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TRAINING PROGRAMMETraining Issue:"Occupational Health Services for COVID-19 in the health sector”HealthWISE COVID-19 risk assessment for the 3rd wave in South African healthfacilitiesPresenterMr Jonathan Ramodike
Methods Study design– Participatory Action Research Population and setting– 4 tertiary hospitals in 2 provinces in South Africa– Population (HealthWISE experts (NIOH & UP) as well as health workers from participating hospitalsand trade unions)– The hospitals that were assessed had a total number of workers of 14,743 SamplingProvince 1Province 2 Hospital A: 5300 Hospital C: 1043 Hospital B: 6500 Hospital D: 1200– Convenience sampling Data collection tools– HealthWISE Checklist– Qualitative observational HealthWISE risk assessment.
HealthWISEA practical, participatory quality improvement tool for health facilities. Whichencourages workers and managers to work together to improve workplaces andpractices using local low-cost solutions.
HealthWISE Checklist Results for Entrance/SecurityHospital AHospital BHospital CHospital DYesNoYesNoWhat action do youpropose/Suggestions.N/ANeed for thermometers,screening, surgical masksfor security, currentlyusing cloth maskN/AHealth screening shouldbe done in order todetect infections in thework placeAre measures taken to preventand control droplet-bornehazards such as COVID-19?YesNoYesYesWhat action do youpropose/Suggestions.N/ASocial distancing, reviewvisiting hours currently 2to 4 pmN/AN/AIs a comprehensive workplaceCOVID-19 and TB preventionand care programmeimplementedYesNoYesNoN/ANo visuals of informationon prevention thereforemore visual information,active training from visibleOHS teamN/AInfer provision of inservice trainings. Plan tobe made available inorder to guide the staff.Is there a routine to identifyand assess biological hazards atthe workplace?What action do youpropose/Suggestions.
HealthWISE Checklist Results for Out PatientIs there a routine to identify andassess biological hazards at theworkplace?What action do youpropose/Suggestions.Hospital AHospital BHospital CHospital DNoNoNoYesScreening at door, crowded,social distancinguncontrollable, no space.Need space, crowdAdd cleaners/ at night,need space, crowd control,control, arguing withno equipment/PPE, noscreening, arguing withpatients,screeningatgatehot waterpatientsN/AAre measures taken to prevent andcontrol droplet-borne hazards such asCOVID-19?YesYesYesYesWhat action do youpropose/Suggestions.N/AN/AN/AN/AIs a comprehensive workplace COVID19 and TB prevention and careprogramme implementedYesYesNoYesN/AEducation, counsellingbecause of patientsdyingN/AWhat action do youpropose/Suggestions.N/A
HealthWISE Checklist Results for CasualtyHospital AHospital BHospital CHospital DIs there a routine to identify andassess biological hazards at theworkplace?YesYesNoYesWhat action do youpropose/Suggestions.N/AN/ANo SuggestionsN/AAre measures taken to prevent andcontrol droplet-borne hazards such asCOVID-19?NoNoYesYesN/AN/AWhat action do youpropose/Suggestions.Is a comprehensive workplace COVID19 and TB prevention and careprogramme implementedWhat action do youpropose/Suggestions.Over crowding/ increase air More masks, minimisecirculation, space, biggernumber of peoplecasualty, most patients spenddays in casualtyYesUnsureNoYesN/AThey do not feel theneed to test becausethey are already exposedCan’t think ofanythingN/A
HealthWISE Checklist Results for Covid-19 wardsHospital AHospital BHospital CHospital DIs there a routine to identify andassess biological hazards at theworkplace?NoYesNoYesWhat action do youpropose/Suggestions.Specimen taking inprocess of workinspectionN/AProper in-service trainingN/AAre measures taken to prevent andcontrol droplet-borne hazards such asCOVID-19?YesYesNoYesWhat action do youpropose/Suggestions.N/AN/AProvide enough routinefumigationN/AIs a comprehensive workplace COVID19 and TB prevention and careprogramme implementedYesYesYesNoWhat action do youpropose/Suggestions.N/AN/AN/AThey do not have aprogram
Qualitative observationalHealthWISE risk assessment.Recap: Implement measures to prevent and control “approach”8
5Entrance/Security Administrative ControlsProvince 1Province 2Hospital A Hospital B Hospital C Hospital DAre staff social oYesNoNoNoNoAre there posters or information leaflets about COVID-19?Is furniture positioned for social distancing?Is there an area with water and soap to clean hands?Are there hand sanitizers in all entrances and exit points?Is waste properly segregated?
