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Sustaining a COVID-free medical facility during the world’s worst pandemic

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Sheikh Shakhbout Medical City
Lessons from Sheikh Shakhbout Medical City on keeping COVID-free throughout the pandemic.

The UAE and Abu Dhabi’s response to the COVID-19 pandemic has been excellent. It is, therefore, no surprise that the UAE is ranked as one of the best and safest places to be in during the pandemic. The country’s authorities and emergency response team have taken swift action and coordinated the healthcare system’s response in collaboration with the UAE’s healthcare network led by SEHA.

SSMC, one of the UAE’s largest hospitals for serious and complex care and a joint-venture partnership between Abu Dhabi Health Services Company (SEHA) and Mayo Clinic, is an integral part of the Abu Dhabi healthcare network and has played a key role in the national efforts to mitigate the impact of COVID-19 and stop the spread of the virus. The deep resilience, collaboration and selfless hard work shown by our people and the sustained levels of care shown to our patients was astounding.

During the first wave of the pandemic, SSMC operated as a COVID hospital and provided care to a large number of patients with COVID-19 as well as patients who did not have the disease. SSMC, therefore, had to significantly expand its emergency department, internal medicine and critical care services to look after the surge in COVID-19 patients.

However, in June 2020, a plan was put in place for SSMC to become a COVID-free hospital, and since then the hospital has been identified by the Department of Health – Abu Dhabi (DoH) as a prime COVID-free facility to meet the needs of other patients in the community.

What does it mean to be a COVID-free hospital?

A COVID-free hospital provides care for patients who need hospitalisation and who tested negative for COVID-19. It ensures that maximum precautions are taken to reduce the risk of staff and patients acquiring and transmitting the novel coronavirus from the hospital environment. SSMC, therefore, admits and accepts patients who do not have COVID-19 unless a unique service needs to be provided for a patient who has the disease such as a patient who has a major burn and is admitted to the National Burns Unit. Implementing such measures facilitated access to high-quality medical and surgical care for all patients, whilst adhering to the globally recognised levels of safety standards across the hospital.

How did we do it?

We were able to draw from the legacy of SEHA in the UAE, the international best practice and expertise contributed by our Mayo Clinic partners. This, together with our highly committed SSMC team, uniquely positioned us to take queues and learnings from the international medical community and incorporate international best practice into our processes.

SSMC’s response to COVID-19 was coordinated by a multidisciplinary taskforce, which met daily, and at times more than once, and worked with internal and external stakeholders. Becoming COVID-free and maintaining our COVID-free status was reliant on a number of strategies, most importantly:

1. Working closely with other SEHA hospitals and designated healthcare facilities

SSMC could only become COVID-free because of the help of other SEHA hospitals such as Al Rahba and Sheikh Khalifa Medical City (SKMC) hospitals who were designated as COVID-19 hospitals. Patients who tested positive while in the Emergency Department would stay there until they were transferred to a COVID facility.

In addition, patients who were already admitted and subsequently found to be COVID-19 positive would also be transferred out. This was done efficiently on a daily basis with the help of our Bed Management Team working with the SEHA Operations Team to identify beds for the patients and transfer them out of SSMC. The laboratory at SSMC also introduced a rapid antigen and gene-based test (PCR) for COVID-19 in order to rapidly detect infection in a patient and speed up decision-making about his or her transfer.

2. Keeping staff safe

A number of interventions were used to reduce the risk of staff acquiring or transmitting COVID-19 in the hospital. For example, there were frequent reminders through screen savers, pop ups and email messages reminding staff about the importance of maintaining COVID-19 precautionary and preventive measures. Managers were also asked to ensure that all staff had their temperature checked before every shift. Any staff member with symptoms would be sent to the Occupational Health Clinic for assessment and testing.

The Infection Prevention and Control Team performed daily audits with feedback to staff and managers. Additionally, a COVID-19 preparedness checklist and audit tool was developed to help departments remain COVID-free.

Careful steps were also taken to minimise exposure and transmission risks amongst our staff, including universal masking, physical distancing measures, allocating remote working processes for staff who were able to work from home, switching to virtual meetings, managing ward rounds to minimise contact risk and initiating early vaccination when it became available to frontline workers.

