The Department of Health briefed the Committee on the safety protocols at the Tygerberg and Paarl Hospitals during the Covid-19 pandemic, and also provided a status update on the Tygerberg Hospital infrastructure programme.
The Department said the Occupational Health and Safety protocols it had implemented at the two hospitals included staff risk assessments, as well as occupational risk management. New standard operating procedures had also been introduced for staff members who had been infected with the virus.
The status update on the Tygerberg Hospital infrastructure programme indicated that the current state of the hospital posed a risk. The mitigation strategy included maintenance and remedial work, a new central hospital, as well as a new regional hospital.
Members wanted to know how staff fears of infection were being allayed. They asked for details on the projects that were on hold, and whether this was due to COVID, or other reasons. They wanted to know the exact number of healthcare workers who were infected, and whether labour unions had been involved in the protocols affecting their members.
Safety protocols at Tygerberg Hospital
Dr Dimitri Erasmus, Chief Executive Officer: Tygerberg Hospital, said the hospital had had 1 500 COVID-19 admissions since being designated as the primary healthcare facility for those infected with the virus.
With regard to staff infections, the labour ward, the main kitchen and the intensive care unit (ICU), were the most affected areas, with more than three staff members testing positive. There were currently no positive cases among hospital staff members.
He outlined the Occupational Health and Safety (OHS) protocols, as well as the infection prevention and control measures for Tygerberg Hospital. These included symptom monitoring and management; staff risk assessments; occupational risk management; as well as the standard operating procedure (SOP) when a staff member tested positive.
He said that when the risk assessment was done, the were two areas of focus – personal, as well as workplace risk assessment.
Individual vulnerability was assessed based on the risk of serious disease or death. The working environment was assessed to determine the likelihood of coming into contact with COVID-19 positive individuals. If an individual scored between 9 and 16 on the ‘risk scorecard’, that was deemed as an unacceptable risk, and that individual would need a full OHS assessment.
He said 653 OHS assessments had been done. These assessments were carried out by all line managers. Very high risk individuals, such as those with co-morbidities, and who could not function anywhere in the hospital, were put on special leave and came in for regular assessment of their condition.
The workplace assessments included a rapid (desktop) assessment, as well as area risk assessments. The rapid assessment was performed by a team of experts in view of the novelty of the risk. An area risk assessment had followed a Department of Employment and Labour (DEL) inspection, which had found that the initial overarching risk assessment was not adequate.
He said the strategy at the hospital also included risk mitigation, medical surveillance as well as case management.
Safety protocols at Paarl Hospital
Mr Francois van der Watt, Chief Executive Officer: Paarl Hospital, said 451 staff members had been assessed. Of the 160 staff members to test positive, 157 had already returned to work, and there had been no deaths.
He said patients arriving at the emergency centre were screened and streamed to appropriate clinic areas for interventions. Patients were seen and placed in allocated areas, and overcrowding was prevented as far possible. Curtains were drawn to prevent droplet spread between patients. All elective procedures had been stopped.
A specific and designated high risk COVID ward had been identified and deployed.
All psychiatric admissions were tested for COVID and placed in isolation until proven negative, since coughing behaviour and mask etiquette was a challenge with these patients.
He said the OHS protocol at Paarl also included individual and COVID-19 workplace risk assessments. All staff self-screened every day for symptoms. Everybody entering the facility was screened. Staff had received further training regarding COVID, social distancing, and personal protective equipment (PPE). Staff had been further supported through an Employee Assistance Programme that provided psychosocial support.
Other safety measures included the installation of foot-operated mechanisms, flu vaccinations for all staff, and new standard operating procedures had been written. All staff infections were monitored and reported daily as part of medical surveillance. There have been no new staff infections for five to six days.
He said six medical officers, plus 21 nurses, had been appointed on a six-month contract basis. Administrative, clerical and support services had been appointed through an agency.
Additional services that had to be procured included environmental cleaning, and external contractors were also assisting with deep cleaning. Additional ambulance services had been procured to support transfers between Paarl and Sonstraal. Extra wall-mounted oxygen points had also been installed.
Tygerberg Hospital Infrastructure Programme
Dr Laura Angeletti du Toit, Chief Director: Infrastructure and Technical Management, Department of Health, WCPP, said the current state of the hospital’s infrastructure posed a risk in the following ways: service interruption; congested environment; logistical and operational inefficiencies; fire compliance; and staff stress.
