JDWNRH prepares for a scenario of the virus entering the hospital

Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) is an apex hospital that receives referral cases from the high-risk areas. On any given day, JDWNRH receives a large number of patients, especially for baby deliveries.

Officiating Medical Superintendent of JDWNRH, Dr Pem Chuki, said the hospital has been following preventative strategies during the pandemic. All the patients and their attendants are tested for COVID-19 with RT-PCR, including health staff who are tested every week.

The hospital is also restricting the change of patients’ attendants and addition of extra attendants. JDWNRH is also strictly monitoring the meal pick and drop system, which the hospital initiated before the lockdown. It is being done to stop a lot of people from coming into the hospital and mitigate the risk of COVID-19 spread, given the highly transmissibility of the Omicron variant.

The hospital is also careful to not mix the health staff of in-patient and out-patient departments. Health staff working in the Out-Patient Department (OPD) do not enter into the main building.

“We are also keeping vigilant about our own staff, reminding them to avoid crowds, gatherings and funerals as much as possible, if it is avoidable,” said Dr Pem Chuki.

As of now, JDWNRH has started all the services with crowd restriction inside the main buildings. Patients or visitors are screened at the triaging desks before entering the hospital building, and those people suffering from flu like symptoms and with travel history are screened and tested at the flu clinic.

The hospital has four triaging desks, one in the OPD, one in the dental department, one in the main building, and one in the eye department.

Similarly, screening is done in the mother and child health hospital. However, patients or visitors are not tested for COVID-19 on OPD visits because RT-PCR results require long duration. Moreover, the hospital  does not see the cost benefit of testing for OPD visits, but at the same time, all the health staff are encouraged to wear PPE, and the infection control nurses are doing the audit monitoring in all the chambers everyday.

JDWNRH does not admit patients directly into the wards, as they are kept under observation in the holding area.

“We keep these patients of high-risk who actually do not need immediate care inside the main building, but patients who need immediate care, such as emergency cases, surgery, ICU, NICU OR PICU care or any OT services then we do Genexpert ,which takes about 60 to 90 minutes, and then we admit them inside the main building. We see that the risk to the patient’s life is more than the COVID-19 death,” said Dr Pem Chuki.

Dr Pem Chiki said if any departments or wards detects positive cases, then the entire ward is shifted to a new relocation ward. The new relocation ward has about 90 beds. When a particular department or ward is compromised then all the patients and attendants will be shifted to a new ward with the health staff, and the old ward will be disinfected, cleaned and cordoned off for 48 hours.

After 48 hours, only new patients will be admitted there. And the patients and attendants, shifted in the new relocation, are kept there for up to 10 days, as per the protocol. And on day 10, patients and attendants and all the health staff will be tested, and if they test negative, they are no longer treated as primary contacts.

Similarly, if there are cases, like patients that require dialysis or chemotherapy, the hospital has a relocation unit where the hospital provides dialysis and chemotherapy for all the primary contacts with exposure to a positive case. At the same time, even in the observation unit/ward, they have a birthing unit, so any pregnant woman who is coming from high risk can deliver there. There are also operation theatre and birthing services in the COVID-19 isolation ward.

According to JDWNRH, there were incidents in the hospital during the previous lockdown, where one ward was compromised, and even during the lockdown this year, one of the health staff tested positive from the community after four days of joining her duty in one of the medical ward in JDWNRH, which is the busiest ward in terms of patients turn around.

However, her primary contact tested negative, even her own roommate and the entire 32 patients and attendant too tested negative.

The hospital had shifted 32 patients, out of which 19 patients who were oxygen dependent, and 4 patients were put on ventilation. “We could shift them without any misfortune. Which shows that we are prepared,” said Dr Pem Chuki.

In the beginning of the lockdown, a taxi driver tested positive, at that time, the hospital kept monitoring the taxi driver and all of his contacts in the emergency room, and they were put under quarantine, and all of them tested negative.

The dedicated health staff at JDWNRH worked for 12 hours a day continuously, with a buffer staff in place, for two weeks during the lockdown.

Meanwhile, there are five COVID-19 patients in JDWNRH COVID-19 isolation ward, as of Thursday. The youngest patient is a six-month-old baby and the oldest is 76 years old. They are in stable condition. All services are being facilitated in JDWNRH except for aerosol generating procedures.

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