Dedicated ward for Black Fungus patients must be created in all hospitals of Assam: New SoP

June 11: A Standard Operating Procedure (SOP) has been issued  by the Assam Health and Family Welfare  Department to the Hospitals following the detection of some suspected cases of mucormycosis or black fungus in the state. The new directive was issued to contain the further spread of the disease and it will come into effect with immediate effect and will remain in force till further orders.

1. Early identification of COVID/Non-COVID patients at risk for Mucormycosis including patients with Uncontrolled Diabetes Mellitus (especially having Diabetic Ketoacidosis), Neutroperuc patients with a history of frequent blood transfusion( may lead to increase free iron in the blood) any immune suppressant state and those into long-standing chronic issues including kidney diseases and subsequent follow up must be ensured.

2. Injudicious use of Steroids and Broad Spectrum Antibiotics I prophylactic Anhfungal particularly Vonconazole must be avoided at all costs

3 Possible sources of Mucormycetes in the hospital environment like Damp wall and floor. AC filters Old food matenals. Any organic materials. Soiled and contaminated linens including bandage etc. Soiled and contaminated mask. Equipment and devices used for patient care, Contaminated oxygen Cylinder, and its accessories. Humidifiers, Leakage in water pipes, etc should be specifically checked frequently to avoid any occurrence of mucormycosis.

4 Accordingly the following actions must be taken strictly in all health institutions:

• Regular cleaning and wet mopping of ICU wards and hospital premises at least two times a day
• No food materials should be kept inside the hospital Premises for more than one hour
• Hospital environment should be free of all organic materials.
• Regular cleaning and changing of equipment and devices.
• AC filters have to be cleaned at least monthly in the ICU
• Oxygen cylinders including accessories have to be cleaned before taking into hospital premises
• Daily decontaminate delivery tubes and masks
• Daily disinfect and refill humidifier Humidifier bottles must be changed once in a week for the same patient and in between patients Only STERILE waters to be used in the humidifiers
• Humidifier bottle must be cleaned with mild detergent and hot water using a small brush and dry
• Weekly cleaning of the cylinder valve and flowmeter
• Nasal cannula to be changed in 2-4 weeks

Patient’s care:

1 There should be a dedicated ward for Mucormycosis Patients A separate waste disposal mechanism has to be in place

2. A multi-specialty team, that includes specialists from Oro-Facial maxillary, ENT, Neurosurgery, Ophthalmology, and plastic surgery should be ready for immediate surgery as debridement tissue is the only confirmatory treatment.

3 All high-risk patients who had steroid treatment should be subjected to baseline Neutrophil count and then every third day until discharge. In case the Count less than normal, they should be screened for any fungal infections

4 The use of prophylactic antifungal particularly Vonconazole has to be restricted

5 The use of Broad-Spectrum Antibiotics has to restrict and judiciously administered.