This next item in the Covid-19 series is from a nurse in the operating theatres in Addenbrookes, Helen Torode.
Theatre life during Covid-19
So much has happened in theatre life since “lockdown”, that it’s difficult to know where to start or how to surmise it.
I work as a theatre practitioner, in the Addenbrooke’s Treatment Centre, caring for patients undergoing surgery, and ensuring that the surgeons have the correct tools for the job.
Up to and including Wednesday 18th March, we were working as per normal, covering our 6 theatre lists and another in main theatres.
From then on we saw a gradual decrease to a halt on elective surgery, in order for the hospital to prepare for a peak in admissions.
In the 40 or so years of nursing I can’t remember a time of such anxiety in myself and others, not knowing what to expect, where we would be working, the effect not only on us and our families, but also patients and the impact on their treatment.
Over the forth coming days we had training in “donning” and “doffing” of PPE, fit testing for masks, which as capacity increased, soon became fit checking. Our support workers received “pronation” training, to support the critical care staff in positioning patients face down, to assist ventilation. As a link trainer in moving and handling, I accompanied them, and was able to carry out training sessions on return to the department. Within days, they were working in the critical care wards, as capacity increased.
Registered nurses received a 4 hour training, more like a crash course in working on the wards, an area I hadn’t worked in for over 30 years. Those working in anesthetics and recovery, had a 2 day training in caring for ventilated patients, so that they could be redeployed to critical care areas.
The treatment centre theatres were closed. Equipment that could be used in critical care areas, such as monitoring, anaesthetic machines, and syringe pumps were taken. Theatre flow was determined and zones decided upon, marked into red, amber and green.
By week 2/3 of the lockdown, some sort of normality had returned and there was more stability. Endoscopy suite were using one of our theatres and had a list daily, they too had “lost” their equipment to critical care. Two/three days a week, we went up to main theatres as two of our specialities were performing urgent cancer surgery. However, as we had to treat all the patients as Covid-19 positive, our throughput was lower than normal, which to this day we are trying to fine tune to reduce delays, whilst our patients and colleagues remain safe.
The private sector took urgent NHS surgery, and we have been responsible for organising required equipment including PPE, not without the occasional problem.
The last 4-6 weeks has seen some return to normality, the theatres in the treatment centre re-opened, enabling us to commence elective surgery. We were given 10 days to prepare the theatres, which may seem adequate time. However, they had to be cleaned and passed by infection control before we could return equipment to them, equipment that had to be tracked down to wherever it may have been sent. We prepare trollies outside the theatres for PPE for staff to don prior to entering the theatre.
The patients themselves, have to have self isolated/shielded for 14 days and have negative Covid swab, before surgery, as we are classed as a “green” area. Any failure in these restrictions can compromise or postpone their treatment. However, at present, staff continue to wear full PPE.
PPE is causing a great issue in theatres and in fact now that we have to wear masks throughout the hospital, for all. The masks the staff are wearing in theatre range from a respirator type with filters, which are reusable to single use masks. They are uncomfortable to wear for long periods of time, staff are suffering from headaches, dehydration and broken skin. Communication is a huge problem, particularly if you have staff members who are generally quietly spoken. They’re also a particular barrier when communicating with patients, as difficult to convey any facial expressions, or those that may rely on lip reading.
For the last four weeks I have been involved in fit testing for masks, it seems at times that we have been doing the majority of the trust, for both the reusable and single use masks. In order to pass and find a suitable mask, staff have to go through a series of exercises, similar to every day movements. It has been interesting but at the same time frightening to test staff on masks they have been wearing throughout the time, have not had an adequate seal, and have failed the test on one of the exercises. Obviously this is worrying for them, and a different level of anxiety on us as testers.
For those that we are unable to fit a mask, we now have respirator hoods, enabling them to work in the red zones, but again there are issues with communication. Although you can see the face of the member of staff, read lips and facial expressions.
Although it has been a challenging time, I am thankful that I have been able to have some normality and structure to my days. That on my downtime I have been able to enjoy the village and walks around the area, being able to help with paper deliveries in Little Wilbraham. I’ve probably read more books than usual. The hospital has provided space to relax with refreshments, learning origami, doing mindful colouring and through one of the anaesthetists TRE, raising we might have a degree of PTSD, having carried out one of these sessions, I had probably one of the most refreshing nights sleep in months, something I hadn’t realised I was lacking.