Orthopedic clinics under the coronavirus disease-2019 (COVID-19) pandemic: Time to revisit the safety measures

Sanjay Keshkar; Dilip Kumar Mazumder

doi:10.4103/ijors.ijors_15_21

EDITORIAL

Year : 2021 | Volume : 29 | Issue : 1 | Page : 1-2

Orthopedic clinics under the coronavirus disease-2019 (COVID-19) pandemic: Time to revisit the safety measures

Sanjay Keshkar, Dilip Kumar Mazumder
Department of Orthopaedics, ESIC Medical College & ESI-PGIMSR, ESI Hospital Joka, Kolkata, West Bengal, India

Date of Submission	05-Jul-2021
Date of Acceptance	06-Jul-2021
Date of Web Publication	21-Aug-2021

Correspondence Address:
Sanjay Keshkar
Department of Orthopaedics, ESIC Medical College & ESI-PGIMSR, ESI Hospital Joka, Kolkata 700104, West Bengal
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/ijors.ijors_15_21

Abstract

Coronavirus disease-2019 (COVID-19) pandemic has changed the seen in each and every field of the globe and is true for orthopedic clinics as well. As the second surge of COVID-19 pandemic is fading away, number of patients in orthopedic clinics of hospitals, nursing homes, and even private chambers is increasing day by day. Very soon we will see a sudden surge of patients in orthopedic OPD (outpatient department) as the cold cases have been differed for the last one and half years. Visiting/handling the increasing number of patients in the same space of consulting and waiting area will be a challenge and it is quite possible that we may commit a mistake by compromising the protective guidelines, as we did during the beginning of this year. However, the first surge was fading away, which resulted into the entry of second surge of COVID pandemic. Therefore, it is time to revisit the situation in terms of safety measures while attending the patients in orthopedic clinic.

Keywords: COVID-19 pandemic, orthopedic clinics, safety measures

How to cite this article:
Keshkar S, Mazumder DK. Orthopedic clinics under the coronavirus disease-2019 (COVID-19) pandemic: Time to revisit the safety measures. Int J Orthop Surg 2021;29:1-2

How to cite this URL:
Keshkar S, Mazumder DK. Orthopedic clinics under the coronavirus disease-2019 (COVID-19) pandemic: Time to revisit the safety measures. Int J Orthop Surg [serial online] 2021 [cited 2023 Mar 25];29:1-2. Available from: https://www.ijos.in/text.asp?2021/29/1/1/324270

Introduction

The novel coronavirus first emerged in Wuhan, China in December 2019 from the wet seafood market.^[1] After about 2 months of its inception, it was regarded as a public health emergency of international concern in the world by mid-February 2019.^[2] Now it is a well-known fact that coronavirus is a respiratory virus, just like RNA virus of influenza and is capable of mutation.^[3] Despite availability of so many facts about coronavirus, the burning questions pondering one’s mind are about third wave? and complete release of lockdown? It is difficult to answer about third surge but it is for sure that even after the complete release of lockdown, the situation will not be the same as in the past and we have to be more careful in attending patients.^[4] In India, there is one allopathic doctor per 10,926 population, which is below World Health Organization (WHO’s) recommendation of 1:1000,^[5] putting tremendous pressure on the health-care system including orthopedics. In this scenario of COVID pandemic, let us revisit to see some insights related to “orthopedic clinics.”

Ensure Safe Examination Room and Safe Health Caregivers

The standard guideline should be followed in orthopedic clinic as well. The examination area in the outpatient department (OPD) especially door handles, working stations, and frequently used items should be cleaned regularly at least four times a day with 1% hypochlorite/lysol.^[4] Ensure availability of pulse oximeter in OPD and sanitization in every 15-min interval. Ensure that the health-care staff including the doctors, nurses, and paramedical staff have no signs and symptoms related to coronavirus disease-2019 (COVID-19) infection or any contact with COVID patients in the past 14 days and it is better to screen the health-care staff, if feasible. The orthopedic surgeon and all health-care providers of clinic must wear face mask (three-layer mask), face shield, gloves-powdered, and shoe covers on. PPE kit is cumbersome due to sweating particularly in hot and humid conditions but for extra safety, one should use it, if possible. The examination/consulting room should have been two compartments separated by a transparent protective curtain. Patient with only one attendant (if required) is allowed to outer compartment from where the history and other relevant information can be taken by minimum talk. Education of health-care staff, patients, and their attendants should be of utmost priority.

Protocol For Patient and Attendant While Entering Orthopedic Clinic

One should maintain an strict protocol for patients and their attendants, right from entry gate of the orthopedic clinic where a three-layer surgical mask, hand sanitizer, and a disposable glove box should be available.^[4] They should be allowed only after ensuring the mask, with sanitized hand with gloves. After the entry, patient and attendant both should be screened by proper history of COVID-19 such as symptoms and any history of contact and if there is any positive history then isolate both patient and attendant and treat as COVID positive unless proved otherwise. Maintain a separate dressing room and plaster room for patients and waste such as dressing material and gauges of suspected patients should be disposed of carefully.

How to Do Clinical examination: No Touch Technique

Once you ensured the safe examination room, safe health caregivers, safe patient, and safe attendant, then the first step of examination is to guide the patient or their attendant to fill a case history. Once history is over, then approach the patient by minimum talk. While entering into the clinic, observe the gait of the patient which will give you an idea about lower limb/spine problem. Then allow the patient to lie down in couch. In orthopedics, the examination consists of inspection, palpation, movements, and measurements. In this COVID pandemic situation, the inspection and observing movements play a great role in diagnosis and should be done meticulously with taking enough time. So “Maximum Inspection & observation of Movements with minimal Palpation & Measurements” should be the dictum. One should do palpation/measurements with utmost care only if it is necessary.

How to Earn Patient’s Confidence

We can make diagnosis in more than 80% of patients early. Now majority of them are not satisfied with our no-touch technique. Touching the painful site to appreciate tenderness is boosting and encouraging point to enter into the hearts of more literate/little literate patients, especially follow-up patients, aggrieve of missing previous examination style of care, and confirmation of signs. Pushing them more to expensive/academic investigations (hope to earn psychological boosting) is less satisfactory than a true clinical examination. These patients needs to be tackled cleverly.

Take Home Points!

Mind is responsible for thought. Thought is responsible for word and action. Purity of action depends upon the purity of the source (mind). Thus, an inward cleansing process can set the mind clean, calm, courageous, and capable to dole out positive vibes to sail the dark clouds of COVID pandemic. Third wave of coronavirus is on the way, so one should never lower the guard rather more vigilant at least till vaccination of all citizens is completed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Authors’ contribution

SK studied and the prepared the manuscript. DKM contributed to ideology and teaching in preparing the manuscript.

References

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2.	World Health Organization. Statement on the Second Meeting of the International Health Regulations 92005). Emergency Committee Regarding the Outbreak of Novel Coronavirus (2019-nCoV). 2005. Available from: https://www.who.int/news-room/detail/30-01-2020-statement-on-the-secondmeeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novelcoronavirus-(2019-ncov). [Last accessed on 3 Jul 2021].
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