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July 8, 2020

Corrective actions at PIMS: Number of infected healthcare workers declines


July 8, 2020

ISLAMABAD: A steep ascent in COVID-19 positivity among healthcare workers serving at the Pakistan Institute of Medical Sciences (PIMS) was evident during early May 2020, with 190 staffers testing positive at one point.

Two months down the road, the number of infected healthcare workers at PIMS has dropped to 84 — not by force of magic, but by implementing the recommendations of an epidemiological study which, aside from alerting the hospital administration to startling facts on probable reasons for the high rate of infection among HCWs, also propelled action on proposed mitigation measures.

Talking exclusively to The News here on Tuesday, Joint Executive Director of PIMS Dr Minhajus Siraj said, “We started implementation of the study recommendations in mid-June and the results are very promising, as today, the number of COVID-19 positive HCWs is less than half the number reported two months ago.” Interestingly, a majority of the infected healthcare workers at PIMS were not even deployed in the corona isolation ward or involved in critical care of COVID-19 patients, it was learnt.

The study was conducted by a three-member research committee with assistance from the Public Health Department of Shaheed ZulfiKar Ali Bhutto Medical University (SZABMU). “We are keeping the checks on for further protection of healthcare workers. One major help came through the ‘We Care’ initiative of the Ministry of Health Services. Most of the infected healthcare workers who were interviewed conceded a casual approach towards use of personal protective equipment (PPEs) — even facemasks. With training, the staff is now more geared towards self-protection. We are trying to safeguard our workforce to be able to better fight the pandemic and to keep our emergency services open,” Dr Minhaj stated.

Healthcare workers are about three times more likely to get infected with COVID-19 as compared to the general population. Their risk is higher due to increased time spent in the hospital; long-term exposure to COVID-19 patients; shortage of PPEs; and lack of training, supervision and monitoring of infection prevention and control mechanisms.

According to Dr Minhaj, the study deployed a two-pronged approach wherein all four components of PIMS (Islamabad Hospital, Children’s Hospital, Mother and Child Hospital, and Burn Care Centre) were evaluated for their “readiness” to respond to the pandemic while HCWs were assessed for their “risk exposure.”

The study recommended eight action areas on the basis of available evidence. “To begin with, the heads of all four components of the hospital have been designated as COVID-19 focal persons (FPs) for improved coordination. They generate data on a daily basis, monitor supply and use of PPE, and act as a bridge between the wards and administration,” Dr Minhaj shared.

The hospital has also paid the hosting fee for development of a website for data uploading/sharing to enable evidence-based decision-making. The website will be up and running by July 9.

Corrective measures have also been taken to overcome disparities in demand and supply of corona-related products, for which a supply chain management system has been devised under the leadership of the hospital’s Deputy Executive Director Dr Farhana Zareef. The indent system has been simplified and liaison with NDMA and NIH is being strengthened.

Acting on the committee’s recommendation, mandatory training of all HCWs across the board has been completed, while psycho-social support therapies for health workers are currently ongoing. Moreover, Consultant General Medicine Dr Fibhaa Syed has been designated as the focal person for training.

On a positive note, the study noted that triage form and SOPs had been devised and a well-ventilated space, away from the ‘Respiratory Waiting Area’ had also been allocated. Relevant signs and posters are also visible in reception areas, but infrequently in other parts of PIMS. Face-to-face encounter between healthcare and patients was limited but present in indoor wards.

In the initial days of the pandemic, PIMS had no mechanism to confine confirmed/suspected patients to isolation areas. A strict policy is now being observed to keep such patients away from general wards. Moreover, the doctors’ cafeteria and seven staff canteens which were serving meals to attendants until three weeks ago, have all been closed. “Food service has been banned in all seven cafeterias,” Dr Minhaj disclosed.

There was huge disparity in statements regarding availability of PPEs. Those responsible for procurement and disbursement at the ward level said there had been acute shortages in the past, but PPEs were now adequately available. However, healthcare workers were adamant that even if the hospital was receiving PPEs in adequate supply, it was not reaching them, and they had to buy their own stocks for self-protection. The same was reported even for aerosol generating procedures conducted in the hospital.

Among other measures, PIMS has constituted a ‘Surge Committee’ to forecast and prepare for a sudden marked increase in COVID-19 cases. The committee is headed by Dr Minhaj himself. A ward-level COVID Oversight Committee to remove bottlenecks in the day-to-day functioning of different wards and to safeguard the interests of healthcare workers and patients has also been formed, with Head of the Department of General Surgery Prof Dr SH Waqar as its lead.

According to the study, PIMS had no mechanism for routinely checking/reporting the body temperature of healthcare workers. Routine surveillance was only done in 6 percent of the cases. Now, active surveillance policy is being done to ensure screening of healthcare workers; their body temperature is checked at entry points.

Similarly, gloves were reported to be short in supply, and masks were also not provided regularly and were worn erratically by HCWs. Only 40 percent of the doctors as against 80 percent of the nurses said that they always wore a mask. A quarter (25.7 percent) of the doctors reported wearing it only occasionally, or not at all. Gloves, goggles and gown were considered less important and were worn less regularly than the medical mask. When asked, Dr Minhaj said, the hospital’s security is now responsible for ensuring that healthcare workers adhere to SOPs. He also claimed adequate availability of PPE.

According to the study, 15 percent workers reported transmitting the infection to one or more of their family members, and a similar proportion felt that they had not been supported by the hospital during their illness. More than half (56.5 percent) of the HCWs were at home, 30.4 percent had resumed their duties upon recovery, and 11 percent were in isolation at the hostel. A vast majority (n=36, 82.4 percent) perceived COVID-19 exposure at PIMS as the reason for their illness. “We have installed a PCR machine for staff and dead bodies only; results are received in just two hours,” Dr Minhaj concluded amidst optimism for greater protection of HCWs. He also revealed that the hospital now has 227 beds for COVID-19 patients, and that the number will be ramped to 262 by July 15.