COVID-19 in Kenya: Renewed urgency for infection control in maternal and neonatal wards

By Edith Gicheha & Beatrice Njoroge

In Kenya, cases of COVID-19 began to appear in March 2020. Although the Kenyan health system, as that of others, was not prepared for such a pandemic, hospital administrators in some facilities responded by asking their staff: Do you want COVID to run your hospital or do you want your hospital to run COVID? This view has motivated staff across hospitals and especially in the maternal and neonatal ward to take every precaution to respond to COVID-19.

Do you want COVID to run your hospital or do you want your hospital to run COVID? ~ ~ ~ We are now taking every precaution to respond to COVID-19 across the hospital and especially in the maternal and neonatal wards.

In our Facility, COVID-19 has given us a renewed urgency to quickly implement policies regarding infection prevention and control (IPC) techniques. Despite historical barriers to implement IPC, efforts to ensure hand washing or sanitizing, use of personal protective equipment (PPE), social distancing, general frequent cleaning of the unit and education have been instituted. Change in the daily IPC routine of staff and mothers attending to the babies in the unit has been inevitable.

In the Maternal & Neonatal Wards

We are committed to making infection prevention routine

We have ensured hand hygiene is strictly observed by all who enter the unit. When entering the newborn unit, everyone is required to wash their hands with soap and water for at least 20 seconds. Clinicians are also required to sanitize or wash hands again, before and after examining babies. The mothers who are partners in the care we offer to the babies are also taught the steps and technique for hand washing to ensure they also always observe hand hygiene.

In relation to Personal Protective Equipment, we have made it a requirement that all mothers wear a face mask while breastfeeding and taking care of their baby. All clinicians are also required to wear a sterile gown, a mask and gloves upon entry in to the unit. In the beginning, we had challenges with access to masks and gowns, but now we have an almost consistent supply. Disposal of these, especially the surgical masks given to mothers, has also been improved.

The number of people in the unit has also been limited to establish social distancing. The unit is small and so achieving the one-meter distance apart is difficult. Sometimes we may have 20 babies in the one small room. This means if all mothers came into the unit at once with maybe one visitor or the father, it will be very crowded. So, we have restricted the number by only allowing mothers to be with their babies and when they come, they come in batches so that if we have 20 mothers, we group them into groups of five so we leave enough space between them and the health team taking care of the babies. We have had to put a bench outside the unit for mothers to wait their turn to see their babies. Mothers performing Kangaroo Mother Care (KMC) with their small baby have a separate space outside the newborn unit. Only staff working in the unit are allowed into the unit, even students are not allowed into the unit.

Cleaning the unit and all the equipment in the unit has also been intensified. Cleaning of the unit used to be done twice daily using a chlorine-based disinfectant. Now we do it every two to three hours after the mothers have fed their babies. The cleaners have gotten used to cleaning the unit often with the rule being, even if it looks clean, it still needs to be cleaned so we don’t take any chances. We have ensured that the people doing the cleaning do it before and after mothers feed; that way their physical contact is reduced. Segregation of used gowns has also been improved, and now we have a bucket where used gowns are placed awaiting laundry for the next day’s use. The disinfectant wash used to clean feeding cups is also now being changed more frequently to respond to COVID-19; we used to change the solution twice a day, and now it is happening four times per day.

Education of mothers, clinical workers, and staff on COVID-19 prevention and control is ongoing. The hospital has organized a few sessions on hand hygiene and correct use of PPE. More COVID-19 sessions run by the hospital are needed to ensure safety of staff and to keep their morale high during this difficult time. The Newborn Essential Solutions & Technologies (NEST360°) Program is supporting us as the health team with webinars every Friday evening to help us prepare and respond to COVID-19. NEST360° has given us webinars on Oxygen Therapy, Newborn Feeding, Neonatal Hypoglycemia and Identification, Management and Treatment of COVID-19 Cases, so far. These have been very enriching and instructive.

Across the Hospital – responding to COVID & ongoing challenges

Our hospital has been designated as a COVID-19 response hospital,meaning if cases are identified country wide, they could be brought to our facility. In Kenya we have such centers all over each county. In Nairobi County we already have an infectious unit set up and running, and we also have the national referral hospital. Our facility has been set aside as an added site and is currently being set up as such. A part of the hospital was under construction as an expansion, and so we hope that space will be completed and used for COVID-19 response.

As a county hospital, we have also seen some changes in how the hospital is run. At the entrance of the hospital, there are two tents that have been set up to ensure prompt identification of the COVID-19 cases. One of the tents is for any patient presenting to the hospital with respiratory symptoms and the other for patients with other ailments. Those with the respiratory symptoms and a fever are isolated, screened and testing and management for COVID-19 instituted immediately. Also, the hospital has reduced the visiting hours to restrict movement in and out of the hospital.

Despite challenges like fear and anxiety associated with coming to work daily, staff shortages due to government movement restrictions, staff exhaustion due to longer working hours, and lack of a consistent and adequate supply of gowns, surgical masks and N95 masks, we have seen some improvements in our hospital because of COVID-19. Previously, we would have had a challenge with running water, but now efforts have been put in place to ensure there is continuous supply of running water and other hand hygiene facilities. Although running water is a minimum requirement for any hospital, we hope this continuous supply of water will continue even after the pandemic is over.

Hope for sustained improvements in Kenya

The efforts taken in our small unit have seen us cope with the pandemic as well as improve how we deliver care to the small and sick newborns. Thankfully, we are not the only ones making changes in how we deliver care to our most vulnerable population. Every newborn unit across Kenya is making similar changes. Every hospital and sector in Kenya are making changes. We have seen our local manufacturers now making PPEs for Kenyan consumption. We have seen intensive care and isolation units built and equipped across the counties. We have seen county governments advertise for health workers’ positions. We have seen health workers appreciated for their hard work and sacrifice when all TV and radio stations stop all programming every Wednesday at noon to give a hand clap. The only question is, will this continue?

Will this momentum to improve our health system continue after the pandemic? Will we, on the ground, continue to make changes to improve the care we give our small and sick babies? Will our local manufacturers continue producing high quality PPE to ensure a consistent and adequate supply to all hospitals? Will appreciation for health workers continue after the pandemic in more relevant and practical ways? Will our hospital managers, governors and other political leaders continue to choose to improve our health system after the pandemic?

We need to make this crisis count! All of us, at the newborn unit, the hospital, the county and as a nation. Let’s make this crisis count. Let’s take this opportunity to find lasting solutions to make our health system more efficient and safer especially for our innocent newborns.

Edith Gicheha is a midwife and NEST Kenya clinical instructor. Her passion is to improve maternal child health.

Beatrice Njoroge is a neonatal nurse at Kenya’s Mbagathi District Hospital newborn care unit