The two Netcare private hospitals in KwaZulu-Natal hardest hit by Covid-19 coronavirus outbreaks reopened this week, with lessons that there’s no room to drop the ball when it comes to infection control.
More than anything, *Dina would love to scoop her four-year-old into her arms when he runs to greet her on her return home from work. But the nurse, who works at a Netcare private hospital in KwaZulu-Natal, has her heart broken each time she tells him to stay back and “wait a few minutes for mommy”.
Those minutes are for her to remove her shoes, keeping them outside her house.
She undresses and leaves her clothes in a bucket to be soaked overnight then steps into the shower. Only afterwards will she hold her child.
This is nursing in the time of Covid-19.
Her heightened personal precautions come off the back of a bruising month for the private healthcare group, whose hospitals were at the centre of two outbreaks in the province at the end of March.
Both St Augustine’s and Kingsway hospitals reopened for new admissions this week after being closed on April 2 and 14, respectively, following the death of five people from the virus and 48 people testing positive.
Among the hard lessons to be learnt has been the importance of keeping staff informed and provided with sufficient personal protective equipment (PPE).
“In the beginning, they could have done things differently. We were given a three-ply mask and told to use if for seven days unless it got wet or soiled.
After a while, they gave us N95 masks that got zapped (decontaminated) up to five times. Now we get a fresh mask at the start of every shift,” says Dina.
“In the beginning, dealing with the virus was new to everyone, so I think people weren’t taking the use of PPE that seriously,” she says.
For Dina, nursing is a vocation and she says she’s less afraid than she was a month ago. There are Covid-19 patients in her hospital, but she says staff working in these isolated wards use separate entrances and have separate facilities.
“We are screened every day and our temperature is taken every day. Nurses also won’t lose income if they test positive and Netcare has a place in which you can self-isolate if you are infected.
“It’s important because you don’t want people to be scared to answer screening questions honestly because they’re scared that they won’t be able to work and won’t have an income,” she says.
Dina doesn’t want to be identified because she is afraid of being victimised or singled out by her employer.
It was just less than a month ago that one of her colleagues at one of Netcare’s Johannesburg hospitals raised concerns with Spotlight over the group’s Covid-19 preparedness – also asking not to be identified.
Healthcare worker *Sindi was outraged with the treatment she and her colleagues were receiving.
She described, like Dina, how they were issued with a single three-ply surgical mask and told to place it in a brown paper bag with her name and the date of issue written on the bag.
She sent Spotlight photographs of how the masks were being stored and forwarded email correspondence telling staff of the policy on masks.
“I thought maybe they were going to sterilise the mask because these were single-use disposable masks, but they were not sterilised and I was shocked.
Masks get wet and are quite disgusting after a few hours of wearing them. They can also become contaminated and even if it was not passing on Covid-19, we could be passing on all kinds of other illnesses to each other and patients,” Sindi said.
WhatsApp group messages she shared outlined anxiety and resentment at what staff perceived to be Netcare skimping on basics such as new masks for each person at each new shift.
There was also concern that adherence to safety protocol was patchy. Comments included: “They ignored my warnings that they are not following protocols even after they were approached by some of us.”
Sindi says she and her colleagues received training for using PPE correctly, but it is adherence to the training that worries her most.
“People pull the masks on to their heads or under their chins and go for lunch and a smoke break then put them back on. There’s not much social distancing going on and no one is enforcing the guidelines. I really am not comfortable working in a situation like this,” she said.
Khaya Xaba, the spokesperson for the National Education, Health and Allied Workers Union (Nehawu) said: “We met with Health Minister Zweli Mkhize and agreed that no worker must be forced to work without PPE, and they must not be punished for refusing to work,” he told Spotlight.
Xaba reiterated the union’s stance, outlined in its press statement released at the middle of last month, when the news of 19 staff members at the Morningside Mediclinic – another private hospital group – tested positive in the days after the outbreak at St Augustine’s and Kingsway.
“The attitude and negligence of managers in the private healthcare industry is making a mockery of [the chief health advisor’s] warning that we need to stop small flames to reduce the risk of raging fires,” the statement read.
“This egregious conduct by private healthcare providers is in stark contrast with requirements and dictates of the Occupational Health and Safety Act, which clearly states that the employer has an obligation to provide and maintain a workplace that is safe and without risk to the health of workers. Nehawu maintains that failure to protect workers is tantamount to murder.”
Dr Anchen Laubscher, medical director of the Netcare Group, said they did not expect staff members to work without appropriate PPE.
“We reject any claim that staff are required to re-use single-use PPE in the strongest possible terms.”
However, she acknowledged that they had to revise their directive on masks early last month.
“Certain categories of staff were issued with a mask which could, and had to be, worn over five shifts and was safely stored in between shifts. In the event that masks got soiled, damaged or wet at any time, a new mask was issued to the staff member,” Laubscher said.
Netcare said they have been preparing for Covid-19 since January this year, with the establishment of a multidisciplinary task team and the introduction of daily briefings via Skype.
About 250 key personnel log on to “discuss key developments, learnings and matters of importance to all operations”, and this is disseminated to all staff and contractors.
Anyone entering a Netcare hospital is also risk-assessed and screened for Covid-19, and the hospital has introduced separate zones for treating patients based on their Covid-19 risk, given that many Covid-19 patients are now known to be asymptomatic.
Laubscher added that Netcare had distributed re-usable fabric masks to staff and monitored staff for adherence to safety protocol via CCTV, spotters, colleagues and hospital leadership.
“PPE, hand washing and social distancing retraining has involved 21 000 staff members, doctors and other workers at our hospitals, and has been done by clinical facilitators, infection prevention practitioners and occupational health and safety specialists,” Laubser said.
“Part of the retraining requires that each individual has to practically demonstrate the correct use of PPE. A register is also kept of all persons trained and a certificate of competence is issued.”
This article was produced by Spotlight, an online publication monitoring South Africa’s response to TB and HIV