From the Frontline: control the controllable

Michelle Hennebry, her husband Shane, an engineer with Abbot Vascular in Clonmel, and their three small children live near Rathgormack, Co Waterford. Much has changed in Michelle’s day-to-day life as a clinical nurse specialist in infection prevention and control (IP&C) within University Hospital Waterford (UHW) since COVID-19 entered the country.

Happily, she tells Irish Country Living, her children are pretty unaware of what’s going on.

My hours are changing as demand increases

“They go to the farm, where my aunt-in-law minds them. They are running around feeding lambs and calves on the same farm as I was reared on myself, which was my grandparents.

“My hours are changing as demand increases, but my manager is doing her best to ensure that our team maintain as much of a work-life balance as possible.”

Her role as clinical nurse specialist normally comprises of:

Her role and responsibilities are quite extensive when viewed in full. “We would always have infectious patients in the hospital, for example with MRSA, but this disease has resulted in us being a lot busier.”

With the COVID-19 outbreak, her job is primarily to educate staff on the appropriate use of personal protective equipment (PPE).

The process of putting it on, and more importantly the process of taking it off so that staff members don’t contract COVID-19, which could potentially be on their PPE after being in the room with a patient.

The advice is changing every day and it is very draining

“This education element is a big remit currently, as we are trying to educate not only nursing and medical staff, but catering staff, porters and anyone else that could encounter this virus.

“As you can’t get everyone together because of social distancing, training is in small groups.

“At the moment, we are getting a lot of questions from different cohorts of staff. The advice is changing every day and it is very draining. This is no one’s fault, as this is all new, but it’s our job to reassure staff as they are scared.

“Going forward, certain areas of the hospital will be closing and these staff will be redeployed, so they are acquiring additional training to help up-skill for the caseload ahead.

“It’s all additional preparation at the moment, as we need to be prepared for what is being anticipated nationally.”

Concern for patients who might stay away

Anyone that has COVID-19 symptoms are normally referred to the hospital by their GP. If someone is very sick and needs an ambulance, they need to disclose that they have COVID-19 symptoms to the ambulance service.

This ensures that appropriate measures are implemented to prevent other people being exposed to the virus, through taking appropriate precautions.

Our emergency departments are unusually quiet

“There is a concern that people with other illnesses are not going to the hospital. An example would be stroke patients,from whom the outcome is better the sooner they present to hospital and start treatment. If you are ill outside of COVID-19, don’t put off coming into hospital.

“Our emergency departments are unusually quiet, we have no one waiting on trollies and it’s the same nationally. This is concerning.

“There is a fear that people who are sick and in need of hospital care are delaying attending for treatment. We are doing everything we can to protect and separate the sick and those sick with COVID-19, to avoid exposure.”

As recommended nationally, UHW has two parallel streams for assessing patients. Patients enter a “COVID stream” or a “non-COVID stream”. With the COVID stream, the medical staff will assess if the patient requires hospitalisation or not. If the patient is admitted, they are brought through a separate area to reduce the risk to people that have no symptoms, or are being admitted for other reasons.

The hospital has just opened the new Dunmore wing, which has individual en-suite rooms, ideal for infection control.

Other areas of the hospital are also being identified for a time, when and if, the existing identified areas become full. It is all about reducing risk and keeping people that are in hospital for non-COVID related issues from becoming exposed to the virus.

A lot of my colleagues and friends are under strain and I am advising them to stop listening to endless news

Michelle stresses the importance of people educating themselves and the risk misinformation or too much bad news poses to people’s mental health.

“If people need information, they need to look up the HSE and the Health Protection Surveillance Centre websites.

“A lot of my colleagues and friends are under strain and I am advising them to stop listening to endless news. Listen to it once a day. It is out of our control and we need to control what we can.

“Don’t focus on other countries, listen to what they say on the national news and stop listening to social media, as a lot of the information is misleading.”

Gloves in particular are a bugbear for Michelle. She says that people outside of the healthcare setting don’t need to wear them, as there is the potential for even greater contamination by using them.

People are more inclined to clean their hands regularly if they don’t have gloves on

“In the healthcare setting, we use gloves when required, remove them after the task and clean our hands. Some people in the public are wearing gloves, but continue to touch their eyes, mouth or nose with their gloves on.

“The gloves have been contaminated and are possibly being re-used, therefore increasing the risk of becoming infected. People are more inclined to clean their hands regularly if they don’t have gloves on.

“Recently, I passed two men wearing gloves while they were smoking. They probably thought they were protecting themselves, but really, they had gloves on that were probably contaminated and were using them to hold their cigarette and bring it up to their mouths. It is definitely a lack of knowledge.

“People see this on the television or in public and believe it must be best practice. The most important forms of protection are to ensure social distancing, utilise appropriate cough etiquette, wash your hands regularly and clean and disinfect frequently touched objects and surfaces regularly”.

“Also, as an infection control professional, I have noted that more people are wearing masks in public.

If someone is wearing a single-use disposable mask, it is of no use to put it in your pocket and take it out agai

“They are trying to protect themselves, but in the hospital setting, masks are single use – once used they are put in the bin and we clean our hands.

“If someone is wearing a single-use disposable mask, it is of no use to put it in your pocket and take it out again. It has been contaminated and once again, it could lead to a higher risk of becoming infected. If possible, people should try to prevent touching their eyes, nose and mouth. This is the entry point into your body for COVID-19.

“People need to educate themselves. At the moment, information is constantly being reviewed and changed.

“Therefore, education is best achieved through reliable sources. Mental health is so important, don’t stress about what is out of your control. Control what is controllable.”

Read more

Adjusting to the impact of COVID-19 on daily living

COVID-19: protecting our frontline medical staff