Ventilation and PPE for Entrance/SecurityEntrance VentilationIn all the 4 hospitals the ventilation was adequate except if you are in the securityguard room.PPE Staff was wearing at the entranceProvince 1Cloth maskSurgical maskN95 RespiratorProvince 2Hospital AHospital BHospital C Hospital DYesYesYesYesYesYesYesYesNoYesNoNoHealth workers were not wearing PPE properly
15Casualty VentilationHospital A: It was inadequate because of infrastructure which allowed limited natural crossventilation, absence of extractors even though their air-conditions were working.Hospital B: It was adequate they are using mechanical ventilation (extractors and air-conditionssimultaneously)Hospital C: It was Inadequate, the extractors were not working and no natural cross ventilation.Hospital D: It was adequate, even the extractors were tested and were working.
8Casualty Administrative ControlsProvince 1Hospital AIs staff social distancing?Are there posters or information leaflets about COVID-19?Is furniture positioned for social distancing?Is there an area with water and soap to clean hands?Are there hand sanitizers in all entrances and exit points?Is waste properly segregated?Are there COVID19 waste management boxes?Province 2Hospital B Hospital C Hospital YesYesYesYesNoNoNo
13PPE Staff was wearing at CasualtyProvince 1Hospital AHospital BCloth maskSurgical maskN95 RespiratorGloves/latexGloves/otherOver garmentOver BootsFace shieldApronsGogglesCapsProvince 2Hospital CHospital esYesNoYesYesYesYes
OPD VentilationHospital A: It was inadequate because no natural cross ventilation and the mechanical ventilationwas not working (extractors were not working)Hospital B: It was adequate they are using mechanical ventilation (extractors were tested and wereworking)Hospital C:. It was inadequate no windows and mechanical ventilation systems not workingHospital D: It was inadequate, there was no natural cross ventilation and not mechanical ventilation.11
15OPD Administrative ControlsProvince 1Province 2Hospital A Hospital B Hospital C Hospital DIs staff social distancing?Are there posters or information leaflets about COVID-19?Is furniture positioned for social distancing?Is there an area with water and soap to clean hands?Are there hand sanitizers in all entrances and exit points?Is waste properly segregated?Are there COVID19 waste management sNoNoYesYesYesNoNoYes
16PPE Staff was wearing at OPDProvince 1Hospital AHospital BCloth maskSurgical maskN95 RespiratorGloves/latexGloves/otherOver garmentOver BootsFace shieldApronsGogglesProvince 2Hospital CHospital oNoYes
21COVID-19 ward VentilationHospital A: Its was adequate. They were exclusively using mechanical ventilation (extractors werechecked and were working)Hospital B: Its was adequate. They were exclusively using mechanical ventilation (extractors werechecked and were working)Hospital C: It was inadequate, no mechanical ventilation system and inadequate natural crossventilation.Hospital D: It was inadequate, no mechanical ventilation system and inadequate natural crossventilation.
14Administrative controls at COVID-19 WardProvince 1Province 2Hospital A Hospital B Hospital C Hospital DIs staff social distancing?Are there posters or information leaflets about COVID-19?Is furniture positioned for social distancing?Is there an area with water and soap to clean hands?Are there hand sanitizers in all entrances and exit points?Is waste properly segregated?Are there COVID19 waste management sYesYesNoYesYesYesYesYesYesYesYes
15PPE Staff was wearing at COVID-19 WardProvince 1Hospital AHospital BCloth maskSurgical maskN95 RespiratorGloves/latexGloves/otherOver garmentOver BootsFace shieldApronsGogglesProvince 2Hospital CHospital YesYesYesYesYes
DiscussionThe checklist revealed that there are inconsistencies in responses as well as a lackof knowledge and practices and some confusions in mitigating approaches forCOVID-19 in the health facilities. Furthermore the overall perception of healthworkers towards covid-19 mitigating measures to reduce their risks in the workingplace is unsatisfactory.The HealthWISE qualitative observational assessment revealed that ventilationwas poor, administrative control measures were inadequate and although suppliesof personal protective equipment (PPE) were adequate, PPE were often not wornproperly.The overall results of the observations shows that efforts to protect healthworkers have been done but they are very much warranted.
Thank you
need space, crowd control, screening, arguing with patients Need space, crowd control, arguing with patients, screening at gate Add cleaners/ at night, no equipment/PPE, no hot water N/A Are measures taken to prevent and control droplet-borne hazards such as COVID-19? Yes Yes Yes Yes What action do you propose/Suggestions. N/A N/A N/A N/A
