Lack of PPE, poor infection control put medical staff at risk of Covid-19

Healthcare workers risk contracting Covid-19 due to a lack of infection control in hospitals, doctors say amid complaints about substandard personal protective equipment ( PPE) and lack of basic items like N 95 masks and even sanitisers.

Dr Indranil Khan, an oncologist in Kolkata, who was detained for complaining about sub-standard PPEs on March 29, said doctors are at risk of getting infected along with other patients.“I have friends, juniors, seniors who are working in various hospitals in Kolkata and outside like in Siliguri who will not lie. The material supplied to hospitals has been substandard and inadequate. ...fighting a disease like Covid-19 is not a joke,” said Khan. “...we were not prepared for an epidemic of this scale but government hospitals are not equipped at all which, in turn, will lead to the spread of infection not just among health workers but also among other patients.” He said doctors and sanitation workers interacting with any suspected patient need to be protected because they go to other wards as well.

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Khan on March 29 cited a news report about substandard PPEs and tweeted to request West Bengal chief minister Mamata Banerjee to take necessary action. “All I need is real PPE to protect frontline doctors nurses fighting COVID 19. Raincoats are not adequate...,” he tweeted.

He received a response from the government assuring him of immediate steps to address the situation. “But that evening I was picked up by cops for bringing disrepute to the government. After moving the high court, I got interim relief after the court upheld freedom of speech,” Khan said.

Dr Raveendra Reddy, an Intensive Care Unit consultant in Bengaluru, said anybody interacting with patients with Covid-19 like symptoms or even with asymptomatic ones will need a good two-layered fluid-resistant apron. “They will need goggles, N 95 masks, ideally a face shield, PPE gowns. China had two to three different kinds of PPEs. That is not needed. We need basic fluid-resistant gear. The load of asymptomatic patients is very high and for interactions particularly in fever clinics, this is a must. It should be a composite kit. That is not happening.”

Krishna Murthy, a doctor at a private Bengulrur hospital, said let alone N95 masks, there is a shortage of surgical masks. He added some vendors are providing PPEs but its very difficult to get them and so health workers are wearing raincoat like gowns. “Even hand sanitisers are not available. We have some pneumonia patients but they have not been tested yet. N 95 masks used to cost Rs 150 but are being sold at Rs 400 now. Bodysuits cost Rs 2,000 per piece, surgical masks are being procured for Rs 20; they used to cost Rs 2. These need to be standardised very urgently.”

Some doctors and nurses at Delhi’s Hindu Rao Hospital have submitted resignations allegedly due to lack of safety and protective gear, the hospital administration said on April 1. The resignations are not being accepted in view of Covid-19 pandemic. “They are resigning because of some family issues. We are getting PPEs here but they are not of appropriate quality. The matter is being taken up with authorities to procure better and safe material,” said Dr Piyush Pushkar Singh of the Hindu Rao Hospital’s Resident Doctors’ Association.

Federation of Resident Doctors’ Associations president, Dr Shivaji Barman, said it is still being investigated whether the doctors, who have contracted the infection, got it in hospitals or outside. “As far as doctors and health workers quitting in some hospitals... I think those are individual decisions. The resident doctors can complain to the hospital authorities if there is a shortage.”

Officials said the Union health ministry has designated public-sector undertaking (PSU), HLL Lifecare Limited, as the single window procurement agency for PPEs for hospitals and healthcare organisations. The ministry has also issued guidelines on the rational use of PPEs.

An HLL executive responsible for procurement said, “I do not want to comment. We have been asked not to.”

Preventive Wear Manufacturers’ Association of India chairman, Sanjiv Relhan, said they are getting frantic calls from hospitals to provide PPEs, which means there is an acute shortage. “Manufacturers are not able to comply with guidelines issued by the government. The material cannot be sent for testing to Coimbatore, as per protocol because of the lockdown. This needs to be addressed urgently,” he said.

The health ministry on Saturday announced it will procure a million masks from other countries and was in talks with Indian manufacturers to supply PPEs.