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Ready for any emergency to serve patients, COVID or no COVID, while safeguarding the staff
The Karapitiya Teaching Hospital (KTH) has looked at all angles of patient care and set up pathways on how to protect its staff while serving its patients to the fullest in the challenging times of COVID-19.
Hospital preparedness to face any situation is the mantra, the Sunday Times understands, with the Health Ministry’s common guidelines being adapted to make them applicable in the KTH setting.
“As healthcare workers, it is inevitable that we would get exposed to infections in our line of duty. But it should be a ‘protected exposure’ to ensure the safety of the staff,” says KTH’s Consultant Microbiologist Dr. Bhagya Piyasiri.
Patient interviewing at fever corner
The latest step is an emergency where someone needs urgent surgery, the Sunday Times learns.
Galle is a high-risk area for COVID-19. If a person involved in a road traffic accident needs an emergency neurosurgical procedure, what should KTH do, she asks, with the answers being given without hesitation by this ‘Infection Controller’ behind the hospital’s COVID-19 preparedness.
“We cannot refuse treatment to such a critically-injured patient but we also have to make sure that he is not COVID-19 infectious,” she says.
Immediately, the staff in protective gear would perform a Rapid Antigen Test, the results of which come within 30 minutes. If positive they would take all the precautions according to ‘Guidelines for the preparation for surgery in an emergency situation’.
These guidelines have been drawn up by Dr. Piyasiri in close consultation with the Surgeons and Anaesthetists.
Dr. Piyasiri states: “We will assess the status of infection and decide whether the team is willing to accept the risk, if positive, and perform the procedure with the available resources. The decision is to go-ahead with available facilities and resources, taking maximum precautions.”
Recently, the KTH had a close call, but it was well-prepared. The preparations had been in place much in advance since the early months when the COVID-19 pandemic hit the world including Sri Lanka.
Not just was the over 1,892-bed KTH with the doctor cadre, including specialists, of more than 600 and nursing staff of nearly 1,500 prepared, but it had also kept on updating its precautionary protocols on the run. This hospital catering to a large catchment area has about 500 patient admissions per day currently.
No sooner that incident took place, it was all systems go, without missing a beat to ensure the protection of healthcare staff and patients who may have had the slightest exposure to COVID-19.
With regard to the incident, she says that a patient with a psychiatric illness who also had chronic kidney disease had been admitted to the KTH for haemodialysis. As there were no symptoms suggestive of a respiratory tract infection, the patient was not categorized as high risk on admission. She had been in the psychiatric ward when she developed symptoms and an RT-PCR test was done which found that she was COVID-19 positive.
“We closed the ward for new admissions immediately and the ‘index’ patient (the person with psychiatric illness) was transferred to the ‘Special Care Isolation Unit’. Thereafter, the ward was cleaned according to the recommended protocol and all the health staff and patients who came into contact with her were assessed for risk, once again keeping to protocols set by the Health Ministry and the institutional (hospital) protocols. This risk assessment is done by a multidisciplinary team,” says Dr. Piyasiri.
Such risk assessment is chaired by a Deputy Director and carried out by a team of two Physicians, the Virologist, the Microbiologist and the Chief Nursing Officer.
The 15 staff members, from about 65 from all involved units, who fell into the significant-risk exposure category and 30 patients had undergone RT-PCR testing, with each and every one being negative.
How did KTH achieve this?
“This is due to all necessary precautions being taken as well as proper Personal Protective Equipment (PPE) being used,” Dr. Piyasiri underscores.
She says that people with diabetes, heart diseases, hypertension and chronic kidney disease should be cautious and avoid leaving home unless essential. However, if they have any illnesses like infections, chest pain and breathing difficulties with asthmatic exacerbation, then they should seek medical advice without delay.
“Many people are worried whether they would get COVID-19 during their hospital stay. That’s a reasonable fear. But as a hospital, we have taken measures, as far as possible, to ensure that a COVID-19 suspected patient is not admitted to a normal ward,” explains Dr. Piyasiri.
