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.
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.
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.