key: cord-0785643-umd47pue authors: Aicha, Chaibi; Amal, Mrani Alaoui; Fatima-Zahra, Lasri; Redouane, Abouqal; Naoufel, Madani title: New strategies proposed by clinical pharmacists in the management of the covid-19 pandemic in a developing country date: 2020-12-17 journal: nan DOI: 10.1016/j.phclin.2020.12.002 sha: 974d58e45f542b7fe910776fb40634b81016dc75 doc_id: 785643 cord_uid: umd47pue The current exceptional pandemic situation requires that health professionals reorganize and adapt their practices to face the crisis. The clinical pharmacy department of the Rabat Ibn Sina hospital has proposed a series of actions that aim to standardize practices, train teams and raise their awareness on environmental hygiene and personal protective equipment. The objective of the current article is to highlight the role of clinical pharmacists as well as the strategies and means implemented to reinforce protection measures and infection control within hospitals in the context of the SARS-COV2 pandemic. When the pandemic broke out, working strategy was declined in 7 steps. First of all, it became necessary to set up an expert made up of clinical pharmacists and their collaborators. The work started by collecting all the documents containing relevant data relating to the coronavirus. The next step was to draft and validate bio-cleaning protocols and the equipment information sheets. Training and simulations were organized with the different care units. During this health crisis, the clinical pharmacy department effectively adapted to the new situation and reinvented itself by putting personal protection and environmental hygiene as absolute priorities in addition to its routine missions. La situation pandémique exceptionnelle actuelle nécessite de la part des professionnels de santé une réorganisation et une adaptation des pratiques. Le service de pharmacie clinique de l'hôpital Ibn Sina de Rabat a proposé une série d'actions qui visent à standardiser les pratiques, former les équipes et les sensibiliser à l'hygiène du milieu et aux équipements de protection individuelle. L'objectif du présent article est de mettre en évidence le rôle des pharmaciens cliniciens ainsi que les stratégies et moyens mis en oeuvre pour renforcer les mesures de protection et la lutte contre les infections dans les hôpitaux dans le contexte de la pandémie du SRAS-COV2. Le travail a commencé par la collecte de tous les documents contenant des données pertinentes relatives au coronavirus. L'étape suivante a consisté à rédiger et à valider les protocoles de bionettoyage et les fiches d'information sur les équipements. Des formations et des simulations ont été organisées avec les différentes unités de soins. Le service de pharmacie clinique s'est réinventé durant cette crise sanitaire et s'est adapté efficacement à la nouvelle donne en faisant de la protection individuelle et de l'hygiène du milieu une priorité absolue en plus de ses missions habituelles. The current exceptional pandemic situation requires mobilizing all energies and resources to care patients suffering from the SARS-Cov2 virus within hospital services as well as the protection of the medical staff. In addition to the National Watch and Response Plan for the Coronavirus 2019-nCoV infection issued by the Moroccan Ministry of Health [1], this situation requires that health professionals reorganize and adapt their practices to face the crisis. In Morocco, clinical pharmacy was introduced in 2017 through the full-time assignment of internal and resident pharmacists to different healthcare units including Emergency department and Intensive Care [2] . As part of the healthcare team, pharmacists have access to medical information relating to the patients and to the service. Clinical pharmacists main missions include the optimization of therapeutic strategies, the fight against iatrogenia, information and training on health products and development of protocols on healthcare practices. Clinical pharmacists also stand as contact persons between the central pharmacy and hospital services. When faced with a new infectious respiratory disease, as is currently the case with the COVID-19 pandemic, it is essential that healthcare professionals, or anyone who comes into contact with a suspected or infected patient, comply with WHO guidelines on infection prevention and control (PCI) [3] . Infection spread control within hospitals requires a rational and correct use of protective means while respecting their proper use, but also a strict bio-cleaning system. Such strategies take time and are difficult to implement in the current emergency context [4] . When the pandemic broke out, five hospital services were turned into dedicated COVID-19 care units and healthcare staff needed to have precise guidelines on the use of personal protective equipment (PPE). Step 3: Definition and prioritization of the actions to be carried out