Dermatologists in China share safety measures amid COVID-19

A group of dermatologists from West China Hospital of Sichuan University detailed some of the measures they took in attempting to treat patients in the midst of the COVID-19 outbreak.

Yusha Chen, MD, of the department of dermatology at West China Hospital of Sichuan University, and colleagues wrote that the number of dermatology clinics was cut in half, as a starting point. When possible, telemedicine visits were conducted, and patients who had appointments that could be postponed were asked to do so.

“People entering the outpatient and inpatient buildings must wear masks and have their body temperature monitored by professionals wearing tight protective clothing,” they wrote. “At the entrance of the building, anyone with a fever (body temperature 37.3°C), travel history to Wuhan in last 2 weeks, clear contact with residents in Wuhan in last 2 weeks or contact with people with a fever would be directly sent to the fever clinic for screening.”

Given their exposure, a 2-week quarantine period was instituted. People with potential exposure were asked to quarantine themselves at home for 2 weeks.

“During the skin clinic, patients are not allowed to take off their masks except on indications of facial lesions,” Chen and colleagues wrote. “Doctors must wear masks, surgical caps, protective suits, gloves and goggles at work; they take off their protective equipment only after their work in a designated disposable area.”

Educational activities at West China Hospital were canceled. The hospital also instituted psychological counseling for patients concerned about the infection.

In an accompanying editorial, Dirk M. Elston, MD, of the department of dermatology and dermatologic surgery at the Medical University of South Carolina, wrote that the paper by Chen and colleagues should serve as a reminder that every dermatology clinic should have infection control policies in place.

“Patients with varicella, measles and other viral exanthems present to the dermatologist and may pose a risk to patients and office staff,” Elston wrote. “Employees should receive all appropriate vaccinations, and testing should be available for employees to determine their immune status.”

Women of childbearing age should be particularly cognizant of these protocols, according to Elston. He added that a negative pressure isolation room should be available for patients with respiratory pathogens and that furlough policies should be in place for patients who have had exposure to various infectious vectors.

Another key consideration is that while large health systems have infection control policies in place, private practice dermatologists may need to review policies to ensure optimum safety in the eventuality that a patient with exposure to an infectious pathogen enters the clinic.

“Our responsibility for patient and employee safety is not limited to respiratory pathogens,” Elston wrote. “Virulent streptococcal infections associated with necrotizing fasciitis and death have been spread during liposuction in outpatient facilities.”

Blood-borne infectious pathogens also deserve some consideration, according to Elston. He suggested that every dermatologist should review the literature for protocols in managing these cases.

“Standard precautions should be enforced, and policies should be in place for postexposure prophylaxis,” he wrote. “As captains of our individual ships, it falls to us to put policies in place to prevent the spread of disease and prepare for the needle-stick injuries and transmissible diseases that are part of the practice of medicine.” – by Rob Volansky

Disclosures: Chen and colleagues report no relevant financial disclosures. Elston reports no relevant financial disclosures.