A pandemic is declared

In march of this year the WHO declared corona virus as a pandemic and it through the whole world into a spin. Airports were shut down, schools were closed and ultimately countries shut down, run and hid!

Now several months later we realized that we have to live and work with the virus around us. So the governments and health ministries came up with guidelines for us to follow to be able to stay safe and if we are infected keep others safe. For the person working an office job this is cumbersome but manageable (someone like me!).

However, for the healthcare workers on the front line its a lot more scary. Its akin to firefighters who on a daily basis thrust themselves into burning buildings to save lives when the rest of us would just pick up our skirts and run in the opposite direction.

In essence the more effort we put towards keeping ourselves safe the more we keep our patients safe and ultimately the community at large.

Working Safe

We must continue to speak up for health worker safety. Ensure that all the bare minimum personal protective equipment is provided at the least and then strive to provide better or higher quality PPEs where possible. We must also educate the public on the type and level of protection that they need so that the rest and more specialized materials can be reserved for the health workers.

We also need to incentivise our local manufacturers to continue producing the PPEs and ensure that we meet continued demand.

During the pandemic we have realized the value of primary healthcare and the need to boost the capabilities of the lower level facilities (1-3) and this way mild conditions can be managed at these sites without having to move majority of the patients to level 5/6 facilities even when they are being managed with minimal interventions.

We have by now probably participated in lots of training (we are basically seeing them in our dreams!) and now know proper procedures for donning and doffing our PPEs. But just in case you need a refresher, watch this video on proper practices https://youtu.be/t1lxq2OUy-U that was done by the CDC.

More than the risk of contamination by various pathogens we also have to consider, risks of mental stress or distress. A lot of health workers during this period have seen more death than they have ever experienced in their entire careers. Issues like burn out also come up for example in the African setting there is a huge shortfall in HRH to patient ratios. In times of pandemics and high health worker demand, this variance is even more visible. As many patients are still being admitted and the ones already in care are under care for longer periods, the health worker is left to work for longer periods and under higher stress scenarios. This can lead to poor decision making or even an increase in risk behavior. As employers we need to focus on this side of our health workers and ensure to establish focus groups or opportunities for the teams to decompress and share their experiences (virtual meets preferred to account for social distancing). Studies have shown that we spend almost one third of our live at work if not more.

Patient Safety

Patient safety is a serious global public health concern. It is estimated that there is a 1 in 3 million risk of dying while travelling by airplane. In comparison, the risk of patient death occurring due to a preventable medical accident, while receiving health care, is estimated to be 1 in 300. Industries with a perceived higher risk, such as the aviation and nuclear industries, have a much better safety record than health care does.

According to the WHO fact sheet on patient safety 1 in 10 patients is harmed while receiving care and further 4 in 10 patients is harmed in an primary or outpatient health care. Out of every 100 hospitalized patients 10 (in low income countries) will develop on or more hospital acquired infections (HAIs). Take for example the number of patients that have so far been admitted for COVID complications, 10% of them will likely develop HAIs.

One of the basic principles that is always taught in first aid is to ensure that as a first aider we are not in any danger before we go to help a victim. I feel that this principle can be extrapolated to health worker safety especially during this time. Keep yourself safe and keep your patient safe.

Remember that its not the PPEs themselves that keep us safe but how we choose to use them.

PPEs Optimization

Most healthcare facilities have difiiculy in assessing the needed PPEs, therefore the best way to deal with this is to come up with strategies that are easy to implement and track. The facilities need to assess their surge capacity, that is their capacity to deal with a sudden increase in demand for PPEs.

Using the CDC PPE burn rate calculator a facility can determine their surge capacity. This calculator is based on three strata namely: conventional capacity, contingency capacity, crisis capacity. The calculator is available for download and requires some excel competency. For the calculator to work well a facility must understand their utilization rate, inventory, additional supply sources among other criteria.

Syspharma has an occupational assessment tool that looks at the risk of exposure but also analyses the use of PPEs per department or per facility. This can be very useful for planning purposes as a unit or a sector. Want more info@syspharma.co.ke

References

https://www.who.int/features/factfiles/patient_safety/en/

https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html Strategies for optimizing the use of PPEs.

We are hopeful that as humanity we will beat this scourge of the corona virus but as we do it, we best do it in the right way, with the right tools, to protect from further loss of life or materials. Stay safe, stay masked!