After chemotherapy, Covid-19 was obtained by the household, but the patient died. Two others have been hospitalized with a heart attack, negative Covid-19 tests, positive after several days, and after a while, life ends in the Covid-19 ward of the same or another hospital. But someone else has become a contact person because a ward member has been shown to be ill, and patients have been left in one ward for several hours after the infection was discovered. These are some of the well-known stories of the LTV program “De facto”, about which the relatives are not ready to talk about it in public yet. Meanwhile, hospitals do not really have clear and uniform procedures for dealing with such cases, especially after internal outbreaks have been detected. It is up to each hospital.
- People with Covid-19 also get sick in the hospital.
- This is especially true in large university hospitals.
- It is estimated at Stradins Hospital that patients may only arrive during the incubation period when a negative test is presented.
- Hospitals do not have the same standard for controlling internal Covid-19 outbreaks.
- Hospitals indicate that standards could not be met at all due to infrastructure.
- The VM indicates that due to the long incubation period, it is not possible to determine whether a person is infected in a hospital.
- The VM plans to further tighten patient flows.
Medical institutions as a possible site of infection have been a topical issue since the beginning of the pandemic, said Maris Liepins, Head of the Infection Surveillance Service of Riga East Hospital.
“It simply came to our notice then. If a person has been in the hospital, he or she could be potentially infectious. And in this respect, that’s what we are [secinājuši]that this is our problem. I think that this is also the case in all Latvian hospitals and throughout Europe, ”he admitted.
The Center for Disease Prevention and Control (SPCC) concludes that by the end of January, more than 1,600 cases of Covid-19 could be linked to the acquisition of the infection in a medical facility as a patient. In addition, there is no week when there are no such cases. In the first two weeks of the year there were 130 such, but in the third of January – 150.
SPKC specialist Santa Pildava explained: “In most cases, in 95% of cases, we are talking about inpatient treatment facilities, because in them we can still prove the possibility that its infection has taken place there. Because the patient can only express suspicions about outpatient facilities – I was at the doctor, maybe I became infected there. But it is very difficult to confirm. Then it must be that the doctor has also been positive and that person has been there, and then there is a possibility that he became infected there. ”
The risk of developing the disease is similar in all hospitals, regardless of the region or hospital level. There are more such cases in large university hospitals. “But there is also a much higher proportion of patients, and I would not say that there is worse care or a higher chance of infection; there is simply a much larger flow of patients, and there are also many more Covid-19 infected patients, ”added Pildava.
In one of the university hospitals – Stradiņš Hospital, it was admitted that such cases occur every week. “And then it’s the job of our group of infectologists, who are trying to trace how it could have happened, why and where,” said Janita Veinberga, a hospital spokeswoman.
An employee, as a vector, is most likely to be present if Covid-19 breaks out in several departments in several wards at the same time. But such a case in the hospital has been one, and also – not recently. Small outbreaks within a single chamber are more common. But this in turn means that the original sieve with the test and transit or observation department has gone through another Covid-19 incubation period.
“We cannot rule out the possibility that the infection does not enter the hospital, because it would require us to hospitalize each patient in an individual ward. Of course, this is not possible.
We have observed all epidemiological norms, distances to patient beds, thinned everything as much as possible, and yet, ”concluded a representative of Stradiņš Hospital.
The Eastern Hospital also stated that due to the long incubation period of up to 14 days, it is not possible to rule out the introduction of Covid-19 into non-Covid-19 wards at all. “I will probably not be original, I will say that there have been outbreaks in any ward of our hospital. Bigger, smaller; it has been that we are closing the chapters, and it has been that there are one, two people [ar Covid-19], and we are coping very well, without serious consequences, ”said Liepiņš.
There is no single standard in hospitals
From what has been said in several hospitals, however, “De facto” it follows that there is no single standard for further action when finding a ward of Covid-19. An infected patient can be isolated immediately or after several hours. All those in the Chamber may be transferred to another department. But they are just as well left there, but with a warning to staff that there must be increased security measures.
Hospitals say that strict rules would not be feasible without the possibility of adapting them.
Egons Liepiņš, Chairman of the Board of Jūrmala Hospital, said: “Most of our hospitals have not been designed in such a way that such strict epidemiological regimes will have to be observed there. For example, the last building was handed over to our hospital in 1988, and then its capacity to adapt to its epidemiological needs is less extensive. Well, then there are those variations, yes, unfortunately. ”
Longer follow-up of patients is not a solution either, as it is important to start treatment quickly enough. In addition, it is not uncommon for not only the first but also subsequent tests of Covid-19 to show disease, despite typical symptoms. “He has a clinic, he has a radiological site, and he has four or five tests, and he is negative. And this is the sixth time the show. And the patient can no longer be in an observation unit for so long, it is not realistic, ”concluded Edvīns Striks, the manager of Liepāja Regional Hospitals.
Apart from individual cases of epidemiological investigations in the hospitals themselves, there has been no in-depth analysis of this situation in the country as a whole. The Health Inspectorate points out that hospitals do not currently have any complaints at all, but remotely deal with complaints, including non-segregation of patients, but there are no conclusions and, consequently, no comments yet.
The Ministry of Health, on the one hand, acknowledges the problem, on the other – also points to a certain inevitability. Sanita Janka, the head of the Ministry’s Medical Quality Department, assessing the number of patients in hospitals, said: “I think this is quite a large number, because here patients are still under the supervision of medical personnel.
However, we cannot claim 100% that they are infected in a medical institution.
This may have happened before the treatment facility, as the incubation period for this disease is 5-14 days. And a patient can become Covid-19 positive even if the patient does not have these symptoms at all. ”
The Ministry of Health is planning new measures, separating patient flows even more strictly, and is also asking for extra money for surveillance beds, so that the movement in them does not have to be rushed. However, changes in the hospital infrastructure cannot be resolved quickly.
Hospitals are not the most common site of infection with Covid-19. Of the cases detected, in terms of patients, they account for 3% of the total number of infections. However, unlike other places, it is not a matter of choice, such as visiting a public place or not.