Ever since the COVID-19 pandemic has struck the world, many nurses across the globe haven’t seen daylight in many days. These angels toil everyday burning the midnight lamp to protect us from the deadly virus even at the cost of their own lives. Sr Minimole Varghese, Chief Nursing Officer, Fortis Hospital, Mulund – one such angel, tells us about her key learning from COVID and ways to ensure that our protectors are protected in every way
Honestly, in India, infection prevention and control within hospitals and our public health systems has not been planned for situations like the one we are witnessing at the moment. After the 1918 Spanish flu, the country saw the nation-wide smallpox epidemic in 1974, the HIV-aids epidemic during the 80s and 90s, then some sporadic outbreaks, such as the 1994 plague in Surat, swine flu in 2015 in some parts for the country, 2014-2015 Odisha jaundice outbreak and then the 2018 nipah virus outbreak in Kerala, but nothing to this extent that we had to undergo a nation-wide lockdown. However, past lessons haven’t taught us much, experts believe.
Well, infection control and prevention within hospitals could not possibly be a timelier subject these days, with the COVID-19 virus surging nationwide and globally. Sr Minimole Varghese, Chief Nursing Officer, Fortis Hospital, Mulund, who is in the thick of things right now shares about her experience as an infection control nurse while she and her team battle COVID-19 in her hospital. In a chat with her, we realise the significance of hospital preparedness for health emergencies and crisis as well as the need for healthcare leaders and policymakers to ensure services to non-COVID health emergencies.
Let’s begin with understanding her and many other nursing leaders’ role in the times of COVID-19.
Role of the nursing head in infection control
Infection prevention and control is a priority for all healthcare staff across all areas of clinical practice in hospital settings. The nursing staff plays a key role in infection control. Building an infection control team, along with nursing leaders is said to be an effective system in raising infection control profile and changing practice in clinical areas, especially during such a health crisis.
Explains Sr Varghese, “Nursing leaders play a vital role when it comes to formulating protocols and processes which will ensure patients’ as well as employees’ safety across the hospital. This includes segregation of patients as per their clinical conditions, creating isolation units for COVID-19 positive and suspected cases, ensuring adequate availability of PPE for all healthcare staff, skilled manpower and resources, and the well-being of all healthcare workers by providing them with prophylaxis, nutritious food and psychological support. Further, nursing leaders ensure that care provided to non-COVID patients is not affected.”
So, this is one part of the planning and establishing Standard Operating Procedures (SOPs). The next step is the preparedness implementation. Sr Varghese informs that when the outbreak happened in Mumbai, her hospital was well-prepared with the much-needed infrastructure and support from the staff. They followed a strict protocol which proved to be effective.
A plan well executed
“It began with meticulous planning. Early in March 2020, a strategic plan was put in place to ensure the safety of the nurses and medical teams who cared for patients in the COVID-19 wing. Alongside infrastructure development, manpower management also became a crucial aspect of this plan; the first step towards this was identifying the right nurses. After the COVID-19 preparedness plan was explained, many nurses volunteered to work in the wing, ensuring the right fitment was important. Senior nurses, with experience of having managed patients needing intensive care, and those specialised in managing infectious diseases were chosen. Comprising of 50 highly trained and experienced nurses, the team was split into four groups to manage the COVID-19 clinic, daycare isolation unit, special isolation units (for inpatients) and Emergency Room Triage. A team leader was nominated across each group; who were further trained to have a better understanding of the job at hand. Mock drills were hosted to ensure that flow of patients is appropriately managed, and that all four nursing teams work in perfect tandem with the infectious disease specialists, intensivists and emergency medicine teams,” she elaborates.
So, when the outbreak hit the city, this is what began following as an everyday protocol for triage and patient management. “After primary screening by clinicians, symptomatic patients are directed to a temporary holding area where they are placed till throat swab is collected and the report is received. Confirmed cases are directly taken to the isolation unit. All COVID-negative patients are further assessed by clinicians and are either admitted to the hospital or discharged based on their clinical condition. For emergency cases, since COVID reports won’t be available, adequate precautions are being taken to avoid contracting and spreading the disease,” she adds.
