Abstract
BackgroundA binary triage system based on infectivity and facilitated by departmental restructuring was developed to manage suspected COVID-19 patients with an aim to provide effective prevention and control of infection among health care workers (HCWs) in the emergency department. This study analyses the effectiveness of the new triage system and structural reorganization in response to the COVID-19 pandemic.MethodsA cross-sectional observational study was conducted in the Emergency and Trauma Department, Hospital Kuala Lumpur (ETDHKL). The implementation of a binary triage system separates patients with risk of COVID-19 who present with fever and respiratory symptoms from other patients. Data on exposed HCWs to COVID-19 patients were captured pre-restructuring and post-restructuring of the emergency department and analysed using descriptive statistics.ResultsA total of 846 HCWs were involved in this study. Pre-restructuring reported 542 HCWs exposed to COVID-19 patients while post-restructuring reported 122. Using the four categorical exposure risks for HCWs which are no identifiable risk, low risk, medium risk, and high risk, the number of HCWs exposed during pre-restructuring were 15(1.8%), 504 (59.6%), 15 (1.8%), and 8 (0.9%), respectively, while post-restructuring the numbers were 122 (14.4%), 8 (0.9%), 109 (12.9%), and 5 (0.1%), respectively. There was a 77.5% reduction in the number of exposed HCWs after our implementation of the new system (542 vs 122).ConclusionA binary triage system based on severity and infectivity and supported with structural reorganization can be effective in reducing HCWs COVID-19 exposure.
Highlights
The world was on high alert when Wuhan city in China was hit hard by a novel coronavirus infection, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in late December 2019
The inclusion criteria were all doctors, nurses, assistant medical officers (AMO), and health care assistants working in the ETDHKL during the study period while the exclusion criteria were the clerks, administrative staff, and cleaners who do not come in contact with patients
During the pre-restructuring period, the contact tracing of Health care worker (HCW) revealed that 542 out of 846 ETDHKL personnel were exposed to COVID-19 patients (Table 4) with 15 (1.8%) staff having no identifiable risk, 504 (59.6%) low risk, 15 (1.8%) medium risk and 8 (0.9%) high risk
Summary
The world was on high alert when Wuhan city in China was hit hard by a novel coronavirus infection, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in late December 2019. Reports of COVID-19 infections among health care workers (HCWs) started to emerge in Wuhan, China in January 2020 [3]. A single-centre study by Xiaoqian Lai et al [4] reported 1.1% of infections among HCWs of Tongji Hospital, Wuhan, China, whereby 0.9% of the HCWs with COVID-19 infections were asymptomatic. A similar study conducted by Kluytmans-van den Bergh MFQ et al [5] in Dutch hospitals reported an infection rate of 1% among HCWs. In our local settings, a study by University Malaya Medical Centre reported a prevalence of 0.3% COVID-19 infection among HCWs [6]. A binary triage system based on infectivity and facilitated by departmental restructuring was developed to manage suspected COVID-19 patients with an aim to provide effective prevention and control of infection among health care workers (HCWs) in the emergency department. This study analyses the effectiveness of the new triage system and structural reorganization in response to the COVID-19 pandemic
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