on the basis of the problems observed; these actions concerned two areas: PPE and bio-cleaning. Step 4: Constitution of two working groups: one group worked on the bio-cleaning protocols and Step 5: Drafting and validation of bio-cleaning protocols and PPE information sheets Step 6: Training and simulations with the different teams of the "COVID-19" care units. Step 7: Communication with printing and posting of PPE information sheets at the entrance to all departments hosting COVID-19 patients and at the hospital pharmacy. Personal Protective Equipment (PPE) information sheets: Given the data available at the present time on the SARS-COV2 virus, contact precautions are recommended regarding respiratory droplets for routine healthcare of patients whose infection with COVID-19 is either suspected or confirmed [5] . The protection of individuals is one of the key elements of this pandemic, which implies the proper use of PPE as well as a strict compliance with the indications to avoid a risk of shortage. The practical PPE information sheets elaborated are as follows: 1. Principle of wearing masks intra-hospital in the context of the coronavirus pandemic: appropriate conditions of use of FFP2 masks and surgical masks. The elaboration of these sheets was inspired by WHO [6] .However, the protection level has been increased while taking into account the stocks available. A training intended for the healthcare staff was carried out on the correct use of masks, the objective was to raise their awareness to the interest to wear a mask, to list the difference between a surgical mask and a FFP2 mask, to show how to wear the mask and when to change it. The training was also an opportunity to remind the healthcare staff of the importance of hand washing. Bio-cleaning protocols: According to a study published in the NEJM [7] on March 11, 2020, the Covid-19 can continue to live in the air for several hours and on certain surfaces for two or three days it also reveals that plastic and stainless steel offer greater stability to the virus. This same study shows that SARS-CoV-2 remains viable and infectious in aerosols for up to 3 hours. Another recent article by Ong et al. [8] evaluated viral dispersion intra-hospital by taking samples of air and surfaces in the room of hospitalized patients, before routine cleaning, SARS-CoV-2 was identified on 61% of the samples of surface in a patient's room. As SARS-COV-2 is an enveloped virus, the guide from the European Centre for Disease Prevention and Control (ECDC) indicates that the standard EN 14476 for detergents / disinfectants is recommended for enveloped viruses and would by analogy inactivate SARS-CoV -2 [9, 10] . As all this data highlights the spread and persistence of the virus in the environment, it was essential for the team to take environmental and technical measures. New protocols have been developed on the basis of former ICC protocols by incorporating data related to SARS-COV2: Furthermore, an email gathering all these files and protocols was sent to the heads of departments of the "COVID-19" units for dissemination of the information. A document containing all the PPE information sheets and bio-cleaning protocols was also handed over to each service for the healthcare staff. All of these documents were also sent by email to pharmacists and doctors in other hospitals. During this health crisis, the clinical pharmacy department effectively adapted to the new situation and reinvented itself by putting personal protection and environmental hygiene as absolute priorities in addition to its routine missions. Other pharmaceutical teams, especially in developing countries, could implement the strategies developed in this article in order to reinforce intra-hospital safety measures and improve working conditions for their healthcare staff. Interventions pharmaceutiques dans un service d'urgences médicales : résultats de l'expérience d'un pays du Maghreb Modèle pour l'évaluation de la prévention et du contrôle des infections (PCI) au niveau des établissements de soins Personal protective equipment for preventing highl y infectious diseases due to exposure to contaminated body fluids in healthcare staff Recommendations and guidance for providing pharmaceutical care services during COVID-19 pandemic: a China perspective Rational use of personal protective equipment for coronavirus disease (COVID-19) and considerations during severe shortages Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1 Air, surface environmental, and personal protective equipment contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from a symptomatic patient Disinfection of environments in healthcare and non-healthcare settings potentially contaminated with SARS-CoV-2 SF2H. relatif aux conditions de désinfection des surfaces lors de la réalisation d'un scanner ou autres actes d'imagerie chez un patient COVID-19. 05 avril 2020