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We asked for feedback during the process of developing the poster to help keep Pacific health workers safe in the event of a Covid-19 outbreak.

 

This is what people said…..

 

FIJI

 

What are you doing already? 

 

• Fever clinic - this is where all the screening is done. Its right next to the ED isolation so once cases assessed can be managed accordingly

• we are wiping all counter tops especially where we sit to write notes, our screening tables and consultation room tables every 2-3 hours and/ or at change of shifts with alcohol solution.

 

What do you think about the protocol? 

 

• It is good but there should be provision in the protocol for the hospital to deliver and pack food in disposable takeaway containers for staff

• Staff quarantine and accommodation: Also we need clear guidelines  about who gets quarantined and for how long. We had quarantined our staff in the hotels and we also had quarantine facilities like schools or centres for them.

 

Your handwashing or change facilities? 

 

• We reviewed our Hospital guidelines and included an isolation unit with good staff amenities e.g change rooms, rest areas, tea rooms and bathrooms. 

• Extra handwashing stations provided.

• Yes we have a staff change room and hand washing facilities. We actually have had a sink and soap dispenser installed outside our department and so every staff and patient relative that is permitted to enter is required to wash their hands before entering the department.

 

What about food sharing? 

 

• Hospital delivered packed food in disposable containers for staff

• Food sharing plays a crucial role in team bonding and stress reduction

• Eating only in tea room and not in a big group

• If meeting outside the hospital never in work clothes

 

What are some ideas of what is needed or hopes of what could be provided?

 

• WASH teams - the mandatory availability of these teams to help with disinfection in these units. We need teams in each department and 24hrs. We use the other stakeholders for example military and fire personnel, train them and involved as WASH teams in the hospital

 

Vanuatu 

 

What are you doing already? 

 

• Setting up a dedicated emergency operations centre to process administrative support for staff. The centre has enough space to run twice weekly sessions for PPE and IPC 

• Key messages on IPC and PPE were repeated at each shift handover

• Simulation scenarios run in ED and the staff found it very useful

• The possibility of spreading Covid-19 by aerosol has led to us pushing the use of spacers for asthma to the extent that acceptance is really taking off and we were able to remove the nebulisers completely from the ED last week with great success and buy in. It greatly reduced the number of people who were seeking to use the nebulisers for non asthma indications

 

What do you think about the protocol? 

 

• Looks good

• Simplicity  is a strong point and should stay

• The poster is really good. I would really love to have a copy when you’re done. 

• Yes, this would be useful for clinical staff, noting: 

  • Would require translation in Bislama (Ministry of Health would assist).

  • Checks on terms eg ‘open toed shoes’ - slippers etc. 

  • Would need to liaise with hospital to see if this matches their clinical guidelines

  • Due to lack of hot water we are emphasising use of detergent and drying in the sun

• Yes it would be very helpful but posters in colour are more attractive and bigger writing for better captions

• Pens should be kept at work

 

Your handwashing or change facilities? 

 

• At Vila Central Hospital there are no proper change rooms in some areas  but there is a combined  changing room exists in outpatients  that could be better utilised 

• Theres no proper changing area ...we did have sinks in place outside the buildings that everyone has to wash their hands before consultation.

• Changing and shower areas are long standing issues that have been overlooked by management

 

What about food sharing? 

 

• Gathering together for food is part of the activities associated with socialising in the workplace and has immense benefit for staff under stressful situations.. Staff sharing food in designated covid wards might have to have meal breaks  where they could come out into grounds or lawns and eat their own meals while keeping 1-2 m apart and still be close enough to have a social conversation

• If Covid19 is to be test positive in Vanuatu then its best not to share food in workplace

• Food to be consumed in appropriate locations in the hospital.

• A designated local caterer (paid by hospital or sponsored by local businesses would minimise unnecessary food handling by staff at home

• Vanuatu is where people are not used to eat /drink something by themselves in front of others so sharing has been always practiced, including using the same eating/drinking utensils or share fruits or a piece of laplap after biting it. In order to share food safely, we need to try and adapt the "western selfish" model of sharing, in other words meaning sharing hygienically.

 

What are some ideas of what is needed or hopes of what could be provided? 

