|Year : 2022 | Volume
| Issue : 2 | Page : 28-32
Training in management of COVID-19 cases among first responders before deployment to makeshift COVID hospital
Arun Kumar Yadav1, Anuj Singhal2, Kiran K Kompella3, Anand S Menon2, Saurabh Mahajan2
1 Department of Community Medicine, Armed Forces Medical College, Pune, Maharashtra, India
2 Department of Internal Medicine, Armed Forces Medical College, Pune, Maharashtra, India
3 Department of Internal Medicine, Army Hospital R and R, Delhi, India
|Date of Submission||13-Mar-2022|
|Date of Decision||26-Mar-2022|
|Date of Acceptance||22-Apr-2022|
|Date of Web Publication||24-May-2022|
Dr. Arun Kumar Yadav
Department of Community Medicine, Armed Forces Medical College, Pune - 411 040, Maharashtra
Source of Support: None, Conflict of Interest: None
Background: The COVID-19 pandemic commenced in China in December 2019 and has since become a major public health problem. India, as a country, faced many challenges in preparing for the coronavirus pandemic. Due to the novelty of the disease, high infectivity rates, and constant risk of health-care workers (HCWs) getting infected, the training of the first responder, including primary care physicians, in the management of COVID-19 is paramount importance. This study analyses the benefits of a short training session imparted to HCWs involved in a makeshift COVID-19 hospital. Methodology: A structured training program consisting of lectures and workshops was formed for the HCWs detailed for the COVID-19 hospital. A questionnaire was prepared and administered to HCWs pre- and post-training sessions. Paired t-test was used to determine the mean difference, and P < 0.05 was taken as statistically significant. Results: A total of 260 HCWs participated in the study. The doctors gained the most in the critical care aspect, especially in oxygen requirement for the patient and knowledge of oxygen delivery by various apparatuses. The nurses showed a significant improvement in knowledge regarding recommended drugs for severe COVID cases (P < 0.05). Conclusion: HCWs are required to man the COVID facility at very short notice. The article showed the utility of short, structured, and quick training for HCWs. Regular training sessions are important in this regard, and there is a requirement for standardization of the training program and curriculum.
Keywords: COVID-19 training, health-care workers, training the trained
|How to cite this article:|
Yadav AK, Singhal A, Kompella KK, Menon AS, Mahajan S. Training in management of COVID-19 cases among first responders before deployment to makeshift COVID hospital. J Prim Care Spec 2022;3:28-32
|How to cite this URL:|
Yadav AK, Singhal A, Kompella KK, Menon AS, Mahajan S. Training in management of COVID-19 cases among first responders before deployment to makeshift COVID hospital. J Prim Care Spec [serial online] 2022 [cited 2022 Oct 3];3:28-32. Available from: https://www.jpcsonline.org/text.asp?2022/3/2/28/345848
| Introduction|| |
COVID-19 is a novel disease caused by a newly identified virus called Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). On December 31, 2019, several cases of pneumonia of unknown etiology were reported by the China Health Authority to the World Health Organization (WHO) in Wuhan City in Hubei Province in central China. The WHO Director-General declared the novel coronavirus outbreak a Public Health Emergency of International Concern on January 30, 2020. The disease caused by the novel coronavirus (SARS-CoV-2) was named COVID-19 on February 11, 2020, and it was declared a pandemic by the WHO on March 11, 2020. As of now on May 2, India has more than 19 million cases. India is currently at 2nd position in the world in the number of confirmed COVID-19 cases. Person-to-person transmission is the main route of spread of coronavirus, which occurs due to direct contact or through droplet spread by coughing or sneezing. Transmission from asymptomatic carriers is seen and it has been found that the viral load of asymptomatic carriers is comparable to symptomatic carriers; hence, it has been an uphill task to control the spread of the coronavirus worldwide.
