Providing for the healthcare worker in periods of Epidemic

Sir: Corona virus is now a nightmare to all including healthcare workers not because of the case fatality associated with the disease but because it is highly contagious. We have had contagious diseases in the past but nothing compared to what is currently being witnessed because virtually every country is affected.

Just as we bother about the public acquiring the disease the health worker is far more exposed than anyone else in the community. So, he/she requires to be protected. The methods reeled out these days effective as they are in check-mating community spread fall short of what the average healthcare worker or frontline staff in the fight against the disease requires. Personal protective equipment are meant for such workers and they go beyond proving facemask and caps.

At peace times these PPEs are sourced from the same countries that are hard hit with the disease. In response to the outbreak countries of make of the PPEs have taken drastic actions that have affected supplies. It is, therefore, no use expecting large-scale supplies from such countries either for cash or in kind. We can, however, look inwards in the bid to supply the PPEs. The concept behind PPEs is creating a mobile barrier between the health worker and the patient. Whereas fixed barriers can be created readily mobile barriers are difficult to create.

In principle the health worker at risk wears a covering seemingly impervious to the infecting agent. His entire body is covered but with sufficient flexibility to allow for movement and normal function. The PPE components include a top wear with headgear, a cap, google, facemask, elbow-length gloves, trousers and boots. Materials for making these components or most of them can be sourced locally. It requires the ingenuity of leaders to have them made. Post-production sterilisation can be achieved in most tertiary hospitals.

The next challenge is disposal of expended PPEs. Most components of PPE are single-use items and can be incinerated. The handling of used items is hazardous and handlers must also be protected against hazards using standard protocols that can be sourced from the internet. Having removed the PPE the health worker should have access to running water laced with weak sodium hypochlorite to ensure full decontamination. The use of scrubs is only a measure good enough outside epidemic. It can be incorporated as extra measure to protect family members.

It is intriguing that managers of resources beat their chest about readiness to combat the spread outbreak without taking into consideration the needs of the frontliners. No one talks about donations or procurement of PPEs. Donations centre around wrist length gloves, masks and caps. The Associations in charge of various healthcare workers have not emphasised sufficiently the needs of their members.

Quarantine and isolation are not the same. They are meant for different categories of patients or prospective patients. Some hospitals in realisation of their inadequate preparedness for the outbreak have closed non-essential areas, maintaining skeletal services at the entry points only. It will be travesty for hospitals to shut done in the face of the outbreak. Those saddled with caring for the overt and covert patients need to be adequately protected. Ingenuity is needed to overcome socio-economic challenges surrounding the supply of PPEs at these times.
Prof Michael Ibadin is consultant and immediate past Chief Medical Director (CMD), University of Benin Teaching Hospital (UBTH), wrote from Benin City.