A monitoring investigation into West Tallinn Central Hospital (Lääne-Tallinna Keskhaigla) reported that there had been a shortage of personal protective equipment (PPE) during the coronavirus pandemic, with masks often being reused between hospital staff. Patients diagnosed with COVID-19 had also occasionally shared common rooms with regular patients.
The monitoring procedure was carried out due to suspicions that adequate methods of COVID-19 spread mitigation were not in use in the hospital. Above all, it was suspected that PPE was not routinely and correctly used, which led to further spread of infection.
The hospital recorded 48 cases of COVID-19 infection, split evenly between patients and staff.
Many violations and shortcomings were discovered in the course of the investigation, mostly in relation to lack of PPE and their incorrect use, along with inadequate distribution of work processes between departments.
It was stated in the procedure file that the screening department of the hospital was divided into "dirty" and "clean" zones, and for this the hallway was divided using boards and barriers, with a yellow line marking a buffer zone in between.
No PPE was used to cover footwear in the department, the report said. There were boxes for each person containing a respirator, which were often used at multiple separate times of the day. If hospital staff wanted to enter the "dirty" zone, the respirator was again reused, which the procedure board deemed unsafe in combatting infection spread.
In addition, staff in both screening and emergency medicine departments were not using footwear protection, cuffs, or visors at all times. During the procedure, only one cardiologist wore both a mask and visor. Others were only using a mask or a respirator.
One of the examples brought out was that of transporting a person from the emergency care unit to screening using a wheelchair. In that case, the same wheelchair was taken back to emergency care, where it was cleaned and disinfected. There was no separate room to disinfect it in, however.
A case during the procedure also saw an ambulance arrive with a nurse from the emergency medicine unit going to take the temperature of the patient. After checking the patient, the nurse went back to emergency care wearing the same PPE, which led to danger of cross-contamination between departments.
Although there was a separate elevator for COVID-19 patients, the hallways used to transport patients were commonly used, once again creating danger of cross-contamination. In addition, an elevator for COVID-19 patients was next to one used by the hospital's catering services.
The file also revealed that staff and patient toilets in surgery were not marked.
There were many cases of protective gloves not being used correctly, with one nurse dealing with a patient with protective gloves still in their pocket. There were also violations of hygiene, with caregivers not washing hands when switching patients.
Main rooms in the endoscopy department were designated for patients with a negative COVID-19 diagnosis, but in some cases, untested patients and even positive patients ended up in these areas. The explanation given was that staff would put on and take off their PPE while not leaving the room in question, but there were no instructions for such procedures in the room.
Hospital making changes
West Tallinn Central Hospital said it was actively trying to mitigate these violations during the procedure and will make many rearrangements after findings arising from the report.
Since May 14, workers in the endoscopy department have not been allowed to take on shifts in other departments. There is also be a room in the department assigned for storing unused PPE and clothing.
In addition, staff and patient toilets are correctly separated and marked.
The Health Board has as a result finished their monitoring procedure and scheduled treatments in West Tallinn Hospital are to continue.
There are 1,800 people working in the hospital.
Editor: Kristjan Kallaste