Plea for specialised nurses - too few to run ICU beds at Tygerberg Hospital

Tygerberg Hospital's new Covid-19 testing and triage centre, which is unable to operate at full capacity because of a shortage of nurses.
Tygerberg Hospital's new Covid-19 testing and triage centre, which is unable to operate at full capacity because of a shortage of nurses.
Image: Aron Hyman

A shortage of specialised nurses has meant that Tygerberg Hospital in Cape Town is able to run only 25 of its 42 ICU beds, while a shortage of Covid-19 test kits has resulted in a results backlog.

These were two of the key points raised by hospital managers during a parliamentary committee visit to its new temporary testing and triage facility, built to manage the anticipated large influx of Covid-19 cases.

On Monday the hospital was treating 140 people in connection with the pandemic. About half of these patients were Covid-19 positive while the rest were awaiting results. But with a backlog of 18,000 test results, health experts believe those results may not arrive in time.

In the testing and triage centre - a large, rigid tent built on one of the hospital’s parking lots next to the main entrance - dozens of people sit in chairs waiting to be processed.

It’s a smooth operation run by limited staff under great strain, as the pandemic continues to spread through the Western Cape, where more cases have been recorded than anywhere else in the country - at least for now, say some experts, until other provinces catch up.

Virologist Dr Wolfgang Preiser said the country was experiencing the same test-kit supply backlog that others around the world were experiencing.

Test kits are not manufactured in SA, nor is the sophisticated machinery used to process them.

Preiser explained that the Roche Cobas sample analyser, one of which is situated in Green Point, can process more than 2,000 tests per day - but due to the low availability of kits is only processing a few thousand a week.

Specialised staff and technicians are needed to operate and maintain the machines, but the entire supply chain has been disrupted by lockdown restrictions on travel.

Virtually all personal protection equipment (PPE) such as medical masks and gloves are produced elsewhere in the world, particularly in China, and SA has to wait in line for stock.

“The supply of test kits is a massive problem. We are letting our medical colleagues down by not giving them information to make urgent decisions on whether to admit patients or not,” said Preiser.

SA urgently needed to start manufacturing these products, he said.

In order to streamline testing, hospital staff tests should be expedited so they could get back to work or self-isolate.

“The sheer numbers of people wanting to be tested are overwhelming,” he said.

Workplace regulations were adding to the overburdening by requiring a negative result before allowing employees back to work if a single individual at a facility tested positive.

Tygerberg’s director of clinical services Dr Paul Ciapparelli said the hospital had  dedicated 225 ward beds for Covid-19 patients, including from their ICU and high-care wards.

“We are struggling with a shortage of staff, particularly nursing staff. We have had to redeploy staff from various theatres,” he said, adding that highly skilled nursing staff with particular skills were needed and they were not easily found.

The hospital now runs five Covid-19 teams, consisting of various staff from different wards who work on a 24-hour shift system.

Tygerberg has started pulling in patients from smaller and less-resourced hospitals such as Khayelitsha and Eerste River.

However, Dr Jantjie Taljaard, an infectious disease specialist at Tygerberg, warned that hospitals like Tygerberg were going reach capacity, leaving the smaller hospitals in townships and rural areas around the country with an added burden.

Rural and smaller hospitals are going to be overburdened.
Dr Jantjie Taljaard, infectious disease specialist

“The problems are actually at smaller hospitals. Rural and smaller hospitals are going to be overburdened. We have limited space and when we reach capacity they will be left to mop up. We are very worried about that,” said Taljaard.

Tygerberg hospital CEO Dr Dimitri Erasmus said staff, including cleaners, were under intense emotional strain. Some reported being stigmatised by the public due to their working environment and were in some cases not allowed into taxis if they were known to work at Tygerberg.

Tygerberg’s head of nursing Francilene Marthinus said some of the most specialised nursing staff were over the age of 55 and also suffered from comorbidities. Based on a risk assessment, many of them were not be allowed to work in the high-risk Covid-19 wards.

“These are all well-written plans but when nurses start becoming patients, that’s when it becomes a very difficult situation. They are under a massive psychological and emotional burden,” she said.

Five nurses have died in the province after being infected with Covid-19, including two from Tygerberg.

Bursary holders from private hospitals are now being brought back into the public sector to help alleviate the burden, she said.

Erasmus pleaded with committee members at the briefing - from the portfolio committee on health and the select committee on health and social services - to lobby for nurses and specialised staff to be brought to the Western Cape from provinces currently experiencing lower infection rates.

“If there are specialists from other provinces, we would appreciate the help and we will have to return the favour once we are past our peak. We are not going to get them from anywhere else,” he said.

Portfolio committee member Dr Kenneth Jacobs expressed his appreciation for the transparency with which the medical experts answered the questions.

“There is no-one to blame for these problems. We have a general shortage of nurses nationally. I think it’s a very good idea to spread medical staff out across the country where it’s necessary,” he said.

He also lamented the effect that negative press and stigma were having on medical staff and front line workers putting their lives on the line to save lives daily.

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