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Doctors’ Safety ensures Patient Safety

Doctors’ Safety ensures Patient Safety

Of lately the rogue virus has spread its fangs in the precincts of our premier medical institutions infecting a large number of frontline health Care workers (HCWs) viz. doctors, nurses, paramedics alike. This has raised the number of corona positive cases to 73 in the city beautiful as on April 29, sending chills down the spine of citizens as well as bureaucrats administering the UT. This also brings into sharp focus the aspects of hospital acquired infections (HAIs), threatening the lives of patients and their attendants as well as HCWs. While HAI is one of the major causes of mortality and morbidity of patients, it assumes greater importance during pandemic, since it strikes the medics as well. This puts highly skilled people out of circulation and renders them super-spreaders. Decision of the administration to close all hospitals for non-Covid patients and receive only Covid suspects in the OPDs was flawed de novo. A Covid hospital could have been set up on emergency basis with the help of the army in a place like cricket stadium.

Hospital acquired infections (HAIs); Safety of patients and HCWs

Issue of patient safety in the wake of hospitals being perennial source of infections has been catching the attention of world community from time to time. However, the matter of saving the HCWs from contracting deadly infections from the patients has arisen only now that corona has taken thousands of precious lives of HCWs. It is on record that all hospitalized patients are susceptible to contracting HAIs. Corona has changed the paradigm that all HCWs are also at risk. Elderly and persons with compromised immune systems are more likely to get infected. Other risk factors are long hospital stays, the use of catheters or tube in windpipe, failure of HCWs to wash their hands, and abuse of antibiotics. As per American estimates, HAIs account for 1.7 million infections and 99,000 deaths each year. In India where accountability and awareness is lesser, the numbers may be astronomical.

How do they minimize HAIs in hospitals across the globe?

  • HCWs clean their hands with soap and water frequently;
  • Catheters, Ryle’s tubes used only when  absolutely necessary;
  • Thorough cleaning the skin over the surgical site,
  • HCWs wear appropriate hair covers, masks, gowns, boots and gloves and also contain the infection source from patient/visitors

Saving the saviors

Reports of doctors and other HCWs getting infected with coronavirus are pouring in from all over the country. Rough estimate announced by a TV channel was over 500 HCWs on April 26, which needs to be updated. U.S. figure was 9,000 HCWs as on April 14. The Data further clarifies that most HCWs affected in Chandigarh and other cities like Delhi, Hyderabad, Chennai, Mumbai, Srinagar etc were involved in non-Covid-19 operations and were not provided with good quality N-95 masks and Personal Protective Equipment (PPE) at all times.  In Chandigarh 75% of those affected were working in ‘emergency’ areas dealing with non-Covid-19 patients and they often complained of lack of PPE and training to work in ICU.

This lack of preparedness exposed the HCWs and their families to various hazards including pathogen exposure, long working hours, psychological distress, fatigue, occupational burnout, stigma, physical and psychological violence, and depression and suicides.  According to a recent article published in The Lancet, HCWs deployed at Covid-19 facilities suffered from exhaustion, the torment of difficult triage decisions, and the pain of losing patients and colleagues, in addition to the infection risk. It is vital that governments and society at large treats HCWs not simply as pawns to be deployed without adequate training and protection, but as human beings whose safety must be ensured. HCWs, unlike ventilators or equipments and materials, cannot be urgently manufactured or run at 100% occupancy for long periods. As more and more doctors and HCWs are getting infected, soon the situation might get out of control and lead to paralysis of healthcare services. There is a need to have a dedicated COVID-19 hospital for HCWs, where they can be provided the best possible medical care in order to ensure speedy recovery. As a preventive measure against asymptomatic and pre-symptomatic transmission, implement source control for everyone entering the hospital. Cloth masks are not considered PPE because their capability to protect HCWs is not adequate.  There is a need to screen everyone for fever and symptoms of COVID-19 before they enter the designated area. Emphasize hand hygiene, install barriers to limit contact with patients at triage, cohort COVID patients, limit the numbers of staff providing care, and prioritize respirators for aerosol generating procedures. HCW in such situation should wear an N95 or higher-level respirator such as disposable filtering face-piece respirators (PAPRs) and elastomeric respirators, eye protection shields, gloves, and gowns.  It has been found that PPE kits meant for examining HIV patients are not efficient to resist permeation by coronavirus.

Air borne in hospital set up

Droplet-size body fluids containing microorganisms can be generated during coughing, sneezing, talking, suctioning, and bronchoscopy. They are propelled a short distance before settling quickly onto a surface, which becomes infectious. They can also get deposited directly onto a susceptible person’s mucosal surface (e.g., conjunctivae, mouth, or nose) or onto nearby environmental surfaces, which can then be touched by a susceptible person who auto-inoculates their own mucosal surface.

Due to highly contagious nature of the virus, many staffers have been demanding mass testing of hospital contacts, PPE kits and hazmat suits for all HCWs, but their demands were not heeded citing the constraints of supply and optimization of the scarce protective resource. It is now after a score of HCWs are infected and isolated that the authorities have relaxed Indian Council of Medical Research guidelines to provide n 95 masks and superior PPE kits to every HCW in the emergency department. Similarly HCWs should get suitable protective gear in the OPDs also.

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