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  • Writer's pictureLilian Chiwera

Giving COVID-19 marching orders

Who’s your source of inspiration during this pandemic?

Many of us have been looking up to our politicians, intensivists, epidemiologists, scientists, local and global public health experts, infection prevention and control (IPC) specialists, virologists, microbiologists, pharmacists, families, friends, religion etc. for answers to this catastrophic pandemic. Meanwhile, scientists and others are doing everything they can to come up with a COVID-19 vaccine that will hopefully prevent further devastation. We have all come to appreciate the importance of prompt decision making and implementation of evidence based public health and economic policies that protect key-workers and the general population during global emergencies. Of course, it’s the concerted effort among all the above mentioned professionals with or without prior pandemic experience, together with the rest of the population that will help us to minimise COVID-19 and non-COVID-19 related deaths and suffering. We cannot however forget to prioritise people’s mental well-being, given that prior to this pandemic, 1 in 6 of us in England for example, were reported to experience a common mental health problem each week. Provision of the right policies/guidelines and support systems that not only save lives but also encourage, reassure and comfort all those directly/indirectly affected by the pandemic is therefore of paramount importance.

It’s easier said than done

Pandemic situations have so many different competing priorities that politicians, public health and IPC experts, scientists etc. must consider carefully. It is therefore acknowledged that writing policies and guidelines for imminent implementation during a fast evolving pandemic is not always easy as inevitably, changes are often required when new information becomes available. Constantly changing guidelines however, can be frustrating for front-line staff who will already be under enormous pressure. Policy makers and guideline development committees must therefore stay in touch with reality as much as is practicably possible so they’re better informed when producing and issuing best evidence based public health policies that mitigate risk and save lives whilst reassuring those directly or indirectly involved in managing a crisis. Respecting and valuing positive contributions from various credible sources and key front-line workers whilst acknowledging the not so positive views and investigating possible triggers for those negative responses is important. This may involve having several subcommittees in the background who continue to scrutinise all feedback accordingly. As for me, having theoretical knowledge of IPC policies, knowing the difference between disinfection and decontamination and what high touch surfaces are etc. is important; but having that clinical practical touch has really made a positive contribution to my personal development and better understanding of IPC policies and guidelines. In addition to improved clinical knowledge, my IPC implementation science has been rejuvenated.

It’s all about multi-agency and multidisciplinary working

For some of us working in IPC, writing and updating IPC policies and related Personal Protective Equipment (PPE) action cards in line with updated evidence based COVID-19 guidance as well as attending tactical meetings has almost become a daily routine. We don't work in isolation but look up to other national and global public health agencies for updated evidence based policies and guidelines that enable us to keep staff, patients and the general public safe. I have personally witnessed and been involved in IPC policies and guidelines development for more than 11 years now. From the time I joined the team with a strong clinical background in 2009, I have always been a strong advocate for getting us IPC practitioners out of the offices and into the clinical areas so we can relate to ‘lived front-line experiences’ and promote multidisciplinary team (MDT) working accordingly. I have to acknowledge that of late, I hadn’t spent as much time on the front-line as I would love to. I’m therefore absolutely delighted to have had the privilege and opportunity to return to the front-line during this COVID-19 pandemic where I have revived my clinical expertise and practical implementation of some of our IPC policies. I am also delighted to see practical IPC public health messages being promoted by colleagues on Twitter.

I have worked with various fantastic healthcare professionals from different professional backgrounds in critical care and will never forget a shift I worked alongside Laura, Lorna and Becky (not real names ) in particular. From laughs and cries whilst having coffee and eating lots of food from well-wishers and our well-being service, to the lonely reflective journeys home, it has been an enthralling experience. Some of us even found great comfort in wearing lots of lipstick before putting on our FFP3 masks whilst being watched closely by our colleagues – Yes weird times they call it! And yet in these unprecedented times, we will never forget all the compassionate, encouraging and super uplifting conversations and activities that energised us during challenging and emotionally draining experiences. What a transformation it has been for me – from mainly focusing on IPC and surgical site infection prevention for a number of years to learning the art of critical care nursing again whilst trying to implement those IPC policies and guidelines. You don’t just make a bed, re-position a patient or wash a patient anyhow in this setting - it has to be done in a certain way! If you do it any other way, then you risk upsetting the fantastic critical care professionals! Critical care nurses are not just fussy though, they all really care about how they deliver safe care to their patients. Being a ‘fussy’ critical care nurse who consistently implements evidence based patient safety and IPC policies whilst being surrounded by supportive MDT colleagues is highly desirable in these settings.

