The Impact Of COVID-19 On Outpatient Department Laboratory Hospital Universiti Sains Malaysia
Noorazliyana Shafii1,3, Julia Omar1,3, Zulkarnain Mustapha1,3,Aniza Mat Jelani1,3, Noor Azlin Azraini Che Soh1,3, Wan Norlina Wan Azman1,3, Tuan Salwani Tuan Ismail1,3, Hanim Afzan Ibrahim2,3, Nur Karyatee Kassim2,3
- Pengarang Koresponden:
Dr Noorazliyana Shafii
Department of Chemical Pathology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia.
Coronavirus disease 2019 or COVID-19 has caused major outbreak and give tremendous effects worldwide. It spreads via human-to-human transmission through droplets or direct contact with a mean incubation period of 6.4 days to become infectious. The most common symptoms are fever followed by cough with bilateral lung involvement as evidenced by the appearance of ground-glass opacity on computed tomography of the chest1. The disease was discovered in Wuhan City, Hubei Province, China early December 2019 and was first reported by World Health Organization (WHO) on 31st December 2019. In Malaysia, the first positive case of COVID-19 was reported on 25th January 2020 from three Chinese citizens who came to Johor from Singapore2. The cases were inceased exponentially in March 2020 following religious event at Sri Petaling, Kuala Lumpur3. Since then, the positive cases and mortality due to COVID-19 kept on increasing until we recorded the highest COVID-19 positive cases in South East Asia. In order to control the spreading of the virus and the mortality, Movement Control Order (MCO) was implemented from 18th until 31st March 2020 to restrict the movement of the people into or out of an area4. Then, it was continued with Conditional Movement Control Order (CMCO) and Recovery Movement Control Order (RMCO). Currently, we are in the third wave of the pandemic COVID-19 with 113,010 confirmed cases (till 31st December 20)5.
COVID-19 has given a big impact on the health system. It has changed normal operation and gives psychological impact to the staffs such as working pressure and the fear of being infected. The health system needs to have a strategic planning and actions to provide the best services and safe environment in order to prevent the risk of infection to the staffs and the patients. Hospital Universiti Sains Malaysia (USM) has no exception and has to adapt to the new norms. Although Hospital USM is not gazetted as a COVID-19 centre, we also need to prepare ourselves in managing patients with suspected acute respiratory illness (SARI) before transfer them to COVID-19 hospitals after a positive COVID-19 test. Outpatient Department (OPD) laboratory of the Department of Chemical Pathology is one of the laboratories that directly involve with the patients. OPD laboratory provides capillary blood glucose testing and receives blood and urine samples from the clinics. The blood is analysed for blood urea serum electrolytes, serum creatinine, serum calcium and serum bilirubin. For analysis of the urine, OPD laboratory offers urine analysis (urine full microscopic examination and chemical analysis (dipstick)), microalbumin and urine pregnancy test. Blood samples are sent and analysed in the Chemical Pathology Laboratory while capillary blood glucose testing and urine samples are analysed in OPD laboratory. The most samples received are from Klinik Pakar Perubatan and Klinik Rawatan Keluarga for diabetic monitoring.
In 2019, the total number of patients in OPD laboratory was 21,132 with the average of 1761 patients per month. Compared with 2020, there was a 32.7% reduction of the patients with the lowest in April (Table 1). This is due to the limitations of patients’ appointment by the clinics as the MCO began. The patients with certain condition such as uncontrolled blood pressure or blood glucose which require medications adjustment were given appointment. For the stable cases, the consultation and continuation of the medications were done through COVID-19 hotline. During this time, OPD laboratory only received samples from the low risk patients as patients with SARI were initially screened by the respective clinics. The number of patients started to increase in June 2020 as the RMCO phase was implemented between 10th June and 31st August after the end of the CMCO phase6. The clinics allowed more patients to come for the appointment since the COVID-19 cases were reduced and the community were permitted to continue their works with the standard operating procedure (SOP). From August to October 2020, the number of patients was static but still reduced compared to pre-pandemic. At the end of 2020, the number of patients dropped in November as Kota Bharu was declared a red zone7 and the numbers were slightly increased in December as a result of reduced COVID-19 cases in the state in early till mid-December.
Table 1: Total number of patients in Outpatient Department Laboratory, Hospital USM from January till December 2020.
OPD laboratory has made improvements to the working environment in order to comply with the SOP to reduce the transmisson of COVID-19. The waiting area was re-arranged with the physical distancing of one meter between the patients (Figure 1). The SOP from Ministry of Health were displayed so that the patients can read. Hand sanitizers were prepared for the staffs and patients. For those who need the masks, they can get the masks from the staffs without the need to find at other places (Figure 2). The counter has also been modified to create a barrier with the patients to avoid direct contact (Figure 3).
Figure 1: The arrangement of the sit at the waiting area to ensure physical distancing between the patients.
Figure 2: The face masks and sanitizer for the patients with the flyer on the wall.
Figure 3: The innovation at the main counter.
In order to ensure the safety of the staffs, to reduce the exposure and to prevent the transmission of COVID-19 during MCO, the staffs were limited to a minimum numbers working per day (3 staffs/day). The capillary blood glucose testing was restricted to avoid close contact with the patients. All staffs must follow the standard precautions during working and when handling the clinical specimens as the specimens may contain potentially infectious materials. Standard precautions include hand hygiene and the use of personal protective equipment (PPE), such as laboratory coats or gowns, gloves, and goggles or face shields for eye protection (Figure 4). Although COVID-19 is less likely to be transmitted through the conjunctiva, the staff still need to wear protective goggles or face shield as eyes and nose are very closely located8. Due to the limited supply of the gown, face shield and hand sanitizer, the department took an initiative to sew the gown and made our own face shield and hand sanitizer. The gown is made from non-woven fabric while the face shield is made of clear plastic that provides good visibility. The hand sanitizer has at least 70% strength of alcohol as recommended. All items produced followed the safety standard9. The face shield that has been invented is shown in Figure 5. By doing this, we can prevent sortage of these items and reduce the cost as well.
Figure 4: OPD laboratory staff in full personal protective equipment.
Figure 5: The innovation of the face shield.
In conclusion, COVID-19 has given a huge effect on the health system. The spreading of this virus among health care workers can be prevented by strictly following the SOP and practising the slogan 'Kita Jaga Kita'. In order to avoid overlooked positive cases, the clinician must work hand in hand with the laboratory staff to reduce the transmission and necessary management can be carried out in these patients.
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- Situasi Terkini COVID-19 di Malaysia 31 Disember 2020. 2020; http://covid-19.moh.gov.my/terkini. Accessed 31 December 2020.
- Loo C. CMCO ends June 9, Recovery MCO from June 10 to Aug 31 (Updated). The Sundaily. 7 June 2020.
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