The mitigation strategy was three-pronged, involving a maintenance and remedial works programme, a new central hospital, and a new regional hospital.
She said Provincial Treasury had confirmed an earmarked allocation of R1.97 billion for a ten-year programme. In March 2019, the Western Cape Department of Health, along with the Department of Transport and Public Works, had submitted a joint strategy for the 10-year maintenance and remedial works programme. R150.5 million had been allocated for the 2020/21financial year.
The purpose of the programme was to address the poor physical condition of the hospital, which severely compromised healthcare service delivery and provided a sub-standard working environment.
She said there were 33 active priority projects currently under way in various stages of development and construction, and a further 16 projects were either on hold or planned, pending confirmation of affordability. The published budget requirement for the maintenance and remedial works programme was R2.4 billion. The cost of full repair and renovation of the infrastructure was in the order of R5 billion.
Mr R Allen (DA) wanted to know if psychiatric patients that tested positive for COVID were under 24-hour surveillance. He wanted to know how they were supported.
Ms A Bans (ANC) wanted to know about the external contractors, and if they were cleaning just at the hospital, or if this was province-wide. She asked for clarity regarding patients that were admitted to the hospital with an ailment, and then contracted COVID. Was this due to how the cleaning was done? She asked for details of the completed projects, as well as those that were on hold, and whether this was because of COVID or budget constraints.
Ms R Windvogel (ANC) asked what the total number of infections at Tygerberg Hospital currently was. What was the main reason for high infections in certain areas? She asked if labour unions had been involved by the Department, and also requested an update on the new regional hospital.
Ms L Botha (DA) asked what had been done to allay the fears of staff that had not been infected with the virus.
The Chairperson wanted know if any voluntary services had impacted on the number of OHS assessments.
Dr Keith Cloete, Head of Department: Western Cape Department of Health, said the Department had a combination of in-house and outsourced cleaning staff. When there was a positive case, deep cleaning was required and a company would be contracted for that specific reason.
With psychiatric patients, this was an area where the Department had had to learn and adjust quickly. The process was to isolate COVID-exposed patients, and quarantine those who were COVID-positive.
The Department had found that areas with a high infection rate were not necessarily where the patients were, but where staff members interacted casually. When an area was identified as a risk, a strategy to break transmission was implemented.
The Department had taken the involvement of labour unions very seriously. Labour representatives met with the Department on a bi-weekly basis. The work area assessment required the sign-off of a labour representative.
He said the regional hospital in Belhar would have to be completed before there could be confirmation of the location of a central facility.
He said that 14% of the provincial healthcare workforce had been infected, but the majority of them had come back to work and colleagues had been supportive and empathetic.
Dr Angeletti du Toit provided an update on the infrastructure programme, and said the following projects had been completed: the upgrading of air-conditioning in Block C; two of the lifts; upgrading of the main theatre complex in Block B; and the main kitchen.
She said some projects were on hold, mainly due to lockdown regulations.
Dr Erasmus said 850 staff members had tested positive, 684 of whom had returned to work. There had been zero infections in the last two days. He added that staff were very fearful for themselves, as well as their families.
Ms N Bakubaku-Vos (ANC) wanted clarity on what a ‘footprint’ was, in relation to COVID.
Dr Cloete explained that when a confirmatory test was done, and there was RNA evidence of COVID, and this was referred to as a footprint. This did not mean there was a new infection. Eventually, the footprint wouold disappear.
The Chairperson asked Dr Cloete to inform the Committee on the safety protocols when the Committee was visiting.
Dr Cloete said there was a safety protocol in place, and was on an area-by-area basis.
The Chairperson said were no Committee documents to be considered, so they would be looking at their programme.
Ms Botha proposed visiting only the Emergency Medical Service (EMS) centre in Worcester on 2 September, because she had a meeting at 1:00 pm on that day.
Ms Bakubaku-Vos proposed visiting the Gouda Hospital in Drakenstein.
Ms Bans supported Ms Bakubaku-Vos’s proposal.
Ms Botha said she was proposing visiting one facility because of the meeting she had that day.
Ms Bakubaku-Vos said Gouda was near Worcester.
The Chairperson tasked the Procedural Officer with ironing out the details.
Ms Botha also wanted to know if the Committees would be meeting in person in October.
The Chairperson said she would have to consult with the rest of the Provincial Parliament to confirm when in-person meetings would resume.
The meeting was adjourned.
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