Suspending cross-team nursing care is necessary to prevent health care-associated infection during COVID-19 epidemic.

Abstract

Taiwan's achievement in thwarting a disease outbreak has been recognized globally. One of Taiwan's measures is to stop cross-team nursing support to break the transmission chain. A hospitalized patient not yet diagnosed with COVID-19 at a hospital in Taiwan transmitted the SARS-CoV-2 virus to three nurses and one cleaner.1 Due to this event, the ward was closed immediately and all relevant medical staff were quarantined. This further reduced the availability of health care workers, which was already under pressure. The team-based nursing care delivery model has been in use extensively from the late 1950s in Taiwan and elsewhere. Team-based care has garnered attention as a way to enhance health care delivery and patient care as related to quality and safety through inter-professional collaboration, patient-centered approach, integrated care process, peer support, and integration of peer relationships in the provision of health care.2 The primary feature of the team-based nursing care delivery models is that “the same team of nursing staff is only responsible for taking care of patients in certain wards and supporting each other,”2 but direct care activities across units or wards are sometimes still necessary. However, there are several serious concerns about this. The median time from exposure to onset of SARS-CoV-2 is 2.5 to 14 days3; patients are contagious at the initial stage of infection, and there are many asymptomatic patients without obvious fever and cough.4 Four medical university-affiliated hospitals stopped cross-team nursing support from March 1, 2020. The nursing staff was divided into teams and wards and the following measures were implemented strictly: (a) nursing shift hand-off occurs by the team; (b) nursing team members are not allowed to support direct care activities of a different team in the same ward; (c) nursing team members are not be allowed to transfer patients to other wards or rooms; (d) nursing team members must maintain social distancing during meetings; (e) the number of nursing staff members in the locker room simultaneously is strictly limited, and (f) team members must refrain from conversing during meals, and so forth. These measures aim to mitigate the risk of cross-infection of COVID-19. After the abovementioned measures were initiated, the medical quality and patient safety commission also inspected those and ensured that all nursing staff clearly understood and implemented the epidemic prevention measures required to be taken in team-based nursing at different epidemic response levels. To mitigate risk of health care-associated infection (HAIs) during the ongoing COVID-19 epidemic, we recommend that hospitals stop implementing cross-team nursing activities. Instead, they should implement team-based and ward-based nursing care and require that the same nursing team care for patients in fixed wards, so that individual nursing staff may not become a “contagion carrier,” or “modern Typhoid Mary.”5 If a nurse who is not wearing personal protective equipment comes into contact a diagnosed patient, regardless of the need to minimize the number of quarantined nursing staff, implementation of self-monitoring at home for at least 14 days is an absolute necessity. This prevents the nursing staff of the whole ward from infection and the resultant unavailability of staff and staff shortages. The service of health care professionals has surely never been in greater need. We thank all members of the COVID-19 Response Team of KMU Healthcare System leaded by Professor Ming-Feng Hou, Professor Chao-Hong Kuo, Professor Yen-Hsu Cheng, and Associated Professor Jong-Rung Tsai. Without implementing and supervising all measures by Yu-Mei Liao, Hsiu-Yueh Wu, Ia-Lin Chen, Yu-Pei Li, and Shu-Hui Chen who are deputy directors and directors of Nursing Departments at four medical University Affiliated Hospitals, this article could not be published. We are very grateful to Mr. Shih-Huai Hsiao for assisting in revising the English of this article. None of the staff members mentioned from those departments received any compensation for their contributions. We also express gratitude to all trustees of the Board of Kaohsiung Medical University Trustees for supporting us with a lot of resource to establish a healthy and safe workplace for health care workers. The authors report no conflicts of interest.