CHRISTIAN MEDICAL COLLEGE VELLORE
Not to be ministered unto but to minister

Behind the scenes

"A world war between man and microbes" 

Dr. Malathi Murugesan, 
Hospital Infection Control Officer, talks about the work of CMC's Hospital Infection Control Committee (HICC) , which played a pivotal role in the institution's response to and management of the COVID-19 pandemic. She also talks of her responsibilities within the unit and how the experience impacted her both professionally and personally.

HICC - an incident command centre

Rapidly expanding scientific knowledge and changing governmental policies necessitated creation of teams comprising key cadres of personnel who then went on to lead clinical, diagnostics, logistics, infection control, and environmental cleaning services. HICC under the aegis of MS office has assumed the role of an incident command centre during this pandemic.

My role as a hospital infection control officer has focused on developing COVID-19 pandemic preparedness policies for our institution and to liaise with all departments to ensure these are feasible, and assist with implementation of the policies and protocols.

I have been responsible for notifying details of COVID patients to government authorities. In addition, we routinely contact trace every positive patient to identify primary and HCW contacts and facilitate screening. Also, we routinely meet to discuss the strategies to ensure adequate supply and regulate the rational usage of PPE, ensure adequate infection control and environmental disinfection.
 
Challenge posed by the infodemic 

The COVID-19 pandemic crisis due to SARS CoV2 due to its potential for droplet and possibly airborne spread during aerosol generation has caused a major panic everywhere. The lack of a cure, potential for asymptomatic and pre-symptomatic transmission has been worrying. The infodemic or information pandemic is considered as a major challenge because of the large amount of information being circulated on social media, in preprints etc. 

Finally, constantly changing global and national guidelines every week and sometimes every day based on latest evidence has made policy implementation challenging requiring constant re –inventing and re-training of all categories of staff.

COVID makes the schedule - not us 

Before COVID days, I had a schedule to follow every day. Now I realise, SARS-CoV-2 draws a schedule for everyone in the world. The whole world depends on COVID numbers, colours of zones (red, orange and green) and government regulations. COVID days have nothing like a “routine”; every day we face different situations and we engage in problem solving as a team. I can simply say, the daily routine has changed hugely in terms of working hours, work load and work type.

Initial phase of great stress

In the initial phase of the pandemic, with no clues about how we face the pandemic, there was a lot of stress among everyone. Health care workers were worried that they may transmit the infection to their family members. Due to frequent changes in the policies, there was difficulty keeping track of the updates. The phase 1 training and counselling services were helpful in coping with the situation. 

How we coped 


We function effectively and efficiently because we have individual teams representing administration, medical, nursing, engineering and other support services.
COVID central command team meets every day in the morning; daily updates are shared among all administration. HICC gives updates about COVID census and infection prevention and control activities.
Personal protective equipment (PPE) committee meets every day to discuss the strategies in PPE supply with respect to procurement, funding, financial issues, allocation, supply chain and accountability.
There are also separate teams for staff training, OP triaging, environmental cleaning and disinfection, clinical treatment, logistics and support. 

Team work is everything 

HICC is a part of all the teams; hence it is very easy for us to coordinate with all the team members. We got immense support from all the team members especially from administration and engineering team. This pandemic has taught us team strength and how important is to have good inter-team relations to run an institution. 

 

Sleepless nights as a mother of young twins

Being a microbiologist, I am always used to repeated hand washing, taking bath after coming from hospital and other hygienic measures. Well, my family always tells me I have OCD. The activities were routine in my home, hence it didn’t cause a huge impact in my family member’s minds. Being a mother of twins, yes, I was more worried about not transmitting infection to them and to my in-laws. Even though clinical contact is very little for me, every human being is at risk in a pandemic situation. I had sleepless nights in the initial days of pandemic thinking about my family especially my elderly parents and in-laws. 

To me, there is a connection between the pandemic and Nature

Personally, I’m a nature lover. So I connected this pandemic to nature. Over a decade, there has been a lot of technical/mechanical evolution that had taken this planet for granted. The advancements in technology have changed human lives for the better and also for the worse. 

A world war between man and mircobes 

 The scenario we are facing now is like a world war – between man and microbes, as it is causing a huge impact on health care and also the global economy. The increase in globalisation over this decade caused major destruction of forests, wildlife and agricultural lands lead to global warming, water scarcity, overcrowding, and emergence of new and re-emergence of previous infections.

What I learned professionally 


 Professionally, COVID has taught me three key things:
1. Infection control requirements, infrastructure improvement and capacity rebuilding in an existing institution during a crisis
2. Team work, integration of departments and services during a crisis
3. Importance of staff training and awareness about IPC practices 

Human lives are at danger because of an invisible microbe. How it has caused the pandemic, no one knows. We don’t have a drug to kill the virus; we don’t have a vaccine to prevent the infection and as of now, is an unstoppable virus which can travel to any part of the world hiding inside and on us. The only way to reduce transmission with good evidence is to restrict travel and engage in responsible distancing practices. Though lots of research is ongoing, it may take years to find a good vaccine and cure. 

Extreme suffering for physically, financially and emotionally disadvantaged 

We are in a war-like crisis, so we as individuals need to support those who suffer physically, financially and emotionally. Thousands of migrant workers and homeless people have suffered without food and health care during this crisis. It is our responsibility to help them during this time. As health care workers, we have a responsibility to help patients, without any stigma, to provide them with the support they need.

Listen, strategise, monitor, improve! 

I’m not a senior doctor, and have myself learnt a lot during this crisis. A simple message for everyone is “listen to the problems, develop a strategy (based on evidence) to implement, monitor the situation and think how to improve further”. Pandemic is a disaster which can hit us any time. It is the responsibility of an infection prevention and control specialist to have a disaster/preparedness team and a plan ready all the time.

CMC's uniqueness 

CMC is unique in the way we run our administration. We are a democratic society; we respect everyone’s opinion. But in a situation like we face now, it is sometimes very difficult to make a final decision with consensus. There may be difference in opinion, but the main aim for every health care worker is patient care and health care worker safety. 

Time to consolidate our insights 

I feel we need to maintain this team work and coordination to follow our IPC requirements even during routine times. Antimicrobial resistance is a major threat nowadays with ongoing rises in hospital acquired infections. With a new highly contagious virus, IPC practices have been implemented very effectively everywhere. It is time to consolidate our recent insights into the importance of PPE usage, hand hygiene, and patient safety. We have to expand the audits and team work in our institution to prevent further outbreaks. 

The Virology Department and Laboratory diagnosis of COVID-19