 

• We want a designated area of the hospital where people come in. And also an exit. Sign in/sign out on laptop would help contact tracing

• My take on it would only be for the hospital to provide scrubs instead of nurses bringing their own uniforms. Keeping the bugs at work principle, but i gathered not every hospital has access to scrubs. 

• Is there anything on the poster about mental health? Local health line for talks if staff need or maybe EPA etc…. Just curious and a thought on how we are looking after the mental health of our Pacific staff. 

• I have one suggestion. I have been pushing for the management to get a washing machine purposely for staff scrubs, so that we minimise transmission to our families. What is used in the hospital stays in the hospital. 

• We need more handwashing areas with better models to minimise the chance of contamination right after being washed. For example turning taps to be replaced by flip taps controlled by the elbow or timer taps

• The use of the same towel to dry hands should be replaced by tissues or paper towel. Also we need proper detergent dispensers instead of piece of soap or no soap at all!

• If there is no room for changing a tent could be erected in hospital grounds.

• Being also a Ni Vanuatu Registered Nurse working in Acutes in one of the main hospitals in New Zealand, I might be the only Ni-Van Nurse so far who have had real experience in dealing with Covid19 patients. Every week we learn and adapt to new skills as we go along trying to understand more and more about this deadly new virus outbreak. As nurses, our roles are very vital because we are the most vulnerable part of the medical team which interacts more frequently with these patients. So while working, i am also trying to gather information, ideas, skills, experience, policies and procedures so i can try and run a short in service  training to my fellow nursing colleagues back in Vanuatu when i get a chance to get back in the country. I would also like to write a proposal letter, with the help of some colleagues in Vanuatu, to the MOH, in order to ask more investment in Health (EX: what we can do to achieve a better safe work place for nurses/nurse aids,  which can lead to a better standard of Nursing Care provided to patients and family members who require them)

 

Kiribati 

 

What are you doing already? 

 

• Since I will be in the frontline, it is best that I keep myself safe from this Covid-19 so I can serve others without being infected 

• Following the WHO guideline is also the best practice but advocating to the public on safety measures will be the next strategy to work on

• As part of the preparation for COVID-19, there is an identified place, used to be hotel which has been renovated to cater for COVID-19 cases only. Here we have adequate hand washing facilities with changing rooms but have not considered a place for staff to have their meals. 

 

What do you think about the protocol? 

 

• I love the poster it's pretty simple and it conveys the important messages needed in a simple way.

• This is definitely very helpful in hospitals and clinics.  

• This this will be a good guiding material for the staff 

• Definitely helpful to provide guidance to the nurses to be careful and follow what is the right procedure. 

 

Your handwashing or change facilities? 

 

• I don't have any comments on it cos I think it's perfect. A simple and effective guide in the prevention of Covid19   

• We need more hand washing facilities but will ask the Ministry about it.

• Bathrooms for male and female were proposed to be available on site for staff to take a shower before leaving the health facility. This is very important for our health workforce Staff dealing with covid cases should also shower before leaving work 

• We do not have adequate hand washing facilities but there is a plan with the support from UNICEF to have more installed hand washing facilities.

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What about food sharing? 

 

• Food will be the main issue.  I guess when the food is prepared,it is best that it is kept warm in the kitchen. Maybe when staff are hungry they will get their own meals.

• Will really need to deal about this Pacific social distancing issue though. 

• In our custom, sharing of food is common for everyone so having such notice will be good. Since we do not have a hospital cafeteria, nurses have their tea or meals in their small tea room available in each ward and department. So a reminder in terms of notices to ban such practice will be acceptable if the risks are clear to them. 

 

What are some ideas of what is needed or hopes of what could be provided? 

 

• I am not sure of other Pacific island health facilities if staff locker is available but in Kiribati we do not have those and seeing the importance of it as part of infection prevention and control. Staff can keep their items e.g pens in it rather than to bring them back to their homes.

 

Tuvalu 

 

What are you doing already? 

 

• Having skills and an emergency approach helps in our care. Sometimes everything is down,  hard to reach the  Dr in Funafuti, but I'm really thankful that I had joined the emergency workshop. All the knowledge you 2 shared is the only things that help me out here in outer island.

 

What do you think about the protocol? 

 

• I think this poster is everything we need in our hospital. It’s really nice. Thank you very much. I will pass it on to other nurses for comment. 

• Looking at this chart you’ve sent it’s easy to follow and instructions are clearly stated. 

