COVID-19 prevention and control measures: Emergency Center of the University Clinical Center of Serbia

n less than a year, humanity has managed to start a long and difficult battle against a virus, with a powerful weapon - the vaccine. In addition to vaccination, which is undoubtedly the most important measure in preventing COVID-19, our responsible behavior (wearing masks, hand hygiene, observing physical distance), especially in this period of an increase in the number of patients and the emergence of new strains, also remains an important measure in preventing and controlling the spread of COVID-19. In this paper, an overview of professional recommendations and instructions for the epidemiological surveillance of health care institutions is given. The study objective is to present the manner of organizing the epidemiological surveillance of the Epidemiology Department of the University Clinical Center of Serbia (UCCS) at the Emergency Center of the UCCS (EC-UCCS) as well as the application of measures to prevent and control COVID-19. To this end the method of the triage of patients with suspected COVID-19 in the Emergency Center of the UCCS has been shown. The Guidelines for the Rational Use of Personal Protective Equipment in Healthcare Facilities Depending on the Activities Performed, as well as the Recommendations of the Centers for Disease Prevention and Control (Atlanta, USA) have been presented. The Algorithm for the Procedures with Patients with Suspected and Proven COVID-19 Infection for Patients of the EC-UCCS has been formed. This Algorithm has been in use since March 1, 2020, in the EC-UCCS Admissions Service Triage Facility. In addition to this Algorithm, the screening of medical staff for SARS-CoV-2 has been performed by sampling nasopharyngeal and throat swabs (for PCR analysis and antigen tests) and blood (for serological analyses).

INTRODUCTION

It is fairly easy to answer the question as to what has been the main, and often only topic of discussion, in all the languages of the world, in the past year, with only one word - COVID-19. The pandemic caused by the new corona virus SARS-CoV-2 has changed people’s lives as well as their habits; it has introduced limitations into everyday life, and has brought with it an uncertainty leading to a new dimension in the comprehension of reality and the understanding of what caring for one’s own health entails.

Owing to contemporary scientific and technical achievements, which have also found their application in medicine, quick diagnostics and timely treatment of COVID-19 has become possible. The diagnosis of COVID-19 is swift, the best treatment protocols are being applied, however, more than a year after the start of the COVID-19 pandemic, the entire world is still faced with a large number of those afflicted with the infection and with the severe clinical presentation of the disease.

The corona virus has shown that it is not seasonal in its nature, that it spreads very easily from person to person, if preventive measures are not applied, and that it can surprise us when we least expect it [1],[2]. Worldwide, as of June 14, 2021, 175,541,600 people have been infected, and 3,798,360 people have died, while, in Serbia, as of June 14, 2021, 715,604 people have been infected, and 6,990 people have died [3].

STUDY OBJECTIVES

1. The presentation of the method of organizing epidemiological surveillance of the Epidemiology Department of the UCCS and the Emergency Center of the UCCS, as well the presentation of the application of COVID-19 prevention and control measures.

2. The presentation of the triage method for patients suspected of having COVID-19 at the Emergency Center of the UCCS.

METHODS

This paper presents an overview of professional recommendations and instructions for the epidemiological surveillance of healthcare facilities. Descriptive analysis has been applied for describing the Guidelines for the Rational Use of Personal Protective Equipment in Healthcare Facilities Depending on the Activities Performed [4], as well as the Recommendations of the Centers for Disease Prevention and Control (Atlanta, USA) [5].

RESULTS

In the period between March 1, 2020, and May 31, 2021, more than 490 thousand patients have been processed at the UCCS Admissions Service Triage Facility. The doctors and nurses at the Clinic for Emergency Surgery of the EC-UCCS have examined and taken care of more than 330 thousand patients, while more than 160 thousand patients were processed at the Internal Medicine Emergency Clinic.