India, as a country, faced many challenges in preparing for the coronavirus pandemic as the health-care system was not prepared to handle such a large number of patients with the particular requirement of isolation for treatment and transmission prevention, especially during the second wave of the pandemic. The government hospitals in India had about 8,50,000 beds, and a total of 40,000 ventilators in both private and government hospitals at the beginning of the pandemic. As the number of confirmed COVID-19-positive cases was on the rise and the coronavirus-infected patients are required to be kept separate from the noncoronavirus cases, this has led to the development of dedicated COVID hospitals and COVID care center all across India. The health-care workers (HCW) are at great risk of coronavirus transmission. In China, almost 3300 HCWs were infected, of which 22 HCWs died by the initial weeks of March 2020. The HCWs with limited knowledge and training have to work harder and for a longer duration in the situation of a pandemic of a novel disease. There is a very high chance of person-to-person transmission of coronavirus in hospitals where COVID-19 cases are admitted which puts the HCWs at risk of being infected. Around 22,073 confirmed cases of COVID-19 in HCWs were reported from 52 countries by the WHO in April 2020. The HCWs are required to move on short notice to these COVID care facilities. The government has also requested retired and nonpracticing doctors to join the COVID care facilities as the second wave of COVID-19 is overwhelming. The primary care physicians were the first responders in the hospitals as well as society. The lack of knowledge regarding infection prevention and control (IPC) for respiratory-borne infection and inadequate training for IPC may led to the transmission of coronavirus in these primary care physicians. Adequate knowledge regarding the use of appropriate personal protective equipment (PPE) and IPC measures is highly required for protecting the HCWs from COVID-19 infection also knowledge about the latest treatment guidelines is essential to primary care physicians. Herein, we present our experience of training HCWs in 1000 bedded makeshift dedicated COVID hospital wherein HCWs were flown from across India. This study analyses the benefits of a training session imparted to personnel involved in a makeshift COVID-19 management center.
| Methodology|| |
All personnel detailed for manning the COVID-19 hospital were from different hospitals and consisted of a heterogeneous group of doctors, nurses, and paramedics. A structured training program of 16 h duration was formed. Experts vetted the program in IPC, epidemiologists, clinicians, and critical care experts, and the questionnaire was thus prepared after literature search and wide consultation from them. The questionnaire was pretested on 20 participants using cognitive thinking, and minor modifications were made.
The training program consisted of lectures and workshops. The core topics chosen were specific and related to COVID-19 on IPC measures, common symptomatology, and disease dynamics, including transmission and treatment. After the pretest, these teams were given live demonstration lectures using audio-video visual aids followed by hands-on workshop modules on the above-mentioned aspects. The training was conducted by a physician, infectious disease specialist, and critical care specialists. The training session was conducted in the first half of the day, and after the training was imparted, a post test module was administered in the same format as above, and their responses were recorded.
A total of 28 questions were administered covering various aspects of COVID-19, which included IPC practices (10 questions), common symptomatology (7 questions), and questions related to disease dynamics, including transmission aspects and treatment (11 questions).
For each correct answer, one point was given, and for every wrong answer, zero points were given. The average score was calculated for each group pre- and post-questionnaires administration.
The institutional ethics committee provided the ethics clearance vide their letter number 113/2020 dated September 25, 2020. The data were exported into an excel sheet from Google forms. The continuous variable was defined as mean and standard deviation if they follow a normal distribution or as median and IQR if they do not follow a normal distribution. The Shapiro–Wilk test was used for normality. The categorical variables were defined as numbers and percentages. Paired t-test was used to determine whether the mean difference between two sets of observations is zero. P < 0.05 was considered statistically significant. The analysis was done using Stata Statistical Software: Version 20. College Station, TX, USA: StataCorp LLC. StataCorp. 2017.
| Results|| |
The study participants consisted of 260 HCWs, including doctors (n = 110), nurses (n = 60), and paramedical staff (n = 90) who came from various parts of India for working in a 1000-bed COVID Care Hospital. The pre- and post-responses of HCWs on IPC practices are depicted in [Table 1]. The results analyzed showed that all the three groups were well conversant with the knowledge on hand hygiene, the paramedical staff gained the most in the posttest module as they had a statistically significant observation pre- and post-means of 81.11% and 96.47%, respectively (P < 0.05). This study also brought an interesting finding (although not statistically significant) that the nurses were well versed with WHO five moments of hand hygiene both in pre- and posttest module sessions compared to doctors and paramedical staff. The paramedical staff fared better in the posttest module on the same topic even though not statistically significant with pre- and post-means of 67.39% and 73.17%, respectively. Only 67.78% of paramedical staff were aware of isopropanol content in alcohol-based sanitizer, which improved to 82.35% during the posttest module (P = 0.04).
