Natmed Medical Defence
Personal protective equipment (PPE) was originally designed to protect against the chemical warfare of World War One; the first respirator is thought to have been developed by the forward-thinking Leonardo da Vinci, as early as the 16th Century, to protect the wearer from inhaling harmful dust and chemicals.
How grateful the medical profession can be, today, for the health-protective advances that have been made since.
Healthcare workers are bravely providing healthcare services during these difficult times – whether they are a doctor, nurse or allied healthcare worker, such as a physiotherapist, they continue providing care and saving lives, even when their own life is under threat. The COVID-19 pandemic has been akin to a war zone in that regard.
But an article in Health & Safety Middle East reveals that those striving to provide medical care, anywhere in the world, whether – for example, a burns specialist now administering vaccine jabs (or any other about-turn that has been made in speciality versus current occupation) – have a great deal in their favour, specifically the level of personal protective equipment (PPE) currently available, which should ideally be “selected correctly for the type of hazard that a [healthcare] worker is likely to encounter”.
A piece from C le Roux and A Dramowski, appearing in the South African Medical Journal
– “Personal protective equipment (PPE) in a pandemic: Approaches to PPE preservation for South African healthcare facilities” – advises that PPE is key to protecting healthcare workers from COVID-19 infection. However, the pandemic itself has disrupted supply chains globally and necessitated rapid review of the scientific evidence for PPE re-use.
Corruption in the procurement and disruption in the supply chain have led to severe shortages of PPE in some healthcare facilities, and therefore alternatives may be required. Other articles in the South African Medical Journal (van Wyk et al) suggest that modified full-face snorkels can be used as PPE. Le Roux and Dramowski make further suggestions, such as restricted use, extended use, use of alternatives or emergency replacement PPE, as well as procurement of re-usable PPE.
The authors write that in South Africa, where the COVID-19 epidemic was still developing (at the time, in April 2020, we had just hit our first pandemic wave, and now we are hopefully emerging from wave number 2), “healthcare facilities have [been afforded] a short window of opportunity to improve PPE supply chains, train staff on prudent PPE use, and devise plans to track and manage the inevitable increases in PPE demand”.
The Department of Health’s guidelines from May 2020 suggest that using PPE for an extended period of time may be preferable to reprocessing, because preparing PPE for re-use is expensive and the integrity of reprocessed PPE cannot be guaranteed. Locally, workers and unions note that it would be a missed opportunity if the local market’s production was not ramped up, especially in these dire times.
Now, some months down the line, where healthcare workers are beyond exhausted and this pandemic keeps throwing waves of virus mutation upon us, it is worth examining the legal responsibility behind PPE supply. While you can read an entire article in the British Medical Journal devoted to this subject, the question most of us want answered is: how should the authorities balance, in the future, the needs of patients with the safety of medical staff?
According to John Coutts, policy adviser for governance at NHS Providers, medical authorities and hospital directors are “facing duties that are pulling in potentially different directions”.
He advises that in the UK, as just one example, these entities are facing “both a duty of care to employees and a duty of care to patients under their organisation’s care, to whom they must provide appropriate treatment for the patient’s condition, which might mean asking staff to do things that in other circumstances they would avoid… The job for [hospital] directors is to think long and hard about what the balance of these two duties is; [and] to manage and mitigate risks accordingly,” he concludes.
However, healthcare professionals should advocate for PPE if they are not receiving adequate supplies, because workers are entitled to a safe working environment – as far as this can be achieved under the circumstances. And professionals running private practices should ensure that their employees are suitably equipped and have the necessary PPE – which is reiterated in the HPCSA COVID-19 guidelines.
For medico-legal advice on preferable PPE use in South Africa, within your specific medical speciality, please go to: https://medicaldefence.mobi/
Sources
http://www.samj.org.za/index.php/samj/article/view/12938/
http://www.industriall-union.org/unions-in-south-africa-slam-ppe-procurement-corruption/
https://www.bmj.com/content/369/bmj.m1718/
