Management Issues with Infection Control during Trauma Resuscitation in the Era of COVID-19: South African Experience.

Timothy Craig Hardcastle,Shanisa Naidoo,Feroz Ganchi,Thobekile Nomcebo Shangase,Daniel Den Hollander

doi:10.3329/bjms.v20i5.55410

Abstract

Background: This invited short report aims to document the management of trauma and nontrauma ICU patients in one quaternary facility in South Africa during the first two waves of the SARS CoV2 (Covid-19) pandemic in Kwa Zulu-Natal. Content: The setting of the trauma service and the changes made to ensure staff and patient safety are detailed. A brief overview of the clinical experience of caring for both trauma and non-trauma cases is provided along with the management of those cases who were found to be Covid-19 positive. The concerning aspect of increased antibiotic resistance development and the potential roles of antiseptic sanitisers is briefly discussed. Conclusion: Trauma care is essential during the infectious pandemic and there is a risk of increased antibiotic resistance. Doing the basics “right” can prevent staff contamination or adverse patient outcomes. Bangladesh Journal of Medical Science Vol.20(5) 2021 p.72-76

Highlights

This invited short report aims to document the management of trauma and nontrauma ICU patients in one quaternary facility in South Africa during the first two waves of the SARS CoV2 (Covid-19) pandemic in Kwa Zulu-Natal
In the context of this high trauma burden is the challenge of limited trauma care facilities in a resource-constrained country, in terms of intensive care facilities[3]
In this resource-challenged environment up to now good antibiotic stewardship and surveillance have ensured effective control of antibiotic resistance in the local trauma environment within KwaZulu-Natal.[4]. In light of this background, the ongoing world-wide pandemic known as the SARS2-Cov or COVID-19 hit South Africa in March of 2020[5], causing many infections, whether symptomatic or not, and creating fear and distrust in the medical community, especially in the public sector. This needed a change in the approaches to how, trauma patients in general, and trauma intensive care admissions in particular were managed

Summary

Background

Trauma is the fourth burden of disease in South Africa along with non-communicable disease, infections and maternal-child-health.[1] Compared to many other high-income and even many lowerand-middle-income countries the trauma rates in South Africa are among the highest in the world, with a large penetrating trauma burden, not seen in other African countries without engaging in civil unrest.[2] In the context of this high trauma burden is the challenge of limited trauma care facilities in a resource-constrained country, in terms of intensive care facilities[3] In this resource-challenged environment up to now good antibiotic stewardship and surveillance have ensured effective control of antibiotic resistance in the local trauma environment within KwaZulu-Natal.[4]. The unit still received trauma referrals for ICU from surrounding facilities and directly from the emergency medical services, while absorbing non-trauma urgent major medical and surgical ICU cases from within the facility

Descriptive Experience

Findings

Conclusion