Since the start of the COVID-19 epidemic in the Republic of Serbia, the EC-UCCS, through the support of the staff of the Department for Hospital Epidemiology of the UCCS, has been implementing all the measures for in-hospital prevention and control of COVID-19, based on the recommendations of the competent city and national institutions, and in keeping with the international and European recommendations related to measures for the prevention and control of COVID-19 [4],[5],[6],[7],[8]. Epidemiological surveillance of COVID-19 at the Emergency Center of the UCCS is based on the observance of recommendations for the control and prevention of COVID-19 in healthcare facilities, which relate both to patients but also to medical staff.

Based on the recommendations of the competent national institutions of the Republic of Serbia and the Recommendations of the Centers for Disease Prevention and Control (Atlanta, USA), the Algorithm for the Procedures with Patients with Suspected and Proven COVID-19 Infection for Patients of the EC-UCCS was formed (Table 1). This Algorithm has been in use since March 1, 2021 at the EC-UCCS Admissions Service Triage Facility.

Bearing in mind that the EC-UCCS is open to all patients and that it has been working continuously throughout the pandemic, each hospitalized patient must first be tested for COVID-19. According to the Algorithm (Table 1), if the patient has confirmed suspicion of COVID-19 at the reception desk of the EC-UCCS, he/ she is moved to the disinfected Isolation Room where surgical observation is carried out and, depending on the clinical presentation and the dominant symptoms and signs of disease, the consultant physician on duty is called in - for the purpose of further treatment, while the epidemiologist in charge is called in – to organize COVID-19 testing. Before entering the Isolation Room, the consultant physician on duty and the epidemiologist put on full PPE, as per the required procedure. In the period between March 3, 2020, and May 31, 2021, more than 1,500 throat and nasopharyngeal swabs were taken for the purpose of PCR testing for SARSCoV-2; almost 2,000 antigen tests were carried out, as well as more than a thousand serological tests for the presence of IgG and IgM antibodies.

Table 1. The Algorithm for the Procedures with Patients with Suspected and Proven COVID-19 Infection for Patients of the EC-UCCS comprises ten hierarchically linked procedures:

The Isolation Room is equipped with an ultrasound machine and a mobile X-ray machine, which is why a patient with suspected COVID-19 does not leave the Isolation Room unless it is necessary for the patient to undergo an additional diagnostic procedure that must be performed outside the Isolation Room (e.g., CT scan of the abdomen or thorax). In such cases the patient is equipped with a medical mask and his/her arrival is announced in advance.

When a patient, with suspected COVID-19 is brought into the Room for Surgical Isolation, the patients who had previously been in that room are moved to the space for internist observation. If the capacity of this space is filled out, the patients are temporarily moved to the Emergency Center library or to some other space allocated for that purpose. For example, depending on the clinical assessment, surgical patients with suspected COVID-19 are moved from the Isolation Room to Surgery 4 or directly to an operating theater, or to a room designated for patient isolation on the Intensive Care Ward. If the PCR test for a patient with suspected COVID-19 is negative, this patient is transferred to a surgical or internal medicine ward for further treatment, while patients with positive PCR tests are transferred to one of the hospitals designated for admitting COVID-19 patients.

Every time a patient with suspected or confirmed COVID-19 infection leaves the Isolation Room, for instance for CT diagnostics, or when they are taken to an operating theater, mechanical cleaning of the space is performed, as well as the disinfection of the space and surfaces [8]. In addition to this routine procedure, the rooms of the EC-UCCS are also disinfected with aerosol generating equipment (aerosol generating procedure or UVC disinfection), which additionally disinfects all vertical and horizontal surfaces within the EC-UCCS.

In addition to observing the Algorithm for the Procedures with Patients with Suspected and Proven COVID-19 Infection for Patients of the EC-UCCS, screening of medical staff for SARS-CoV-2 is also being carried out. Medical staff screening is performed by testing nasopharyngeal and throat swab specimens (PCR analysis and antigen tests) and blood samples (serological analyses). This screening is performed in keeping with the Professional Methodological Instructions for the Control of the New Corona Virus SARS-CoV-2 in the Republic of Serbia [8]. In the period between April 1, 2020, and May 31, 2021, more than 1,000 PCR tests were performed on the staff of the EC-UCCS, as well as over 2,000 antigen tests and serological analyses.