• To replace the word plastic with something else due to the restricted of using plastic in Tuvalu. 

• Please note that not all health workers in Tuvalu have uniforms (only nurses have uniforms)

 

Your handwashing or change facilities? 

 

• There is no proper changing place or area for us nurses to change. 

• Kindly note that there are no change rooms in PMH as well as other health places. Rooms or toilets are used by clinical staff as their changing rooms. 

 

What about food sharing? 

 

• I don’t think it will be a problem not sharing, because they understand the risk of sharing during this COVID pandemic. 

• There is no proper place for us to have tea, while most of the times we used the same station where we worked as a tea area.

 

Federated States of Micronesia  

 

What are you doing already? 

 

• We have Triage 1 and Triage 2 stations for the Covid 19 purpose

• We limit in coming of visitors. Actually here's no more visiting hour anymore . Only one attendant is allowed to stay with the patient. Chairs have been placed outside for family attendants to sit on. We advised parents not to bring in their kids in the hospital if they are not sick. We advised sick elderly that need refill of meds to get refill for at least 3 months, so they won't be coming every month just for refill. Well unless if they are very sick. and need medical attention. These are some of the measures that we are already practicing.

 

Your handwashing or change facilities? 

• We have plenty handwashing stations around the hospital premises.

 

What about food sharing? 

 

• We're trying to practice using our own plate and cup, along with our own spoon. We try to minimize bringing in of food in the hospital both in regards with patients and also the hospital staff.

 

Nepal 

 

What do you think about the protocol? 

 

• This poster will be helpful in Nepal. There are still some hospitals in red zone areas where adequate PPE is not available so it may be difficult to follow these posters. People are even non wearing mask in proper way so health worker are busy to advice patient and their visitors  to buy mask and use it while coming to hospital. Some times there is huge crowd in Er and we do-not have adequate guards to control them. I think poster should include some measures that help to decrease crowds in emergency room 

 

Your handwashing or change facilities? 

 

• We have adequate hand washing place and sanitizer. What can be alternatives if we do not  have adequate sun expose area and adequate water ? Can we have PPE that can be autoclave ??

• Safety wise hand hygiene is more evident now and at this time no food sharing is permitted.

 

What about food sharing? 

 

• Better to make short duty duration time of about 4-6 hours so that we don't need a break for food..

 

Pacific General

 

What do you think about the protocol? 

 

• Great concept to explore. Could see this in orientation programme for all health staff. Could be linked to employment policies eg wearing uniform out side work?

• Could add to cover any cuts with adhesive dressings. Clean up any spills of blood, vomit etc safely with gloves and disenfectant

• I love this pictorial blurb style - so many of the COVID guidelines we're receiving are visually very painful, yours is top of the line.

• I was going to say the idea of drying things in sun is great, then I checked WHO website where they're saying there's no evidence for this https://www.who.int/southeastasia/outbreaks-and-emergencies/novel-coronavirus-2019/fact-or-fiction   [ see references at end that support sunlight as disinfectant]. 

• Poster is really effective.

• Congratulations on the resource.  My feedback is that it is fantastic.  Simple and visually appealing.

• What about pens? Should these be kept at work or should we ask them to wash them on coming home?

• Perhaps there should be a message on there that this advice is not a substitute for PPE and once they are at work they should wear the appropriate PPE as indicated by their work institution.

• This is great and it’s about time someone addressed this issue

• Looks great. I can understand the information from each of the squares without reading any of the words. 

 

Your handwashing or change facilities?

 

• We do have enough hand washing facilities. 

 

What about food sharing? 

 

• It is a good wake up. Food sharing is so much about comradery and culturally it does have local implications at work. "Bringing food and sharing blessings" was my first introduction to our Pacific meeting.

• The food issue. There were numerous comments on the webinar that people are enjoying sharing food at work as a morale boosting issue. Would it be OK to just say no food in the clinical space and socially distance in the tearoom/ eating areas?

 

References 

 

Inactivation of vaccinia virus by natural sunlight and by artificial UVB radiation.

Sagripanti JL1, Voss L, Marschall HJ, Lytle CD.

 

Sensitivity to ultraviolet radiation of Lassa, vaccinia, and Ebola viruses dried on surfaces.

Sagripanti JL1, Lytle CD.