On the 31st December, 2019, the global health community woke up to the first reported case of the novel coronavirus (Covid-19) from Wuhan, China. By 31st January, 2020, the World Health Organization (WHO) had elevated the threat level posed by the outbreak as a result of its fast pace of spread. The disease has since been declared as a “Public Health Emergency of International Concern (PHEIC)” by the WHO.
There is presently (19th February, 2020), about 75,201 confirmed cases with 2,012 deaths. Of the total number of confirmed cases, 14,887 have recovered so far. There are also 30 countries that have been affected by this epidemic. Unlike in 2014 and 2015 when three West African nations i.e. Guinea, Sierra Leone and Liberia were ravaged by the scourge of the Ebola outbreak that recorded about 11, 316 deaths and 28,039 confirmed/suspected cases, the continent is yet to record any confirmed case of the novel Coronavirus. Though there have been alert of suspected cases in Cote d’Ivoire and Ghana but have all tested negative.
Healthcare workers have however not been spared of mortalities and casualties in their quest to support the fight against global epidemics. A 34-year old Chinese doctor (who reported the first case) was reported dead on Thursday 6th February, 2020 while 1,760 medical staffs who volunteered to be at the frontline have contracted the disease while delivering care and “six have died”,. A hospital in Wuhan reviewed data of 138 confirmed cases and found 29% (40) of healthcare workers to have been affected mainly through hospital associated infections. During the Ebola epidemic in the three West African nations from January, 2014 to February, 2015, there were a total of 815 health worker infections accounting for 3.1% of all confirmed and probable cases reported.
The good news however is that, health worker infections in any epidemic is very preventable. Healthcare workers can provide quality and safe care without compromising their own safety and security in their quest to save the lives entrusted in their care.
The often-asked question is how? Some of the things that can be done include:
1. Developing process maps and identifying the patient journey. This will make it easy for the hospital to design effective and proactive surveillance system that can follow-up any suspected/confirmed case and also undertake the necessary contact tracing in any unlikely situation. It should also include the development of, and ensuring strict adherence to clinical protocols and standards!
2. Designing the clinical area to establish effective triage systems that can appropriately sort out cases on the basis of severity. This can help prevent patients who could easily have been picked up in any unlikely situation from falling through the cracks. Unfortunately, only a few departments have effective triage systems and it is imperative we get this done as soon as possible. When this is done, an isolation area/holding bay can be considered. This can be done after an effective sorting of our cases to know who to isolate, when to isolate and where. In most instances, many healthcare workers get infected because of the absence of such a system.
3. Health worker infections are often always preventable. Health institutions like ours should begin the process of institutionalizing effective occupational health, and infection prevention and control strategies. Data from the 2014/2015 Ebola Viral Disease outbreak confirmed “a reduction in the infection of healthcare workers as a proportion of all cases from 12% in July 2014 to as low as 1% in February 2015” when standard precautions were strictly applied. The application of standard precautions should be ensured at all times. This includes:
a. Hand hygiene: regular and effective hand washing with soap under running water especially in instances when the hands are visibly soiled and also the effective use of alcohol based hand rubs.
b. Wearing of personal protective equipment (such as gloves, aprons/overcoats, goggles etc) according to the level of risk. Appropriate wearing (donning) and removal (doffing) of these PPEs is very paramount since one can be infected in the process if guidelines are not followed.
c. Ensure respiratory hygiene at all times
d. Safe injection practices, management of sharps and the prevention of injury
e. Effective handling, cleaning and disinfection of all equipment and reusable items.
f. Appropriate and effective handling of soiled linen
g. Environmental cleaning/disinfection and appropriate waste management!
4. Health care managers should ensure the availability of the necessary logistics at all times to ensure that healthcare workers and patients are all safe!
5. Institute measures for effective and honest risk communication at all times.
6. Facilitating the creation of teamwork and quality culture
Continuous and systematic quality improvement is very essential because of the complexity of the care we provide as a tertiary level facility. In the best of facilities where care is provided even with the most sophisticated equipment, best efforts and technologies, there have been slippages; let us be very mindful of these basic and fundamental things to ensure that, we will remain safe and secured in our quest to provide quality and safe healthcare to our clients! Let us always remember the “safety” dimension of the six healthcare quality dimensions (equity, efficiency, effectiveness, person centeredness and timeliness) in times like this!
OTCHI, Elom Hillary| PhD, FISQua
Medical Directorate, KBTH
