29 April 2020 | Story Andre Damons | Photo Supplied
Intubation training on a manikin (Doctors from Department of Anaesthesiology).

The Department of Anaesthesiology at the University of the Free State, in collaboration with the Clinical Simulation and Skills Unit, has trained almost 500 hospital staff members dealing with the Covid-19 pandemic since the lockdown started.

The unit assisted doctors, nurses, and staff working at the Universitas and Pelonomi hospitals with training in the use of personal protective equipment (PPE), including protective clothing, masks, gloves, aprons, and eye protection. The training started the week of 16 March and was led by Prof Gillian Lamacraft, Head of the Pain Control Unit in the Department of Anaesthesiology, and registrars in the Department of Anaesthesiology. Training was not only limited to healthcare workers in hospital wards designated for COVID-19-positive or suspected COVID-19 patients, but workers throughout the hospital received training, lest they be required to care for COVID-19-positive patients in the future, especially if there is an increase in the cases being treated in the hospital.

Training members of the anaesthesia department
According to Prof Lamacraft, the training was initially started to ensure that members of the anaesthesia department would be protected if the need arose for them to wear PPE while treating a COVID-19 patient. Members of the anaesthesia department are not routinely involved in the medical care of patients with serious infectious disease (e.g. Ebola virus), and because they were not previously required to wear PPE regularly, they are not familiar with its use. 
“Internationally, the healthcare workers most exposed to the virus appear to be the ones most at risk of dying, presumably owing to the greater viral load they receive. COVID-19 patients who are severely ill, may require intubation so they can be ventilated – this procedure puts the doctor performing it very close to the airway of the patient, and greatly at risk of being contaminated with COVID 19 during this procedure.” 

“Failure to intubate the patient successfully can lead to the rapid demise of the patient, so it has been decided as hospital policy that anaesthetists will preferably be the doctors performing these intubations, if they are available, as they are considered the doctors best at this procedure. Therefore, anaesthetists will be a group of doctors in the hospital at great risk of COVID virus exposure,” says Prof Lamacraft.

Training other healthcare workers
To facilitate this training, registrars in the Department of Anaesthesiology made videos to demonstrate the donning (putting on) and doffing (taking off) procedure for PPE. Members of the Universitas Academic Hospital’s Infection Control Team provided them with the required information and assessed the training videos for correctness.

The department used the Clinical Simulation and Skills Unit’s facilities at the university to conduct this training, so that the participants could also physically practise putting on and taking off the PPE after watching the videos. 

“Since then, we have been doing this training every working day. Having trained our department, the members of the COVID-19 task team for the Universitas Hospital asked us to train other healthcare workers at the hospital. Accordingly, we have trained many other healthcare workers (over 430 for PPE training alone), including heads of department, professors of medicine, specialists, registrars, medical officers, interns, all ranks of nursing staff, clinical technologists, and household aids.”

The different types of PPE
Prof Lamacraft says it is important that all these healthcare workers are taught the different types of PPE (i.e. standard and aerosol-generating procedure PPE (AGP PPE). In particular, they had to understand that a special type of mask, an N95 mask, should only be used for AGP PPE, as these are in extremely short supply internationally. 

“Many healthcare workers did not know how to put these on correctly, or which size to wear – this had the potential for wastage of this precious commodity. Taking off PPE contaminated with the COVID-19 virus is a very risky procedure. Failure to do so correctly, can lead to not only the healthcare worker contaminating themselves (e.g. by touching their eyes or face while taking off their masks), but also to the contamination of the healthcare workers assisting the person in taking off their PPE; or even to the participant taking home the virus on their bodies and contaminating their family at home. Therefore, the healthcare workers had to be shown how to take off their PPE without contaminating themselves.”
In order to reduce the risk of trainers and other participants being infected during training by healthcare workers who are asymptomatic carriers of COVID-19, only two to four participants have been trained at a time and strict rules were kept regarding social distancing and the use of hand sanitiser.

The training is essential to protect healthcare workers
Prof Mathys Labuschagne, Head: Clinical Simulation and Skills Unit, says volunteering doctors and nurses are also trained to work in ICUs with COVID-19 patients. The ICU department trained these volunteers in the use of ventilators, to assist with putting up drips and lines, intubation, and PPE. The goal is to train healthcare providers to assist in ICU when needed. 

“This training is essential to train and prepare healthcare workers when the patient numbers are increasing. The training is also essential to protect the healthcare workers against infection, because we need them to stay healthy to be able to manage the patients,” according to Prof Labuschagne.

Dr Edwin Turton from the Department of Anaesthesiology says the training is for frontline healthcare workers (nurses, cleaners, porters, doctors, and even washers from theatre) who need to protect themselves in order to protect their patients and all other staff helping them to care for the patients.

“Doctors and nurses need different forms or levels of PPE for working in the clinical environment, and we need them to train to wear appropriate PPE for AGP and contact with PUI and positive patients. They need to be able to protect themselves. The training is for all healthcare workers and not only for doctors and nurses,” says Dr Turton.

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