RESPONSE TO THE COVID-19 OUTBREAK: LESSONS FROM A TERTIARY HEALTHCARE FACILITY IN SOUTHWEST NIGERIA

K. Osungbade1,2, O. Ilesanmi3, R. Oladokun4,5, O. Adekanmbi5,6, U. Eze7, A. Afolabi8, A. Adetunji9, K. Kuti10,11, K. Ojifinni12, O. Olopha13, H. Dada-Adegbola14, A. Fowotade14, A. Adebiyi15,16, T. Oladipo17, V. Akinmoladun18,19, J. Otegbayo5,6

  1. Department of Health Policy and Management, College of Medicine, University of Ibadan, Ibadan, Nigeria.
  2. Disease Surveillance Unit, University College Hospital, Ibadan, Nigeria.
  3. Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia.
  4. Department of Paediatrics, University College Hospital, Ibadan, Oyo State, Nigeria.
  5. College of Medicine, University of Ibadan, Oyo State, Nigeria.
  6. Department of Medicine, University College Hospital, Ibadan, Oyo State, Nigeria.
  7. Department of Pathology, University College Hospital, Ibadan, Nigeria.
  8. Technical and Strategic Research Directorate, MSI Nigeria Reproductive Choices, Abuja, Nigeria.
  9. Department of Family Medicine, University College Hospital, Ibadan, Nigeria.
  10. Infectious Disease Institute, College of Medicine, University of Ibadan, Nigeria.
  11. Staff Medical Services Department, University College Hospital, Ibadan, Nigeria.
  12. Department of Emergency Medicine, University College Hospital, Ibadan, Nigeria.
  13. Nigeria Centre for Disease Control, Abuja, Nigeria.
  14. Department of Medical Microbiology and Parasitology, University College Hospital, Ibadan, Nigeria.
  15. Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria.
  16. Department of Community Medicine, University College Hospital, Ibadan, Nigeria.
  17. Office of the Commissioner for Health, Oyo State Ministry of Health, Ibadan, Nigeria.
  18. Department of Oral and Maxillofacial Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria.
  19. Department of Oral and Maxillofacial Surgery, University College Hospital, Ibadan, Nigeria.

Abstract

Background: Mitigating the risk of nosocomial infection is one of the core functions of healthcare managers in hospital environments. This study aimed to describe the COVID-19 outbreak response in a tertiary healthcare facility in Nigeria.

Methods: A qualitative cross-sectional study was conducted among representatives of Heads of Infection Control Committees and units, the Accident and Emergency unit, Family Medicine unit, and Private Suites on the COVID-19 outbreak response at the University College Hospital, Ibadan, Nigeria. Data were analyzed using Colaizzi’s phenomenological method.

Results: Overall, seven (six physicians and one nurse) HCWs were interviewed; six (71.4%) males and two (28.6%) females. The average age of the key informants was 45 ± 4.73 years. Four themes were identified. Theme one “Essentials of screening protocol and screening area” described the development of screening protocol, and dedication of a triage area. Theme two “Infection prevention and control within consultation premises” detailed adequate spacing; hand hygiene, use of personal protective equipment; environmental sanitation; and waste management. Theme three “Mounting up surveillance in the response activity” specified communication with the Disease Surveillance Unit; and surveillance activities. Theme four “Training and psychosocial support for staff” described staff training, and provision of psychosocial care to infected staff.

Conclusion: The COVID-19 outbreak measures implemented by the management of the University College Hospital, Ibadan were aimed at ensuring that the hospital does not get overwhelmed by the surge in COVID-19 cases. In order to improve outbreak response in hospital settings, it is important to undertake training, modify hospital practices, and evaluate implemented measures.

Keywords: COVID-19, Outbreak, Infection prevention and control, Nigeria, Outbreak control

Correspondence:

Dr. O.S. Ilesanmi
Africa Centres for Disease Control
and Prevention,
Addis Ababa,
Ethiopia.
Email: ileolasteve@yahoo.co.uk
Submission Date: 13th June, 2023
Date of Acceptance: 30th Dec., 2023
Publication Date: 30th Jan., 2024

Introduction

The emergence of the novel Coronavirus disease (COVID-19) has reiterated the frailties in the global health system with profound effects experienced in low and low middle-income countries.1,2 COVID-19 was declared a public health emergency of international concern by the World Health Organization on 11th January 2020 after SARS-CoV-2 had been transmitted to more than 100,000 people across international borders.1 In order to contain the rapid spread of SARS-CoV-2, measures such as border closure, social distancing, and infection prevention and control practices(IPC) including regular hand hygiene wererecommended.3 Shortly afterwards, community transmission of COVID-19 commenced and an increased demand for adequate healthcare ensued, thereby causing healthcare workers (HCWs) to be overwhelmed with increased workload.4 In parallel to public health responses, health facilities have had to swiftly implement internal strategies to maintain their workforce. The COVID-19 pandemic thereforeM required the implementation of adequate response in healthcare facilities, a component of which is surveillance within the health facility.5

Globally, 689,832,315 COVID-19 cases and 6,885,934 COVID-19 deaths have been recorded as of 3rd June 2023.6 Of this global total, Nigeria recorded 266,675 cases and 3,155 deaths.6 COVID-19 positivity rate has been reported to be nearly 10% among HCWs globally.7 This proportion is like the 13.44% reported of the Middle East Respiratory Syndrome Coronavirus disease infection among HCWs.8 China had recorded more than 5,000 HCWs’ infection and Spain had recorded more than 50,000 HCWs’ infection as of December 2020 with a notable difference in the risk of exposure in different wards.9,10 The increasing incidence of COVID-19 among HCWs have disrupted the regular provision of healthcare services to ailing individuals. To ensure that people are not denied their fundamental right to adequate healthcare, strategies for mitigating the risk of exposure to COVID-19 were developed by the administrators of health facilities.

Mitigating the risk of nosocomial transmission of COVID-19 has been demonstrated as one of the coreM functions of healthcare managers.11 Such a hard undertaking required a thorough modification of long consolidated practices with flexible revisions of services in terms of routine governance, workflows, and task responsibilities.12 Many risk assessment tools were developed to quantify the differences in the risk of COVID-19 exposure among different groups of HCWs at health facilities.13 These tools have also informed on the safest approach to adopt to safeguard both HCWs and patients against COVID-19 infection. Amidst such a public health challenge facing the entire globe, public healthcare institutions in Nigeria were challenged to respond to a fast-growing hospital demand to cope with the need to provide inpatient care for severely ill individuals with life-threatening contagious conditions.14

Research among healthcare managers is needed to assess the effectiveness of the response measures as well as the challenges experienced. Findings from this research would be required to inform healthcare managers on evidence-driven solutions to tackling the COVID-19 pandemic and other emerging infectious disease, in healthcare settings. Therefore, this study aimed to describe the COVID-19 outbreak response in a tertiary healthcare facility in Nigeria.