The University of the Free State (UFS) says its Department of Anaesthesiology, in collaboration with the Clinical Simulation and Skills Unit, has trained 500 hospital staff members to deal with the Covid-19 pandemic since the start of lockdown measures in South Africa.

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 in the week of March 16 and was led by UFS Department of Anaesthesiology Pain Control Unit head Professor Gillian Lamacraft, 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, in the event they be required to care for Covid-19-positive patients in the future, especially if there is an increase in the cases being treated at the hospital.

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 (such as the Ebola virus), and because they were not previously required to wear PPE regularly, they are not familiar with its use.

Anaesthetists will be at great risk of Covid-19 virus exposure, Lamacraft highlights.

“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 at risk of being contaminated with Covid-19 during this procedure," says Lamacraft.

“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, if they are available, will preferably be the doctors performing these intubations as they are considered the doctors best at this procedure,” she says.

To facilitate the 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.

“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.”

It is important that all these healthcare workers are taught the different types of PPE (including standard and aerosol-generating procedure PPE (AGP PPE)). In particular, healthcare workers 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, she illustrates.

“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 (such as 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.”

Clinical Simulation and Skills Unit head Professor Mathys Labuschagne says volunteering doctors and nurses are also trained to work in intensive-care units (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,” says Labuschagne.

Department of Anaesthesiology Dr Edwin Turton notes 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 trained to wear appropriate PPE for AGP and contact with people under investigation 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 Turton.

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, Lamacraft concludes.