3. Encouraging COVID-19 vaccination and occupational health services

The Nursing and Occupational Health Team developed an effective vaccination campaign in January 2021 which led to rapid uptake of the Sinopharm COVID-19 vaccine. By March 2021, over 70 per cent of SSMC’s staff had been vaccinated and over 90 per cent of staff are currently fully vaccinated. Furthermore, a system was developed for staff to have weekly PCR tests including reminders directly being sent to them and their managers. The Infection Control Team and Occupational Health Team worked together to ensure that, on a daily basis, every staff member who tested positive was excluded from work and contact tracing was done to identify potential close contacts who required testing and quarantine

4. Maintaining infection prevention measures in outpatient clinics

Special measures were introduced to ensure that the outpatient clinics did not have patients with COVID-19. For example, a system was developed to automatically identify any patient who had tested positive for COVID-19 in the previous 14 days and had a clinic appointment at SSMC. Patients who were considered to be still infectious had their appointments rescheduled or changed to virtual visits or arrangements made to see them in the Emergency Department if they need acute care. Staff were also asked to consider all patients as potentially having COVID-19 and use N95 masks as well as eye protection for all close contacts with patients. Security staff and nursing staff screened all patients at the entrances of the outpatient building using temperature sensors. We also developed and used more telemedicine and home delivery of medication in order to reduce the number of hospital or clinic visits. Furthermore, we took away all unnecessary papers such as journals and newspapers in waiting rooms not only in the outpatient clinics, but also across all the hospital.

5. Implementing stringent precautionary safety measures in inpatient settings

All patients admitted to SSMC are screened for COVID-19 on admission and are put in isolation until screening test results come back negative and a physician decision is made to discontinue isolation. All specialities have also produced pathways to safely manage patients with suspected COVID-19 or when COVID-19 has not yet been excluded. In addition, patients waiting for procedures such as endoscopy or elective surgery are screened within five days of their procedure and asked to self-isolate. Extended use of N95 masks in Emergency Department and Critical care areas was introduced to further reduce the risk of transmission of COVID-19 to staff. SSMC implemented the DoH requirements to have all visitors tested for COVID-19 24 hours before visiting. We also reduced visit time and number of allowed visitors for patients.

Why was this important?

Like in most parts of the world, care for patients who do not have COVID-19 appeared to have suffered during the pandemic due to patients’ fear of contracting COVID-19 if they go to a clinic or hospital, therefore, delaying and waiting too long to seek care for any illness they may have. Patients were afraid to visit hospitals and many hospital services had to be suspended to divert resources towards looking after patients with COVID-19. SSMC has played a key role in maintaining the health and well-being of our communities during the pandemic by focusing on providing high-quality care for non-COVID patients, while other sister hospitals at SEHA like SKMC, Al Rahba concentrated their efforts for COVID 19.

What were some of our challenges, and how did we overcome them?

Inevitably, as a healthcare facility facing an unprecedented crisis, we did have our challenges. Firstly, we had to be flexible and modify our interventions in line with published evidence, surge in transmission of COVID-19 in the community as well as changing recommendations from regulatory authorities. This happened very shortly after we opened our new facility.

Secondly, keeping staff morale high despite long working hours and the constant pressure has been difficult. In addition to using different strategies to ensure they do continue to maintain preventive measures, we also had to ensure we pay particular attention to staff wellbeing and talk openly about the challenges and how to remedy them effectively. 

Lastly, we had to expand our services rapidly and run our hospital at high occupancy levels in order to cater for patients who can no longer be looked after by hospitals that have been converted into designated COVID-19 facilities. On that occasion, I have to send a word of appreciation to SEHA, Mayo Clinic and Zayed Military Hospital for all their assistance in providing additional health care providers and staff for an extended period of time.  We could not have expanded our facility without them. 

Responding to the COVID-19 pandemic and becoming a COVID-free hospital has helped us to think and work differently, develop a number of systems that have helped our overall operations meeting the needs of our patients. We have managed to maintain high-quality services for patients who do not have COVID-19 thanks to the unwavering support of our exceptional staff and government partners. We have also completely redesigned our services to ensure that we focus on looking after patients who do not have COVID-19 and maintain our COVID-free status. The lessons learnt will remain with us as we remain agile, enhance our readiness and ensure we’re able to continue to meet the needs of our communities – building our strength and resilience as an organisation. 

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Dr Naser Ammash

This article appears in the latest issue of Omnia Health Magazine. Read the full issue online today.

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