MDT working & policy implementation

Of course fantastic critical care or IPC professionals do not work in isolation, it’s always an MDT approach that assures holistic safe care. In every healthcare or residential setting, there should be policies and guidelines on how various patient or resident safety activities are undertaken. Such policies and guidelines should incorporate IPC policies and guidelines; in particular for hand hygiene, personal protective equipment (PPE), environment and equipment decontamination etc. For those who know me from my previous clinical experience, they will remember that I always preferred to clean a bed space and associated equipment including mopping the floor after discharging my patients to high dependency units. Well, did I not trust housekeeping staff? The answer is no – I just wanted these fantastic colleagues to know how much I respected (and still do) what they do. I also wanted to demonstrate to them that being a senior nurse did not imply that I couldn’t do what they do and that I was always ready to roll up my sleeves. I was part of their team and they were a part of our team also and together we all did (and still do) a fantastic job for our patients.

Of course housekeeping staff are the best!

I had a brief precious experience working with our housekeeping staff following a patient discharge during this COVID-19 pandemic. This was a once in a lifetime and unforgettable wonderful experience. Our fantastic colleagues didn’t disappoint – they performed way beyond my expectations not that I expected less! The organisation’s decontamination policy was rightly put into practice. I have to say that I don’t ever remember seeing a patient’s environment and all the equipment within, including the patient bed being given the sort of treatment I witnessed that day. Each removable part of the bed and associated clinical equipment (some I never knew could be removed and replaced!) were dismantled or ‘dissected’ to facilitate thorough decontamination. To reiterate, I don’t remember ever seeing the many different parts that constitute a hospital bed! And so I couldn’t help but ask the question… Why all this effort? The responses I got were just breath-taking: ‘we must give this COVID-19 the marching orders!’; ‘it could be me, my family, friends or colleagues in that bed tomorrow’; ‘I don’t understand why anyone would not clean these beds as well as they should be cleaned and yes I understand sometimes people get busy’. ‘I often find some stains (body fluids) in the difficult to reach areas of beds so it is my duty to ensure these are thoroughly decontaminated so the next patient has a clean and safe bed’. Wow – this is why I came into nursing and to hear someone sharing the same views as I do made my day.

It’s very easy to treat one’s job as just for income generation, but for many of us working in healthcare, it goes way beyond that. We don’t just care about what we do and how much money we get, we care about how we do what we do and what the end results of whatever we do ‘will look like’. We really do care! Housekeeping staff are no exception. They are among the ‘hidden gems’ in healthcare and other settings; sadly they’re often underappreciated. I think we should be doing more to show them that we care. It’s not just about the money – sometimes a ‘hello’, ‘good morning’, ‘how is your day going’, ‘how can I be of help’ can make their day. These gestures will let them know that they are appreciated and that their jobs are as highly valued as those of all the other clinical or non-clinical colleagues in respective settings.

COVID-19 has taught me…

Ø Decision makers have a tough job during global health emergencies; it’s easier said than done!

Ø We all need each other and very much depend on one another, directly or indirectly - from the youngest to the oldest, the richest to the poorest, politicians, epidemiologists, scientists, housekeeping staff, critical care staff, public health/IPC experts, other key-workers and the rest of the population. This has been demonstrated by the effectiveness of adherence to quarantine and social distancing rules during this pandemic.

Ø Collective actions will help us beat COVID-19 or other public health threats. Therefore, IPC policies and guidelines are important but are one part of the bigger picture.

Ø Critical care staff can be very fussy but they do such a critical and important job; housekeeping staff are wonderful colleagues who also do a critical and important job. They at least deserve ‘a hello, good morning, how can I be of help’ at every opportunity I find.

Ø The least I can do is show respect, kindness and compassion to everyone I encounter. I must always remember to stay in touch with reality and go back to the front-line and test some of our IPC guidelines and also update my clinical skills at least twice every six months. This will not only improve the way I support and work with colleagues, but will equip me with important/critical clinical and IPC skills.

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