Kirti Adhiakri
With the spike of cases in Nepal every day, a greater number of health worker are tested positive with Corona Virus. Doctors, nurses, paramedics working in hospital and hospital staffs are currently at more risk than any other person now in the world.
An interview given to CNN by Dr. Peter Hotez, dean of National School of Tropical Medicine at Baylor college of Medicine in Houston, Texas said that, “We know the high mortality in older people, but for reasons that we don’t understand front-line health care workers are at great risk for serious illness despite their younger age,”.
He further stated, “Maybe it’s due to higher dose of virus they’re receiving.”
Even though this statement is a view, but we can’t deem it incorrect. Since the amount of exposure is very high, especially in the front-liners. Regardless of all the precaution taken by the health workers, there are still many cases registered positive in health workers.
Not all hospitals in Nepal are well equipped and not all hospitals are providing full PPE set to prone health workers. And not all health workers are also well trained for PPE protocol. But the scenario is not limited to Nepal. Even the developed countries are facing same problem.
Some points to highlight:
1. Long duty hours in an enclosed space.
After COVID-19 spread, nurses’ duty hours, in most of the hospitals, per shift has been increased, instead of 6-8 hours a day, now they are doing 12 hours a day shift. It was done to mitigate/reduce the number of nurses exposed in a day shift. But this has also led to long hours of exposure.
Additionally, they work in enclosed wards, which are considered more risk because the atmosphere of the ward may be precipitated with the virus.
Also, not all the nurses working in the same shift wear full PPE, even in the COVID ward.
An interview given by a nurse in Kantipur channel, working in COVID ward of Bir hospital said that, “Only 1 nurse among all nurses in the shift wears full PPE gear for 6 hours”, which clearly claims that other nurses in the same ward could be in high risk. Cross contamination, use of common washrooms, handling of doors or any equipment’s, etc.
2. Staying in close contact with patients.
Not all the patients enter hospital with PCR report, in fact most of the cases are un-identified or waiting for the report. And not all nurses are geared up fully with PPE in all departments of hospital. In this case, nurses are at more risk. Mask and gloves are the only thing they must rely on and expect not to get interacted by the COVID virus.
In High Care Departments (ICU/CCU/OT/ER, etc.) many procedures, like frequent suctioning, bed bath, changing bed sheets, dressing of wounds, oral care, especially for ventilated or unconscious patients nurses have to be in close contact with the patient.
3. Donning and Doffing the PPE
Before COVID-19, I don’t know how many health professionals wore the complete PPE set which is currently in use. So initially Donning (wearing) and D0ffing (taking off) PPE, was a challenge. Some watched you tube tutorials and hardly any got proper training.
Some may have got proper training and required knowledge and practicing it quite well, but not all and not many.
Many health workers with no theoretical concept of Donning and Doffing practically learned the procedure and applied. This could result in many cross-contamination issues.
If one is not careful while Donning and especially Doffing, there is high chance of spreading the virus instead of protecting.
Ignorance/ Casualness during Donning and Doffing may result in another hazard.
4. Validity and reliability of locally made PPE:
With the demand of time, lack of infrastructure, health workers worldwide not just in Nepal, were bound to use locally made PPE, like instead of Hazmat Suit, they used synthetic/ cotton cloth/ plastic materials as gown. A tailor, who makes raincoat, suddenly starts to make medical gown. People wore self-made head gears, etc. Further, these equipment’s were reused.
The reliability and validity of these equipment’s are still questionable since there are no research done, whether they care effective of not, they can be reused or not, what is the proper technique to disinfect those equipment’s to be able to reuse it.
5. Carefree nature of nurses:
Not always it is situation created but sometimes, some nurses are too casual. If a patient is tested negative today, one should not be liberal in thinking that he might not be tested positive tomorrow.
Sometimes or most of the times patients may not have enough virus developed in body fluid/ swab which may result in negative report on the day. In many situations, it is noted that health workers are handling patients in a casual manner once s/he is tested negative. Whereas no matter what the case is and what the report is patient handling should be done with full precaution.
Few weeks back, one of my friends called Mr.Mahavir Pun, who is doing tremendous job in the field of research and invention of new equipment’s. He shared that, “he had few ‘Helmet face shields’, but he could provide it only to 1 or 2 Doctors working in the hospitals, who are working with COVID cases.”
It is a Good Samaritan effort by him, but even someone knowledgeable like him says he could give it to Doctor and not health worker or nurses who spend more time in hospital and patients.
With the increase casas of COVID, general wards in coming days may be flooded with these patients. And if high precaution is not taken early. Health workers may be at high risk at this point.
