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    10 tips for patient safety amidst the corona outbreak

    Last modified: March 24 2020

    Corona safety tips - Blog

    The number of novel viruses has only increased in recent decades, as evidenced by SARS, Ebola, and now the Coronavirus (COVID-19). And while hospitals and healthcare organizations are aware of the emergency safety measures they must take during outbreaks, the implementation of guidelines can be difficult in practice due to specific work methods, protocols, and barriers to success in each organization.

    The guidelines for fighting infections are based on scientific knowledge. Proper communication of this knowledge and implementation of the guidelines already in place contribute directly to compliance. But if the measures aren’t feasible, implementation will not occur. Consider an example: Washing clothes or bedding at 90 degrees is essential to stopping the spread of norovirus. Hospital laundry functions understand this important fact, but items repeatedly washed at such a high temperature will not endure. So resource restraints may hinder this important guideline from being followed. Likewise, various factors influence the overall level compliance and assurance of patient safety in healthcare across the spectrum.

    Here are 10 tips to ensure the safety of patients, clients, and employees during the coronavirus outbreak. Please share them with all individuals who have a stake in healthcare patient safety.

    1. Pay attention to environmental factors contributing to the feasibility of hygiene measures;
    2. Make clear who makes important decisions;
    3. Work on maintaining a continuous safety culture;
    4. Be aware that not everyone affected understands or remembers the (hygiene) measures;
    5. Consider the usability and readability of protocols;
    6. Ensure that hygiene measures are in line with the healthcare organization's work methods;
    7. Ensure that there is clarity about the effect of hygiene measures;
    8. Ideally, cordon portions of the workplace;
    9. Ensure proper registration of illnesses;
    10. Regularly evaluate and communicate with employees.

    Pay attention to environmental factors contributing to the feasibility of hygiene measures

    Consider the effect of these environmental examples when striving to ensure compliance: The layout of a building can affect the feasibility of protocols and guidelines. Does everyone use the same door handle or do the doors open automatically? Or—at healthcare organizations where patients reside—it makes a difference whether everyone has their own bathroom where they can wash their hands. Or, is the building perhaps also used by external parties, such as a daycare center within? Tips that account for environmental factors include:

    • Sick patients/clients remain in the infected department as long as the department is closed. They also do not participate in group activities outside the department until the department is released when the infection prevention measures are terminated.
    • Mark the room(s) of clients with suspicion of contamination and explain to the patients/clients and/or their contacts why this is necessary.
    • Do not transfer patients/clients to other departments or institutions unless the risk of infection expires. Inform other departments/institutions and other involved care providers (e.g., ambulance staff) so that they can take necessary infection prevention measures.
    • Consider a hospitalization stop depending on the size of the outbreak or if the outbreak is not coming under control.

    Make clear who makes important decisions

    Chain of command during an outbreak is essential. Who decides whether additional personnel will be deployed? Who looks at the work schedule of different disciplines if it is decisive for the spread of the virus? Or who decides on extra efforts from a cleaning company? Are internal employees chosen because they see the importance of extra hygiene measures? And who is responsible at night in case of extreme spread of the virus?

    A location manager makes different choices or considerations than a night head or specialist in elderly medicine, for example about closing departments. Who weighs the costs against the spread of a virus among frail older people? It is important to think about such factors in advance so that responsibility can be taken immediately in the event of a crisis.

    Work on maintaining a continuous safety culture

    Personal hygiene of employees remains one of the most important measures, but we know that culture can influence compliance. For example, addressing hand hygiene is crucial. But how is the policy on handwashing handled? And should someone report noncompliance as soon as they notice it? Make clear agreements within teams to support professional responsibility—which means supporting co-accountability for one another.

    Be aware that not everyone affected understands or remembers the (hygiene) measures

    The physical and psychological well-being, intellectual ability, and behavior of a patient can influence the implementation of the measures taken. For example, residents of a healthcare institution who suffer from dementia may have extra difficulty implementing hygiene measures. For this group it is important to expect an active role from formal and informal caregivers.

    Consider the usability and readability of protocols

    Sometimes healthcare organizations adopt protocols or guidelines from national associations in bulk, at other times one by one. And updates always require adjustments. Whatever the pace of adoption and rollout, protocol during an outbreak can be chaotic, because of the sheer volume of guidelines employees must to filter through to identify what is important to them.

    Tip: A handy checklist, tailored to your own organization or departments within, can help to ensure safety. Read more about the possibilities with tailored checklists here.

    Ensure that hygiene measures are in line with the healthcare organization's work methods

    Each healthcare organization must establish by function what the concrete tasks and responsibilities are, for these key reasons.

    • It creates clarity about roles and responsibilities
    • It prevents needless information-gathering during an outbreak
    • It enables redistribution of work as needed
    • Information can be distributed ahead of the spread of the virus

    Tip: Make a box with laminated cards for all functions with tasks and responsibilities during an outbreak, so that it can be transferred by service and ensure that someone always remains responsible.

    Ensure that there is clarity about the effect of hygiene measures

    The effectiveness and feasibility of (hygiene) measures set through national or accreditor guidelines must be scientifically substantiated. This means that measures proven to be ineffective, or to a limited extent effective, should not be included in the guidelines. Ideally before an outbreak the organization has already identified which measures are effective so informed decisions can be made quickly in a crisis.

    Ideally, cordon portions of the workplace

    It can be predetermined how or what the guidelines are when separation or isolation must occur. For example distinguish or separate:

    • Patient-specific use of sanitary facilities or separation in sanitary facilities for virus-affected and non-affected patients;
    • Employees who take care of virus-affected and non-virus-affected patients;
    • Common living areas for virus-affected and non-affected patients.

    Tip: In situations where the above separation is not possible, the crisis team determines which separation is possible and communicates this to the relevant department(s).

    Other isolation considerations:

    • Do not allow department-bound employees (such as nursing/caring staff and volunteers) to work in a department that has not yet been infected;
    • Do not allow non-departmental employees such as substitute workers, therapists/paramedics, and employees of facility services (e.g., linen service, food service, postal department) into a department with patients who are virus-affected;
    • Do not allow substitute or temporary employees who are or have been working in an infected department work in any non-infected departments;
    • Limit or deny visits of non-departmental employees to the infected department. Rather, instruct them to make appointments if a visit is necessary and ensure they have read the additional infection prevention measures;
    • Do not allow internal or external delivery employees past the entrance of the department. Instead, have department employees distribute the materials.

    Ensure proper registration of illnesses

    New cases can provide insights into the possible means and travel pathways of infection. Register per day/per department individuals (e.g., patients/clients and employees/volunteers) with new complaints for as long as there is suspicion of contamination. Registration of new and recovered virus cases provides an overview of changes in the extent of an outbreak and checks the effectiveness of any controls. It also helps determine the time of termination of the additional infection prevention measures needed.

    Regularly evaluate and communicate with employees

    As a healthcare organization, organize an annual meeting to educate about virus outbreaks for all parties involved (including residents and informal caregivers). Give healthcare professionals the space to tell their stories, share experiences, and provide lessons learned. Information contributes to increased knowledge and the goal of preparing everyone to execute on fighting infections and ensuring patient safety.

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