Equipping Healthcare Facilities to Tackle the rapid spread of COVID-19
By Maki San
Tangible strategies for healthcare facilities to adopt in the fight against Coronavirus.
India at present has 96,405 Coronavirus positive cases and 3,040 people have lost their lives to the deadly virus as on May 18, 2020. Globally, it has infected 47,10,614 people, of whom 3,15,023 have lost their lives. Unfortunately, several doctors, nurses and paramedical staff who have been tackling the virus from the front line have got infected and COVID-19 has claimed some of their lives as well. At the present critical situation, the healthcare facilities must be well prepared to prevent the spread of the virus that is infecting thousands of people in a couple of hours.
The COVID-19 outbreak has stretched healthcare infrastructure and straining health systems worldwide. There is a rapid increase in demand on health facilities and health care workers resulting to overstretch and making it unable to operate effectively among some health systems. It is imperative to have a strong health system to combat any sudden outbreak. India needs a certain infrastructure to deal with the same. Currently, it is reported that logistics of essential commodities to healthcare facilities, everything is super-strained in almost all nations. Creating an infrastructure and resources to support physicians, nurses and care team members is vital. Moreover, optimal utilization of the available resources and supplies becomes crucial during this crisis.
The healthcare providers must adopt a strategy focusing on three essential highlights - how equipped they are to cope with the present situation, their plan of action to protect the workforce and their plan of action to protect the patients and prevent the spread of infection.
Measures that can prep up healthcare providers to face the crisis
Know everything about the local COVID-19 situation: Hospitals must be aware of the local situation and have access to the government sources of information about the pandemic and be on par with the regulations and line of action being issued by the government, both centre and state for better monitoring of the situation. It must follow the strategies being developed by the government for safe transportation and isolation of patients for prevention of transmission.
Work on or review the facility's emergency plan: This is the time when a healthcare facility may need to develop or review its emergency plan. It may have to work with less staff and yet have to handle a large number of patients due to the COVID-19 outbreak. The hospitals must have alternative staffing plans to ensure availability of as many of the staff as possible to cater to the increasing number of patients.
Keep in constant touch with other key private and public healthcare providers in the community and make an emergency contact list: It is essential to work in collaboration, learn about plans to manage patients, accept transfers as well as share supplies. Additionally, an emergency contact list for key partners should be kept handy for people to know how to reach a facility during an emergency.
Create COVID-19 Task Force Team: Many policies related to COVID-19 medical care have to be made. We formed a COVID-19 task force team consisting of multi-disciplinary categories and all policies are drafted by this team. Once a policy is made, the team will communicate & train the people.
Measures to protect the workforce from contraction and burnout
Screen every patient and visitor who steps on the hospital premises: Make arrangements to test every patient and visitor for symptoms of acute respiratory illness like cough, fever, travel history or exposure to COVID-19 suspect/positive patient, difficulty in breathing and more before they enter the healthcare facility.
Use effective strategies like disinfectant tunnels to combat the spread: Disinfectant tunnels work on a simple principle: All employees and visitors have to be encouraged to wear the mask & the house keeping team has to do the frequent disinfection especially for high-touch areas. This can significantly bring down the number of germs on an individual and can be useful for all public places including hospitals that see an influx of a large number of people.
Ensure efficient use of personal protection equipment (PPE): It is of utmost importance for healthcare personnel coming in close contacts with infected people to wear PPE including face protection, goggles and mask or face shield, gloves, gown or coverall, head cover and rubber boots providing standard precautions against airborne high infections. Also, it is essential to plan out a strategy to create an inventory of available PPE and find out strategies to optimise PPE supplies and reusing policy. For instance, we are reusing N95 masks by using alternatively i.e. 5 masks per person.
Let sick employees stay at home: Hospitals must make their sick leave policies flexible in adherence to the government guidelines and encourage staff who develop respiratory symptoms like fever, cough and shortness of breath to not report to work and stay at home or provide accommodation facility.
Arrangements with hotels, service apartments should be considered for staff quarantine and mid rooster breaks due to the vulnerability of the profession, this way the family’s care takers can be at bay. Hostel beds needs configuration to keep social distancing and disinfection. Careful investments on PPE, fever clinic, infrastructure with negative pressure ventilation needs to be arranged as it will be the norm going forward.
Work towards managing workers’ burnout: In the wake of the Coronavirus crisis, the doctors, nurses and paramedical staff who are dealing with the health crisis from the front line are undergoing immense stress, anxiety, burnout and depression. They are in constant fear of passing off the infection to their family members or going through a financial crunch. The hospital management must ensure to support the workers in every way possible. Burden on the healthcare workers should be reduced via organisational strategies for respite to avoid excessively long shifts, maintaining access to breaks for food, snacks and bathroom along with the assurance that their family members will be taken care of in case they get infected. It can implement financial protection for all of its staff and also relax the leave policy so that the workers stay at home without hesitation in case they develop any flu-like symptoms.
Workload redistribution is a necessary step. One way is to allow medical assistants and nurses to make contributions according to their abilities. Splitting and rotating the teams in a hospital not only reduces the risk of infections but help them to rest better after long hours of working. Rotational shifts also proven to drastically improve knowledge retention and enable workers to perform more quickly.
Measures to protect patients and keep spread of infection at bay
Isolate infected patients and keep them separate: In order to prevent the rapid spread of virus, it is essential to contain those who are already infected in one place. The hospitals must identify a separate, well- ventilated place allowing patients to be isolated from the visitors.
Find out strategies that can prevent patients who can be cared for at home from coming to the hospital and exposing themselves to the virus: This could be achieved by leveraging telemedicine technologies and self-assessment tools, using telephone to deliver messages to incoming callers about when to seek medical care, emergency care and where to connect for getting information about caring for a person with COVID-19 at home. Coming up with distinct helplines can be more useful.
This is the need of the hour for the healthcare facilities and hospitals to equip themselves to provide adequate protection to both the patients and its health workers in order to contain the spread of Coronavirus besides the social distancing, self-quarantine guidelines and lockdown being followed by the entire nation. With hospitals adopting the appropriate strategies, it will become much easier for India in particular to overcome this crisis situation.
Author : Maki San, Managing Director, Sakra World Hospital