Protecting Our HCW: Lessons From Sarawak General Hospital — Dr Musa Mohd Nordin & Dr Zulkifli Ismail

By CodeBlue | 05 May 2020

If Covid-19 was acquired within hospital facilities — whether in the pantry or from colleagues — it should be classified as a hospital-acquired infection.

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At least three letters have been written to address various issues related to the soaring rate of Covid-19 infections among health care workers (HCW) at Sarawak General Hospital (SGH).

If one reads closely the Ministry of Health (MOH) press reports in relation to Covid-19 infections involving HCW, one would be led to the definition that Hospital-Acquired Infection (HAI) of Covid-19 only applies when a HCW acquires it whilst managing Covid-19 patients, whether in the ICU or other wards.

This is confirmed by the various press reports which stated:

  1. The HCW acquired whilst they were in the pantry having coffee and not from the caring of Covid-19 patients, so it is not a HAI.
  2. In SGH, the doctors did not practice social distancing, so they passed to their hospital colleagues and since they did not get from nursing Covid-19 patients, it is not HAI.
  3. The nurse in Muar Hospital did not look after a Covid-19 patient. She got the Covid-19 infection from another hospital staff who got it from her husband of the tabligh cluster, so it is not HAI.

Unless we conform to universal concepts of HAI, we will be misleading the rakyat on the basic concepts of HAI. My colleague paediatrician was even more scathing about this narrow understanding of HAI. He exclaimed:

  1. Show that they did not acquire from outside the hospital ambience, for example at kenduri/ wet market.
  2. Otherwise if it was acquired within the hospital facilities, whether in the pantry, on the hospital sofa, or from a nurse or doctor or other HCW colleagues, or even from the hospital cat, they are all classified as HAI! And not just from nursing a Covid-19 positive patient.

From this piece of news, the MOH reported that “none of the cases involved handling coronavirus patients in Covid-19 or intensive care unit (ICU) wards” — reiterating the MOH’s narrow concept of HAI.

However, the discerning doctor will immediately note that in the same news report:

a) 41 cases (18.0%) of MOH staff contracted the virus from patients (this is HAI).

This included:

  • 29 cases (13.0%) from patients with SARI (Severe Acute Respiratory Infections)
  • 9 cases (4.0%) from patients whose status were unknown and
  • 3 cases (1.2%) from screening and other activities on the field.

b) 33 cases (15%) still under investigation.

The increasing number of HCW infected with Covid-19 is a worrying cluster. The most recent outbreak in SGH involving 56 HCW should be a wake-up call.

Does it require another death before the authorities act upon the complaints from the HCW?

In Spain and Italy, one in 10 nurses and doctors are Covid-19 positive. It is higher in Iowa, USA where 20% of doctors are Covid-19 positive. In Newport, UK, 50% of the doctors in the Emergency Department are positive.

Many HCW have died in the line of duty. 120 frontline HCW have died in the UK National Health Service. In Italy, China and Indonesia, 100, 61 and 30 doctors respectively have died from Covid-19 infection. The global death toll is increasing daily.

Before we are confronted with similar tragic outcomes, we need to urgently pay better attention to our HCW, the last line of defence. Apart from other infection control strategies and HCW surveillance in place, we need to better screen our HCW to ensure whether they are:

  1. Immune — presence of antibodies would be reassuring and safe to work.
  2. Asymptomatic positives — need to be isolated to prevent spread to colleagues and high risk/sick patients in hospital. 40% of Covid-19 positives are asymptomatic.
  3. Unwell and Covid-19 positive – they must be treated, isolated and their contacts traced.
  4. Negative – they are safe to work, but they are naive and therefore vulnerable to Covid-19 infection.

We have addressed many of the pertinent issues in an earlier article dated 19 April 2020.

We hope the authorities will act swiftly to allay the fears and vulnerabilities of our HCW at the frontlines.

This is apart from providing our HCW with adequate and appropriate PPEs (personal protective equipment), especially with the recent ramping up of Covid-19 testing.

  • This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
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