Take personal responsibility to prevent infection
We have all seen the almost sci-fi glimpses into ICUs around the world on our TV screens: medical staff in what look like space suits – personal protective equipment (PPE) – attending to extremely ill patients with COVID-19.
The grand message has been hammered home over and over again: wear masks, wash your hands frequently and keep a physical distance of at least two metres between yourself and the other person.
A recent trip to a Cape Town hospital brought into sharp focus these highly sanitised processes. I had to stand in a queue (at least two metres apart) and when I got to the front of the queue there are questions about who I was seeing and they checked with doctor’s lists that this was so. My hands were sprayed with sanitiser and I had my temperature taken and my mask was checked to make sure that it was covering my mouth and nose properly.
In the hospital wards all the staff know that they have to stick to strict protocols regarding infection prevention and control (this is normal routine) but in the age of the Coronavirus it is even more important to observe strict standards of hygiene as the virus is spread by droplets from the mouth and nose which can travel through the air or be picked up from surfaces like bedside lockers and door handles. Sometimes the nurses and other staff are busy and may forget so it is important for every patient and visitor to make sure that anyone who is going to touch a patient washes their hands or uses sanitiser first.
A Bhekesisa Report on May 20 (Joan van Dyk How one COVID-19 case at St Augustine’s Hospital led to 135 infections within 51 days ) tells of a study, seen by Bhekisisa, and conducted by researchers at the University of KwaZulu-Natal’s (UKZN) Nelson R. Mandela School of Medicine and the KwaZulu‐Natal Research Innovation & Sequencing Platform, Krisp.
The investigation shows how the outbreak of coronavirus disease at the Netcare St. Augustine’s Hospital in Durban, that led to the infection of at least 135 patients and staff in the hospital complex and people in a nursing home, was caused by a single patient admitted to the facility’s emergency department early in March.
Says van Dyk: “The investigative report into the rapid spread of infections through the 469-bed facility holds crucial lessons for hospitals about the importance of proper infection control and the deadly consequences of identifying COVID-19 patients too late.”
The researchers contend that the virus spread fast because nurses “were frequently moving patients around inside wards and from one ward to another, Patients were moved often between wards as the hospital began repurposing wards to prepare for an influx of COVID-19 cases. This way, health workers unknowingly exposed patients and colleagues to coronavirus patients who were still undetected.” (van Dyk, Bhekesisa report).
This is sobering: it means that anyone entering a hospital and accidently touching a surface that has been infected by the SARS‐CoV‐2, then touching their face so that droplets enter into their system, will be infected as well. The research found that the virus left on surfaces (for hours and even days) was most responsible for the spread of the virus.
“The main way the virus spread through St. Augustine’s hospital, however, is through droplets left on surfaces and transferred by health workers. The findings suggest that facilities be cleaned often since the report shows the environment around a COVID-19 patient could be contaminated for hours or even days depending on the surfaces.”
“Hand hygiene remains the most important intervention to prevent transmission of SARS‐CoV‐2 inside and outside hospitals,” the researchers note.
What this means is that hospitals that wish to protect patients need to follow strict rules of infection prevention and control. But it also means that patients admitted to a hospital also need to take responsibly for their own safety and health.
Promote infection prevention and control culture
Bhekesisa warns: “The primary lesson learnt is that SARS-COV-2 can spread very rapidly in the hospital environment,” the researchers found. Going forward, hospitals will need strong infection prevention and systems in place to prevent such outbreaks, says the head of infectious diseases at UKZN’s medical school Yunus Moosa in a statement.
“We call on management to promote a culture in which infection prevention and control is everyone’s responsibility and that everyone has a role to play.”
As the COVID19 case numbers creep upwards in a steep incline, frontline medical staff are under unparalleled pressure. Hospitals are soon going to be filling up and as this happens, they will soon suffer what other frontline workers have suffered before them: exhaustion coupled with deep emotional distress means that they can and probably will make mistakes. It would be a good move for patients to tactfully and gently remind nurses to wash their hands and ensure the environment around their bedside is clean. Cleaners must be reminded to disinfect surfaces thoroughly and regularly.
One South African TV station is currently using a hashtag slogan #Inthistogether. It applies particularly in hospitals where not only emergency staff, nurses and doctors must practice infection control at the highest level, but it also applies to patients who must insist that such practices are followed. One hand cannot wash itself; both are needed in a vital and interdependent relationship.
This does not mean abusing nurses and doctors who forget under pressure. It means working with them to eradicate a virus that is turning the world upside down. It is only by collective, responsible action that we can win.