Dr Clive Fernandes, Group Clinical Director, Wockhardt Group Hospitals, Consultant, Joint Commission International Expert at ISQua, RPI Certified Yellow Belt shares insights on how hospitals can successfully deal with challenges that they encounter during the COVID 19 crisis
Today, COVID 19 is the most searched for term on google. The daily number of invitations sent out by anyone and everyone on LinkedIn, Zoom and other mass conferencing platforms regarding education and webinars on all aspects related to COVID would seem to indicate that we have mastered all aspects of the disease. But the stark reality on the ground is different.
There are many challenges that healthcare organisations are facing due to the ongoing Covid19 pandemic. Below are a few of the challenges and how we at Wockhardt hospitals are dealing with them
Lockdown and shutting down of public transport
Since most staff use public transport to commute to the hospital they were left with no mode of transport. Our HR department responded quickly, liaised with the local municipal authorities and arranged for buses from major routes ensuring that staff were able to reach the hospital. Staff using their personal vehicles had their hospital ID cards as well as an official letter on the company letterhead stating that they were part of essential services.
Focus on infection prevention and control at hospital entry points
Screening and triage, an effective screening process helps in identifying and mitigating risks. Every person entering the hospital had to undergo the thermal scanning for temperature and were asked six screening questions (which were based on the symptoms of COVID 19). If the answer to any question was yes, they had to see a medical officer before they were cleared to enter the hospital. Everyone had to practice hand hygiene at the entrance gate of the hospital and had to wear a 3-ply mask before they entered the hospital.
Segregating COVID / suspected COVID patients from routine patients
Wockhardt established a dedicated COVID unit to prevent cross infections among patients with COVID symptoms /diagnosis and other patients. The dedicated COVID 19 unit had a separate entrance and exit. This unit had its own air handling unit that ensured that the airflow did not mix with the airflow with the other parts of the hospital. We identified dedicated staff for this unit and defined additional safety protocols for all clinical processes like medication ordering and administration, food handling, waste handling and clearance etc.
Personal Protective Equipment and its related challenges
Personal Protective Equipment, PPE, is essential to prevent the spread of infection from one person to another. PPE requirements were defined and were provided by the hospital daily to all level of associates as per their exposure risk (from the security guard, cash handlers in the billing department, to clinical staff). We had defined and provided an elaborate PPE kit to all associates working in the COVID unit.
Donning and doffing process
The process of sequentially wearing the PPE is known as donning and the process of sequentially removing the PPE is known as doffing. We identified rooms with a separate air handling unit for donning and doffing. Since these processes are very important, all associates were individually trained in both. Greater emphasis was laid on training staff on the doffing process as if not done correctly there would be a risk of infecting fellow associates. Staff were assigned a buddy to help them familiarize themselves with the processes until they became comfortable. In the donning and doffing rooms, we posted posters on the wall that illustrated sequentially the steps to be followed for the processes and included a demonstration video on donning and doffing that was available on an iPad. There was an assigned showering room adjacent to the doffing room and we made showering post doffing mandatory. This step was taken to eliminate any risks of contamination being transferred out of the unit.
Addressing staff issues
This was the most important challenge that most healthcare organizations faced and continue to face and have to deal with on a daily basis. These are divided into two main categories
Fear of working in a COVID unit– This was a genuine fear as we encouraged social distancing and highlighted the contagious nature of this virus while at the same time had our staff assess patients, administer medications and do procedures if required. We were able to overcome this challenge to an extent by training staff on how the disease was transmitted and how it could be prevented by properly donning and doffing the provided PPE. The showering protocol that we defined post duty actually helped ease most of the staff’s apprehensions. The initial challenge was designing showering facilities in the vicinity of the doffing rooms but our maintenance department did a wonderful job in overcoming that challenge.
Society and neighbourhood issues – The fear created by this pandemic has been such that the very people who came out in their balcony and flashed lights and banged plates to appreciate healthcare professionals acted very differently in reality. Many healthcare professionals were informed by their landlords/societies that they would not be allowed to return home if they went to the hospital. We dealt with this by allowing our staff to stay at the hospital but then this actually decreased the hospital’s available capacity to admit patients.
Reinforcing social distancing – Many times once associates moved back to the hostel post duty they tended to relax safety protocols especially the ones dealing with social distancing. We continuously kept educating staff to follow this 24*7. We identified “marshals” who moved from one department to another enforcing the social distancing norms, especially at tea breaks/meal times where we had witnessed maximum violations. We also instructed staff to prepare a daily line list of all associates with whom they came in close contact with and instructed department heads to check the lists periodically. This helped us to reinforce the social distancing protocol and if any staff tested positive for COVID we were able to easily identify, quarantine and observe their contacts for symptoms.
Today, we all know with absolute certainty that COVID 19 is no myth. It is a reality; something that has changed our way of life in many ways and this is just the beginning. COVID 19 is here to stay and will be a part of our lives going forward. We will have to adapt, and we will adapt and change many things in our way of life going forward.