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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.

News Archive

“My time at the UFS was the golden gem of my career”
2016-07-04

Description: Zig Gibson Tags: Zig Gibson

Prof Alan St Clair Gibson
Photo: Oteng Mpete

“My time at the University of the Free State (UFS) was the golden gem of my career. I have worked at medical schools or biomedical research centres in the United Kingdom, United States and at some of the top medical schools in South Africa, but working at the UFS was one of the highlights of my career,” says Prof Alan St Clair Gibson, Head of the UFS School of Medicine.

After spending just over two years at the UFS, Prof St Clair Gibson resigned from the institution in June 2016 and will take up the position of Dean: Health and Human Performance Sciences at the Waikato University in New Zealand in mid-July, where he will assist to establish a new faculty for all the health-science disciplines. “It was a privilege to work at the UFS. I come from a strong research background and wanted to grow research at the university, which I achieved. I came to the UFS because of the Academic and Human Projects and am proud of what has been achieved at the School of Medicine during the time I was here,” he said.

Prof St Clair Gibson highlighted some of these achievements, including the development of a management infrastructure across the disciplines of the school. “The establishment of an executive management committee for the school, as well as research champions in departments, highlighted the importance of proper governance and strategic management. By developing data dashboards, my management team and I could develop an understanding of research income and productivity, how the school works, what the role of teaching and learning is, and how the school could benefit in terms of third-stream income from the many contracts obtained by its academic staff. As a result, contracts and the financial management model of the school have also been reconfigured to the benefit of the university so that the institution and school can benefit from it,” he said.

His strong belief in an open-door policy has made staff feel part of the environment and it has created an atmosphere of equality and inclusivity. He believes in staff development and has, for instance, established leadership and management courses for heads of departments. Another factor to be proud of is the increase in the number of young researchers who recently joined the school, such as Prof Ross Tucker, who is one of the foremost sport scientists in the country. “It is a fact that staff retire or resign in all schools and departments of any university. It is also true that these departures offer opportunities to bring new academic and professional staff into the UFS. In fact, for the first time virtually every department in the School of Medicine now has a full-time Head of Department and 46 new staff were appointed since January 2015,” said Prof St Clair Gibson.

“I am especially proud of contributing, together with the senior leadership of the UFS, to stabilise the relationship with the Free State Department of Health (DoH). With the assistance of these parties, as well as my executive management team, we could find a better way of working together to the benefit of the school and the province.’’

Transforming the student profile to be representative of the country’s demographics is another milestone Prof St Clair Gibson will remember. “The intake of black and white students is of such a nature that we now have a much more balanced ratio of black and white undergraduate students than before.”

“I wanted to stay longer to see the effect of all the changes I made at the school, but the deanship is an offer I cannot refuse. I would have liked to see a steadier increase in the number of permanent clinical staff and have worked hard with both the UFS management and the DoH to try and achieve that; but more work needs to be done.”

I have worked with a number of fantastic staff members at the school, who are determined to do good in a challenging environment. I am amazed at the energy of the university leadership and how the Human and Academic Projects are executed. My wish for the university is to maintain and grow its standards and for the School of Medicine to maintain its reputation as one of the best schools in the country. I will always be a proud alumnus of the UFS,” he said.

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