COVID-19
In January 2020, the Alliance began to collaborate with WHO SEARO WHE team in the adaptation of the IMAI Quick Check+ tools and the IMAI DCM. The aims in producing the WHO SEARO IMAI SARI tools for country use were to:
Develop health worker clinical skills to reduce mortality from SARI – emphasizing district hospitals without an ICU.
Strengthen the clinician’s role in disease surveillance and response, particularly for influenza and other SARI.
Improve health worker skills in use of appropriate IPC and other precautions, by suspected pathogen, to prevent transmission within health facilities.
Support hospital clinical team implementation planning followed by mentoring and monitoring and evaluation to inform current and future quality improvement activities.
With the arrival of the pandemic, the tools were immediately focussed on COVID-19 clinical management and infection prevention and control (IPC), while retaining their relevance for all SARI. The method of delivery of training for both participants and training of trainers switched from on-site to remote training, using Zoom.
The SEARO SARI tools were adapted to SEAR country epidemiology and iteratively improved based on feedback from SEARO staff and experts to date and early use in Myanmar, Cox’s Bazar and Timor-Leste. They were updated multiple times to keep current and fully consistent with the WHO Headquarters COVID-19 current guidelines.These tools are available to adapt in each country and will be posted on the WHO SEARO WHE site in the near future; until then, access can be requested by email.
This training is complementary to the SARI critical care training for ICU physicians but is aimed at a lower level- the district hospital clinical team who will be evaluating and managing patients before transferring critically ill patients to an ICU, if available. District hospital clinicians (both doctors and nurses) often need a detailed, skills-based approach to learn how to manage respiratory distress and septic shock. Training beyond the central hospitals with ICUs helps assure early detection, isolation and treatment for severely ill patients. This decentralization supports life-saving interventions for severe respiratory distress, septic shock and other emergency conditions in the first hours after presentation to district hospital. Integrated clinical/IPC training can give clinicians the confidence to provide good clinical care while protecting themselves with appropriate IPC.
In addition to practical clinical exercises in how to give and titrate oxygen (to preserve limited supplies), the IMAI oxygen survey used for years in Uganda then Nepal was expanded and adapted to become the SEARO IMAI Oxygen Survey, which was disseminated starting in April 2020 to the SEARO countries and shared with HQ and other colleagues. This focused survey tool allows the rapid on-site assessment of all oxygen sources (cylinders, concentrators, oxygen plants and liquid oxygen), followed by a calculation of total availability of oxygen in each hospital and estimation of how many adults with severe respiratory distress can be managed.