DISCUSSION

The University Clinical Center of Serbia (UCCS) is the third largest healthcare institution in the world [6]. The Emergency Center of the UCCS (EC-UCCS) is a part of this large system where, during a 24-hour period, more than 1,000 patients in need of emergency medical care, are treated. The patients examined in the examination rooms of the EC-UCCS are mostly from the territory of the City of Belgrade. Due to the level of medical equipment and the medical staff potential of this healthcare facility, patients with the most severe medical conditions and states of trauma from the entire territory of the Republic of Serbia, as well as from the region, are treated at the EC-UCCS, primarily in intensive care units

The Algorithm for the Procedures with Patients with Suspected and Proven COVID-19 Infection for Patients of the EC-UCCS has been in use as of March 1, 2020, onwards. The concise and clear explanations of this Algorithm provide precise instructions for the staff of the EC-UCCS regarding the correct procedures to be carried out in cases where there is a suspicion of COVID-19.

According to the Professional Methodological Instructions for the Control of the New Corona Virus SARS-CoV-2 in the Republic of Serbia [8] and the Algorithm for the Procedures with Patients with Suspected and Proven COVID-19 Infection for Patients of the ECUCCS, screening for SARS-CoV-2, for both patients and staff, is performed by sampling throat and nasopharyngeal swabs (for PCR analysis and antigen tests) and blood (for serological analysis).

The Covid Clinic of the EC-UCCS Epidemiology Department has been organizing and carrying out rapid screening of staff exhibiting signs and symptoms of infection indicative of SARS-CoV-2. The UCCS Microbiology Department (the “Fire Eye” laboratory) has been performing rapid diagnostics of COVID-19. Cooperation with the staff of all clinics and departments of the EC-UCCS has enabled the application and monitoring of preventive and control measures related to COVID-19 in the EC-UCCS. As in other branches of medicine, the multidisciplinary approach in the prevention and control of COVID-19 at the EC-UCCS, together with continued epidemiological surveillance of patients and staff, has made it possible for the EC-UCCS to continue admitting, processing and treating critically ill patients throughout the COVID-19 epidemic.

The COVID-19 pandemic has united humanity in the battle against the virus itself, but has, on the other hand, isolated and distanced people. However, despite all that has surprised us regarding the new corona virus infection, the human race has managed, yet again, to fight back against the unknown, and to start a long and difficult battle against the virus, using knowledge to create a mighty weapon – the vaccine.

Within a short time period, less than a year since the start of the COVID-19 pandemic, united scientific teams have given hope, providing a true way to fight COVID-19. New virus strains are warning us that professional efforts need to continue in our fight against the invisible enemy, whose effects on the human race are visible in all the aspects of modern life.

In addition to vaccination, which is undoubtedly the most important measure of COVID-19 prevention, our responsible behavior (wearing masks, hand hygiene, observing physical distance), especially in this period, when the number of infected people is rising and new strains of the virus are emerging, also remains an important measure of COVID-19 prevention and control.

The COVID-19 pandemic is one of those historical and epic tales which the next generations will not remember from personal experience; however, just as is the case with many other events of critical importance to humanity, COVID-19 will be spoken of as one of those that has changed the modern world.

CONCLUSION

In the past 15 months, more than 490 thousand patients have been processed at the Admissions Service Triage Facility of the Clinic for Emergency Medicine of the EC-UCCS. Observing the official guidelines and recommendations for the application of measures for preventing and controlling COVID-19, more than 160 thousand patients were processed at the Internal Medicine Emergency Clinic, while the doctors and nurses of the other departments examined and treated more than 330 thousand patients.

In addition to vaccination, which is undoubtedly the most important measure of COVID-19 prevention, our daily responsible behavior also remains an important measure of COVID-19 prevention and control, aimed at decreasing the number of infected persons and fighting against the new strains of the virus.