GAMBO GENERAL HOSPITAL

CLINICAL GOVERNANCE & QUALITY IMPROVEMENT UNIT

PRETRIAGE SCREENING FOR INFECTIOUS CASES & PATIENTS

CHANNELING TO COUGH CLINIC PROTOCOLS

BY: QUALITY TEAM

April 2024 G.C

1
Contents
Back Ground................................................................................................................................................3
Services Provided by GGH...........................................................................................................................4
Mission & Vision of GGH.............................................................................................................................5
Core Values of GGH.....................................................................................................................................6
Health Care Quality.....................................................................................................................................7
PRETRIAGE SCREENING FOR INFECTIOUS CASES.........................................................................................8
PRETRIAGE SCREENING & ISOLATION CRITERIA FOR COVID-19..............................................................9
Isolation Criteria for Tuberculosis..........................................................................................................13
PATIENTS CHANNELING TO COUGH CLINIC PROTOCOL.............................................................................14
COVID-19 & TB Screening, Isolation & Treatment Algorithm....................................................................15

2
Back Ground
 Gambo General Hospital is found in Oromia regional state, 245 KMs to the
South of AA on Ethio-Kenya main road & 18KMs to the east of Arsi Negele
town in West Arsi Zone

 It was established in 1922G.C as Center for Leprosy Control by Italian

Interior Missionaries

 It was handover to Government in2012 E.C

 Currently its labeled as General Hospital giving service for around 1 million
of population

3
 Services Provided by GGH
1. General OPD services

2. General Emergency services

3. Inpatient Services

4. OBS/GYN services

5. General Surgical Services

6. TB services

7. ART services

8. Leprosy services

9. Imaging services

10. Laboratory services

11. Dental Services

12. Cervical Ca Screening services

13. Specialty clinics

14. MNCH services

15. NICU services

16. Rehabilitative & palliative care services
17. Nutritional rehabilitative service
18. Ultrasound services
19. Major & minor Operation services
20. Emergency & Elective Operation Services

4
Mission & Vision of GGH
1. Mission:- To reduce Morbidity, Mortality, Disability & Improve health
status of the Community through Provision of Preventive, Curative &
Rehabilitative health Services.

2. Vision:-Aspire to be Preferable Hospital to Community with the aim to see

healthy, Productive & Prosperous Community.

5
Core Values of GGH
1. Community First

2. Collaboration

3. Commitment

4. Change

5. Trust

6. Continues Professional Development

6
Health Care Quality
The degree to which health services for individuals and populations increase the
likelihood of desired health outcomes and are consistent with current professional
knowledge OR

Comprehensive and integrated care that is measurably safe, effective, people-

centered, and uniformly delivered in a timely way that is affordable to the
Ethiopian population and appropriately utilizes resources and services efficiently.”

1. The Service is said to have Quality if it is :

1. Safe: Avoiding injuries to patients from Care that is intended to help them.
Patient Safety is the prevention of errors & adverse effects to patients associated
with the health care.

2. Effective : providing services based on Scientific knowledge to all who could

benefit & refraining from providing services to those not likely to be benefited.

3. Timely: reducing Waits & harmful delays for both who receive & those who
give care.

4. Efficient: avoiding waste including waste of Equipment, Supplies, ideas &

Energy.

5. Equitable: Providing care that does not vary in quality because of personal
characteristics such as Gender, Ethnicity, Geographic Location & Socio economic
status.

6. Patient Centered: Providing care that is respectful & responsive to individual

patient preferences, needs & Values ensuring that patient values guide all clinical
decisions

7. Integration: Comprehensive care is provided in a coordinated way across

the continuum of care.

7
PRETRIAGE SCREENING FOR
INFECTIOUS CASES
To reduce the risk of transmission of highly infectious diseases like suspected
COVID-19,TB & etc; patients entering the Emergency Department (ED)/OPD
were assigned to a high-risk (ED) or low-risk (acute medical unit, AMU) area
based on symptoms, travel and contact history.
The COVID-19 pandemic, caused by severe acute respiratory syndrome Corona
virus 2(SARS-CoV-2), has placed an ongoing burden on healthcare systems
globally. With increasing exposure to this new infectious disease, it became
apparent that COVID-19 patients could be relatively asymptomatic in the early
stages of illness or present with gastro-intestinal or atypical symptoms .Ultimately,
screening methods were highly susceptible to these changes.
Pre-triage screening was applied for possible COVID-19 infection based on the
most recent guidelines concerning symptoms, known COVID-19 contacts and
travel history.
A patient suspected for COVID-19 could be identified by the referring general
practitioner (GP), ambulance personnel or an ED nurse. The attending emergency
physician supervised the final decision on the patient’s allocation area.
The COVID-19 case definition in the Netherlands was determined by the Dutch
National Institute for Public Health and Environment. Early in the study period, the
case definition was relatively strict, including only patients with fever, respiratory
complaints and a positive contact and/or travel history. Later in the study period,
the case definition was further extended based on latest evidence, also including

8
patients with gastro-intestinal and non-specific symptoms. Non-specific symptoms
included loss of smell and taste and muscle ache.

Other than covid-19, Tuberculosis is one of the infectious diseases to be screened

prior to central triage entrance of the patients.

