COVID Ward in a Mental Health Establishment: Our Experience.

To the editor,

The impact of the second wave has been severe and global, involving almost all sectors. The medical field has been in the frontline to battle the sudden surge of COVID-19 cases, which challenged our preparedness with respect to infrastructure and human resources. The field of mental health has faced unique and new challenges during this pandemic.

Being a large and populous city located in the south of India, Bengaluru was hit very adversely, with many cases. In our Mental Health Establishment (MHE), the enclosed management model, crowded wards, and uncooperative patients posed significant risk factors for nosocomial infection. Admitting new psychiatry patients and preventing a COVID-19 outbreak within the institution due to the exposure from these patients coming from outside was a crucial challenge.[2-3] We created an isolation ward for new admissions, to facilitate screening before sending them to respective wards to join other inmates, thereby limiting the exposure for our old patients.

Challenges Faced

We faced difficulty in providing quality service to psychiatry patients (almost 150–180 in number) as in the pre-COVID-19 times, due to barriers like time and COVID-protection issues. We braved issues like sudden reduction in the number of regular outpatients and sudden discharges of inpatients out of panic, whereas some patients delayed their discharges due to lockdown and transport issues.

Dealing with government audits and surprise inspections due to a shortage of multiple drugs for COVID was an experience of its own kind. We were also questioned by the people of the neighboring plots and areas regarding our methods of dealing with biomedical waste and COVID patient care. But our stringent waste management ways kept us safe from these false complaints.

Despite these hassles, we started a designated COVID ward in our MHE and even started providing COVID treatment to nonpsychiatric COVID patients too. A total of 180 patients were treated for COVID-19. Out of our 250 beds, 40 were dedicated to COVID-19 care.

Equipment and Personnel for Covid Ward[4–6]

New staff nurses with experience in medical management were recruited to reduce the burden on the existing nursing staff. Additionally, physicians and anesthesiologist, along with chest physicians, were recruited as full-time consultants for specialty consultations. A physiotherapy consultant for chest physiotherapy was recruited, which was a need of the hour for the COVID patients. Patient and family coordinators were recruited for communication with all families on an everyday basis under the guidance of doctors, to address the worries of the family members. Ventilator machines, both noninvasive and invasive, which had not been used for years, were repaired and put to utilization.

Training the Staff

All nursing staff ward boys, security, and office staff, along with doctors, were trained in

Personal protection kit use

Prevention of spread of infection

Patient’s movement from one ward to another

Importance of hand wash, hand sanitizer, bathing at home, washing clothes, etc.

Emergency management of patients

Biomedical waste management

Chest physiotherapy

Optimal utilization of oxygen

Proning techniques

Usage and monitoring of BIPAP and oximetry instruments

Checking oxygen lines and indicators to avoid running out of oxygen

Stress management

Administrative Management

All staff was briefed about charges fixed by the government for the facilities we are giving. Staff was trained to explain to COVID patients and families about medical insurance and its claims thereafter, which is not a routine for psychiatry patients. All government offices were kept updated on statistics and were also welcomed for sudden inspections. All government protocols were followed as and when updated by the government. Drugs for management of COVID regulated by government agencies were procured from them, and strict protocols for their use were followed.

New oxygen lines were created in a short time.

New oxygen cylinders were ordered to manage severe oxygen deficiencies.

New BIPAP machines (NIV) were bought to manage acute patients.

New oximetry instruments were bought and kept in all wards.

New oxygen masks, nonrebreather masks, and nasal prongs were purchased.

Different emergency medicines for medical cases were made available.

Oxygen concentrators were also brought to use to cover an acute shortage of oxygen.

New machines were brought to disinfect the hospital wards fast and more frequently.

Cross-consultation agreement with other superspecialty facilities and lab services was done.

Infrastructure

All doctors were added to one WhatsApp group where all patient’s details were shared and discussed for effective coordination and fast management.

The nonspecific immune response of MMR (Measles, Mumps, Rubella) vaccine was also utilized for consenting staff as an early protective measure and was later followed by vaccination with Covishield. COVID-19 group insurance was made available to all the staff with great difficulty as it was a challenge to get a company that would provide COVID insurance cover for high-risk health workers. Salaries and incentives for the staff who worked during these hard COVID times were raised, which motivated them to keep going.

Psychiatric hospitals are facing major administrative challenges during this pandemic. We sincerely hope and wish that our experiences would help and guide other mental health centers.