_____
Does the patient have the following signs and symptoms? (Check all that apply)
☐ Fever ☐ Cough ☐ Sore throat ☐ Shortness of breath
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Does the patient have close contact with a person who is under investigation for COVID-19
infection while that person was ill? ☐Y ☐N ☐ Unknown
Does the patient have close contact with a laboratory-confirmed COVID-19 case while that case
was ill? ☐Y ☐N ☐ Unknown
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Respiratory diagnostic results:
Test Positive Negative Pending Not done
Influenza rapid Ag □ A ☐ B ☐ ☐ ☐ ☐
Influenza PCR ☐ A □ B ☐ ☐ ☐ ☐
MERS- CoV ☐ ☐ ☐ ☐
RSV ☐ ☐ ☐ ☐
H. metapneumovirus ☐ ☐ ☐ ☐
Parainfluenza (1-4) ☐ ☐ ☐ ☐
Adenovirus ☐ ☐ ☐ ☐
Rhinovirus/enterovirus ☐ ☐ ☐ ☐
Coronavirus (OC43, 229E, HKU1, NL63) ☐ ☐ ☐ ☐
M. pneumoniae ☐ ☐ ☐ ☐
C. pneumoniae ☐ ☐ ☐ ☐
Other, Specify __________________ ☐ ☐ ☐ ☐
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