PRETRIAGE SCREENING & ISOLATION CRITERIA FOR COVID-19

The initial pre-Triage-screening at gate of the hospital will screen for highly
infectious cases symptoms mainly; COVID-19 & TB being the current main issues

Screen all patients for ANY of the following symptoms within the last 7
days:-
COVID-19 Core Respiratory Symptoms (new or worse):
 Cough
 Fever/chills/rigors
 Adults >37.8°C (reported or documented)
 Pediatrics ≥38.0°C (reported or documented)
 Shortness of breath, increased O2 requirements,
 difficulty breathing, Sore throat/painful swallowing
 Runny nose/nasal congestion

 COVID-19 Gastrointestinal (GI) Symptoms (new or worse):

 Vomiting and diarrhea must have had 2 or more episodes of
Immune compromised, critical respiratory failure, or outbreak investigation
 Adults: New or changed cough AND fever (38.0°C or higher) AND any of the
following: sore throat, joint pain, muscle ache, extreme exhaustion/weakness
 Pediatrics: cough OR sneezing OR runny nose

Screen all patients for ANY of the following Risk Factors

9
 COVID-19 test; positive COVID-19 within the last 14 days or currently
pending
Had close contact* with a confirmed or probable case of COVID-19 within 14
days before illness onset
 Had close contact* with a person with acute respiratory illness who has
travelled anywhere outside of Ethiopia in the 14 days before their illness
Travelled anywhere outside of Ethiopia within the last 14 days
Had laboratory exposure to biological material known to contain COVID-19
virus within the last 14 days
 Associated with any healthcare unit/facility, congregate living, or other (e.g.
workplace or social gathering) COVID-19 outbreak/cluster
 Direction has been given for the patient to remain on Contact & Droplet
Precautions
*A close contact is someone who:
• Provided care for the individual, including healthcare workers, family
members or other caregivers, or who had other similar close physical contact
with the person without consistent and appropriate use of personal protective
equipment (PPE),
OR
• Lived with or otherwise had close prolonged contact which may be
cumulative, i.e., multiple interactions for a total of 15 min or more and within
two meters with a case without consistent and appropriate use of PPE and not
isolating,
OR
• Had direct contact with infectious body fluids of a someone who has tested
positive for COVID-19 (e.g., shared cigarettes, glasses/bottles, eating utensils)
or was coughed or sneezed on while not wearing recommended PPE.
10
 If positive for any of the above symptoms and/or risk factors these must be
documented within the patient care record. Immediately have the patient
perform hand hygiene and put on procedure mask and implement Contact
&Droplet Precautions.
 For pediatric patients who cannot tolerate a mask, cover them with a blanket or
have they cuddle with care provider to minimize exposure to others.
 If Yes to ANY of the symptoms and/or risk factors:
• Staff involved in patient assessment and transport should immediately initiate
Contact and Droplet precautions.
• If available, place patient in a single room with hard walls, a door and
dedicated toilet
or commode and implement Contact and Droplet precautions as soon as
possible.
If patient requires an Aerosol Generating Medical Procedure (AGMP), place
patient in negative pressure isolation room if available (not required)
If no single room with hard walls and a door is available, contact IPC and/or
follow site specific processes.

 Physician instructions
• For Patients whose pre-triage/triage have screened as positive for COVID-
19 symptoms/risk factors; Contact & Droplet precaution is indicated.
Wearing PPE (i.e., procedure/surgical mask, eye/face protection, gown,
gloves) before assessing patient is mandatory
• Complete patient history (including confirming travel and exposure
history) and physical exam;
• Consider COVID-19 testing if the patient has new or worse, and

11
 unexplained symptoms from the Expanded Symptoms list:
Headache
 Altered mental status
Myalgia (muscle pain)/arthralgia (joint pain)
Loss of/change to sense of smell(anosmia)/taste (dysgeusia)
Fatigue/extreme exhaustion Conjunctivitis/red eye/chemosis (conjunctival
edema)
Nausea/sudden loss of appetite Any additional symptoms at clinician’s
discretion (e.g. skin manifestations such as “COVID toes”)
• If there is a plausible, alternate (non-COVID-19) clinical diagnosis and
patient does not have any risk factors as determined by the MRHP, COVID-
19 testing is not required.
• Patients who meet the expanded symptom criteria and who do not have
other risk factors do not require Contact and Droplet precautions.
• All patients being admitted to hospital with symptoms consistent with
COVID-19 should be tested
All symptoms/risks will be communicated to the receiving unit on admission
A nasopharyngeal or throat swab, collected under strict Contact and Droplet
precautions and transported in viral transport medium, should be submitted.
• Presenting symptoms, date of symptom onset and travel history, including
country of
travel and return date, must be included.
• Advise all patients and close contacts to follow public health directions to
self-isolate.

12
COVID-19 SCREENING &EVALUATION FLOW CHART

Isolation Criteria for Tuberculosis

 Patient who presented with Cough of 2 or more weeks
 Chest pain
 Difficulty of breathing
 Contact history with known Tb patient/chronically coughing person
 Night sweating
 Significant weight loss
 Any patient who is suspected of Tuberculosis must be isolated and Clinician
who is evaluating such patients should follow contact & droplet precaution
rule

13
PATIENTS CHANNELING TO COUGH
CLINIC PROTOCOL
Once pre-triage screening is conducted; patients with likely hood of being
infectious like patients with COVID-19 suspect & Presumptive Tuberculosis, must
be isolated in order to prevent other patients & staffs from being infected
These patients are directed to cough corner waiting area to wait until their admin
issues are completed by their attendant/ hospital staff if patients have no attendant.
These patients will be given PPE like face mask & ordered on other safety issues to
control infection. Cough Clinic Health care professionals must be informed early
so that they can prepare themselves for evaluating the coming patients. After
Completion of admin issues patients will be directed to Cough Clinic for
evaluation by physician & nurses assigned on Cough clinic.
If a patient is critical like patient who needs oxygen, then admission to integrated
COVID-19 & TB ward is a rule, where treatment & evaluation are cascaded
simultaneously.

14
COVID-19 & TB Screening, Isolation &
Treatment Algorithm

15