KTH is not a designated hospital for the treatment of COVID-19 and if it does detect such a patient, it transfers him/her to a designated hospital.
Dr. Piyasiri gives the important steps in the protocol to keep KTH safe from the virus. They include:
Triaging every patient who seeks treatment at the Outpatients Department (OPD) and the Emergency Treatment Unit (ETU). The triaging is to separate people who fall under the category ‘high risk’ or COVID-19 suspect from all others and admit them to the ‘Special Care Isolation Unit’. These triage criteria are evaluated, analysed and updated daily, according to available data.
The task of triaging them is mainly handled by Consultant Physician Dr. Ganaka Senaratne in charge of the ETU along with his dedicated team in collaboration with the administration, infection control team and other colleagues.
All other patients are sent to their respective wards, where once again another risk evaluation is performed by ward staff to identify any missed cases.
During the triaging at the OPD, meanwhile, all patients with fever and respiratory symptoms are directed to a special ‘Fever Corner’. A doctor will evaluate them and high-risk patients admitted to the ‘Special Care Isolation Unit’. All those in the Special Care Isolation Unit’ will undergo RT-PCR testing and if positive transferred to a COVID-19 dedicated hospital and those negative sent to their usual wards.
Active community surveillance for COVID-19 has been carried out by KTH since mid-April with the support of the infection control team nursing officers and the OPD staff, coordinated by Dr. Piyasiri. The patients who are randomly selected for RT-PCR testing would be informed about the procedure and that individual reports would not be issued.
Nasopharyngeal swabs would then be taken and if the result is positive, it would be conveyed to the patient and also the relevant authorities, as COVID-19 is a notifiable disease.
Since mid-October, this surveillance also encompasses symptomatic or healthy volunteers among the healthcare workers, with 10 slots allocated per day, in addition to mandatory testing after an exposure.
With regard to RT-PCR testing at the KTH, Dr. Piyasiri pays tribute to Consultant Virologist Dr. Nayomi Danthanarayana and her committed team who work round-the-clock to issue reports on time.
“Our virology laboratory provides a service to the whole country and updates its data regularly, while being in contact with the relevant authorities,” she says, explaining that this 24-hour service is crucial in confirming the accidental discovery of suspected patients. Currently, the lab performs more than 800 RT-PCR tests per day, which can be increased to 1,000 per day.
Meanwhile, all healthcare workers have been trained on how to don and doff PPE safely without getting infected or contaminating the environment. The supply-chain of PPEs, without wastage or shortages, is handled efficiently by Chief Pharmacist Nandani and her team, it is learnt.
For patients who seek treatment at KTH, hand-hygiene facilities have been provided at the entrance, the OPD and the clinics, while all visitors are screened through a fever-check. Patients are advised to wear a face mask and those with respiratory symptoms, a surgical mask, in the wards.
Visitors and bystanders (those who are with patients) have been limited. A bystander is allowed only after he/she is evaluated in the ward.
Referring to risk assessments which could come up at any time or day, Dr. Piyasiri says that Physicians Dr. Krishantha Jayasekara and Dr. Senaratne and special grade nursing officers are always available to take up this task. This is while for the smooth functioning of KTH under these circumstances, the staff is assured of the support of Director Dr. Sampath Ranaweera and Deputy Directors Dr. Nishani Ubeysekara and Dr. Harshanie Ubeysekara, while they also coordinate with Health Ministry, Epidemiology Unit, regional health officials and regional epidemiologists.
Health education and quality management units of KTH raise awareness among the public and health staff.
“The success of KTH in keeping COVID-19 at bay is due to the collective efforts of the administrators, doctors, nursing officers, paramedical staff including laboratory staff and pharmacists, the Public Health Inspector, minor employees, police post, security and the people of Galle,” adds Dr. Piyasiri.