Safety measures not observed at Livingstone Hospital, report warns

29 June 2020 - 08:01 By Guy Rogers and Nomazima Nkosi
An audit report has sounded alarm bells about safety and screening measures at Livingstone Hospital during the Covid-19 pandemic.
An audit report has sounded alarm bells about safety and screening measures at Livingstone Hospital during the Covid-19 pandemic.
Image: Google Maps

Screening protocols are falling through the cracks at Livingstone Hospital, common areas are not being regularly sanitised and staff are not wearing their personal protective equipment (PPE) properly, increasing the risk of Covid-19 spreading through the Port Elizabeth hospital and into the community.

These warnings, contained in an internal audit report commissioned by the Eastern Cape health department, coincide with a sudden increase in the number of coronavirus infections and deaths in Nelson Mandela Bay.

The audit report recommends swift and decisive action to fix the problems, but though it was handed over to Livingstone Hospital management a week ago, nothing has changed, according to an informed source.

“Livingstone is in bad shape and this report is the tip of the iceberg,” he said.

“The fact that nothing has been done in response says a lot.”

The report highlights lack of consequence as a major driver for the problems at the hospital in Korsten.

“We noted the facility has no consequence measures in place for non-compliance around the use of the required PPE,” it says.

“Verbal reminders only are given to employees. Regular sanitising of surfaces and the building are not maintained.

“Commonly used areas, like kitchens, canteens and toilets, as well as apparatus like door knobs are not regularly sanitised.”

The cause is clearly an oversight by management, the report says.

“The effect is that it creates the risk of spreading the virus to employees and patients/the public.

“This may result in the spread of the virus to the community and the closing of the facility.

“Furthermore, if the required PPE is not used properly and sanitising is not done, the staff may be accused of being negligent, and this may have financial implications for the department.”

The hospital management has to take immediate steps to rectify the situation, the report says.

“Management should put measures in place to ensure staff adhere to all protocols relating to PPE and sanitising, and disciplinary action should be taken against staff who do not comply.”

The report also highlights poor screening controls.

“We observed that all visitors are not screened daily upon entry to the facility,” it says.

“Therefore, there is no full record of everyone who visited the facility on a particular day, and a person who might have coronavirus symptoms may be allowed to enter.

“Furthermore, staff are not screened daily before they start a shift.

“Temperatures are not taken at the administration block due to a lack of thermometers.”

Once again, the problem is oversight by management and, more specifically, gate security officials are not adequately trained on how to handle visitors, according to the report.

“If everyone entering the facility is not screened, there is a huge risk of them unknowingly spreading the virus if they have symptoms and they are not immediately isolated.”

The report notes further that Livingstone Hospital does not have an appointed compliance officer.

“The cause is oversight by management and shortage of staff, and the effect is no monitoring of the screening team and no accountability if the screening team is not functioning, as required by guidelines.”

To rectify the problem, management needed to appoint a compliance officer who, besides monitoring the screening team, should ensure all staff members and patients adhered to Covid-19 guidelines.

It said management should furthermore ensure all surgical masks and gloves were correctly disposed of, and staff should be reminded of this.

“Proper waste management protocols must be maintained, and bags must be sealed and placed in a safe and secure space ready for collection by the waste company.”

According to the report, there was also a problem with the use of lifts in the hospital, with people not adhering to the social distancing minimum of 1.5m, and using their fingers instead of their elbows or alternatives to press the lift buttons.

The source, who did not want to be named, said the root of the hospital'’s problems was in the provincial health department.

“Bhisho is the problem. They do not want to employ people,” he said.

“That is the bottom line. Budget money is going somewhere, but no-one knows where.”

The secondary problem was with the top management at the hospital, he said.

“There is no permanent management. They are all acting — the CEO, human resources director, financial director, nursing management and soft services.

“Now the officials in those positions no longer want to act because things are not getting any better.”

Poor decision-making was the result of the leadership crisis, he said.

“At the moment they are trying to transfer some of our doctors from Livingstone to the new VW hospital in Neave.

“But we are already short-staffed with our doctors and nurses getting sick, and we are the main designated Covid-19 hospital in Nelson Mandela Bay. It doesn’t make sense.”

Eastern Cape health superintendent-general Dr Thobile Mbengashe said he was not aware of the report.

However, Mbengashe said the department had established occupational health and safety protocols where  safety issues and prevention control in terms of hospitals were discussed by the CEO and department heads.

“This is chaired by the CEO and  heads of units all the way to ordinary workers. Everyone here takes the responsibility of making sure everyone adheres to the rules to keep us safe, ensure infection doesn’t happen and to protect workers.

“To clean surfaces is not a Covid-19 thing. Universal wearing of masks is a strategy to stop transmission.

“We know what causes infection and levels of risk. We need to stay within these to survive infection,” Mbengashe said.

He said he was on record as saying that if staff did not have proper PPE and were meant to go to high-risk areas, they should not go.

“PPE is essentially related to the level of risk you’re exposed to, to make sure you’re able to protect yourself against the level of infection,” he said.

Mbengashe said hospital surfaces should be cleaned every two to six hours, and all hospitals had infection control protocols that should be strictly followed.