|Table 1: Pre- and post-responses of health-care worker on infection prevention and control practices (n=260)|
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A total of seven questions were asked regarding the common symptomatology, and the pre- and post-responses were recorded as depicted in [Table 2]. The nurses were more aware of percentage of cases being asymptomatic or having mild symptoms posttest with a P = 0.002. About 87.8% of nurses were aware of the asymptomatic or mild symptomatic cases posttest as compared 87.7% doctors being aware of the same.
|Table 2: Pre- and post-responses of health-care workers on common symptomatology (n=260)|
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Eleven questions related to disease dynamics, including transmission aspects and treatment, were administered to HCWs and the pre- and post-responses are as shown in [Table 3]. The doctors gained the most in the post-training module in the critical care aspect, especially in the oxygen requirement for the patient and on the knowledge of oxygen delivery by various apparatus, the observation was statistically significant (P < 0.05). The nurses showed a significant improvement in knowledge regarding the recommended drugs for severe COVID cases and the ideal blood glucose levels for hospitalized patients (P < 0.05).
|Table 3: Pre- and post-responses of health-care workers on disease dynamics (n=260)|
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The paramedical staff were found to be keen learners in this training module as they had more statistically significant findings posttraining. The paramedical staff gained good knowledge (posttraining) on the aspects of the incubation period, symptomatology of COVID-19 pandemic.
| Discussion|| |
The COVID-19 pandemic brought out new challenges to the HCWs, the dynamics of viral spread and the varied clinical manifestations with which it presented created a knowledge gap in its treatment and management and also the containment strategies. Since the start of the year 2020, there has been a tremendous churn in the HCWs core profession. The paramedical staff gained the most of the training module, reinforcing the fact that key drivers of health-care workforce at the ground level, namely, the paramedical staff contribute positively if a timely reinforced training module is conducted on basics of infection control aspects, this re-enforcement helps the health-care system to bring down the nosocomial infection and transmission. Another study measured the impact of training module for disinfection among paramedics also observed increase in knowledge score. Similarly, increase in knowledge score is also been seen with video modules for housekeeping.
The lower level of knowledge among the doctors regarding five steps of hand hygiene is somewhat bothersome as the WHO five moments of hand hygiene is a universal concept of infection control and the lack of knowledge regarding the same in a well-qualified workforce like doctors was surprising. This could be explained by the fact that the doctors were not attentive in the training session or possible overconfidence behavior of assumption of knowing about the above-mentioned procedure. However, poor knowledge of hand hygiene among doctors is also previously observed.
The concepts of PPE, don and doff procedures of PPE, handwashing and social distancing, N95/three-ply mask became the most sought after topics, and there was an sense of unease in the HCW to understand them with clarity. The added fear and vulnerability of a HCW in contracting this dreaded disease made the job much more difficult. The studies had earlier observed the lack of knowledge about disinfection and PPE among HCWs. This particular module posted new questions, is the “trained” really trained and how much of training is required. This COVID 19 pandemic brought with it an “infodemic” with it to, more than 3 million preprints on COVID 19 can cloud any ones thought process, the lines between right and wrong are blurred, and there is lack of clarity. However, it must be emphasized that most important aspects of basic infection control measures, diseases dynamics, and symptomatology and treatment options by and large have similar backgrounds and this training helped in addressing these concepts.
The participants reported having benefitted from the training sessions. The study becomes significant as the number of COVID cases increases in the second wave, and most of the HCWs that were not doing COVID duties would be involved in the management of cases. The content of the training material and training schedule needs be standardized as the HCWs would require to do COVID duties at short notices, the training needs to be fast, and content needs to be highly relevant and valid.
The study brought out a very important aspects for primary health-care providers. Primary health-care providers who are generally first point of care need to be trained in management aspects, disinfection, and PPE aspects of the COVID-19 so that they can treat COVID-19 cases and at the same time, prevent themselves from COVID-19.
| Conclusion|| |
The COVID-19 pandemic is posing unique and unprecedented challenges to the health-care system worldwide. The increasing numbers and need for isolated management of patients often forces a restructuring of existing health-care system. To face these challenges in the dynamic scenario, up-to-date knowledge of the disease, the latest management guidelines, and institutional strategies of the personnel involved in the management are of paramount importance. Regular training sessions are important in this regard, and there is a requirement of standardization of the training program and curriculum.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]