Now, India has a high number of asymptomatic cases. In this instance, Sr Varghese revealed that the triage system and screening process within a hospital should be effective and no COVID patient should be missed. She explains how. “All patients entering the hospital are considered as COVID-positive. At entry point, each patient and his/her companion is screened using a questionnaire and thermal scan, they are identified using a sticker “I am screened” on the right arm and further directed to clinical areas as per their needs. They are also instructed on strict use of a mask during the hospital stay. Relatives of patients suspected to have COVID-19 are sent back home until the patient’s report arrives. Patients brought to the emergency department whose swab test result is awaited, are sent to ICU or ward-holding area, depending on their condition; they are kept there until the results arrive. All hospital staff members are also screened using the thermal scan before entering the hospital,” she elucidates.
Protecting the protectors
While providing care to COVID patients, the nursing staff are at high risk of exposure to the virus. Moreover, this crisis has led to a shortage of effective protective equipment for healthcare workers. This is one of the big challenges for providing effective care to the patients. Many a times, healthcare workers become prey to the virus and in the bargain, we lose precious hands that protect us. In such circumstances, some tough decisions are required.
Sr Varghese goes on, “Considering the dynamic situation that is compounded by the shortage of resources, it has been a constant challenge to provide efficient care to all our patients. The nursing leadership, along with the administration team, has toiled day and night to efficiently manage patients and create a safe working environment for the staff. “All staff, including the ones in non-COVID units are made to wear face masks and PPE and follow necessary precautions along with performing hand hygiene, as indicated. Risk ratification is done regularly and all guidelines about quarantining are followed. Staff working in COVID units are covered with HCQ prophylaxis and are accommodated within the hospital premises in a separate location. Training, meetings and other gatherings are suspended until further notice by the management. Also, COVID units are separated from non-COVID units and logistics are managed separately by blocking the free flow of traffic within the hospital premises.”
The emotional factors are considered as well. “Stressful situations do emerge every other day. Team members sit together to deliberate on issues and motivate each other. The COVID unit’s dedicated staff kept in isolation at the hospital, have access to television, etc., and the leadership teams are in constant touch enquiring about their wellbeing, and counselling facility is made available. Proper training and provision of protective gear give the staff confidence that they are protected and are cared for. The willingness and dedication of the staff members have kept the momentum going,” adds Sr Varghese.
Key learnings and a message to leaders
In the end, Sr Varghese emphasises that learnings from COVID-19 combat are extremely crucial to design new epidemic management strategies for healthcare providers and policymakers. She believes that preparedness is the key, and healthcare needs to transform itself to tackle extreme situations like these by bringing about infrastructural and process changes, like specialised isolation units, negative pressure areas, availability and efficient utilisation of manpower and PPE, frequent mock drills, patient flow management drills, etc.
“The pandemic has made us realise that hand hygiene is not to be restricted to healthcare workers alone, but also to be practised by the entire community, thus to be made an integral component of school and college syllabi. This is a lesson on the importance of preparedness to tackle an infectious disease that has great learning for the future. Leaders must put in their efforts to not only in curbing the current crisis caused by COVID, but also to cater to non-COVID emergencies like cardiac arrest, stroke, obstetric emergencies, etc. This is a vital aspect as many smaller hospitals have closed down or have been turned into dedicated COVID facilities. Larger hospitals need to function as hybrid hospitals geared up to admit and treat both COVID as well as non-COVID patients. As leaders, we must make every effort to ensure that every single patient gets appropriate treatment,” she accentuates.
The experience and learnings shared by Sr Varghese will be common to many angels like her who burn the nightlight lamp for our safety. But here she is, one such voice that echoes far and wide telling us the significance of her efforts and warning us of the dangers we may face if infection control is not a part of primary health strategies for our nation.
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