Clinical governance: Protecting the health-care workers

ABSTRACT

Clinical governance in protecting the health-care worker (HCW) refers to measures taken by the organization in providing a safe environment for the HCW while maintaining excellence in the quality of care for the patients. In the wake of the SARS-CoV-2 virus pandemic, the key regulatory measures are taken by the infection control authority of the hospital. The Donabedian model suggests that this process is considered as structure, process, and outcome review measures. Structural changes include surveillance, screening measures, creation of outpatient clinics for COVID-suspected patients, and separate isolated bay for collection of the nasopharyngeal swab. Structural processes also include the creation of separate intensive care units (ICUs) and theaters for infected patients, negative pressure gradient in the operating room (OR), and sites where aerosol generation could occur. Creation of operational pathways such as intubation in the ICU and in the OR should be included in this. The process involves training of HCWs at various levels on the use of personal protective equipment (PPE). Provision of adequate numbers of PPE and cleaning solutions and establishing the diagnostic pathways such as the antigen test, reverse transcriptase-polymerase chain reaction, or nucleic acid amplification test are part of the processes set up by any organization. Outcome analysis involves rates of HCW infection from COVID care wards and ICU, patients testing positive at screening, and patients who may test positive after they undergo treatment at the facility. Long-term outcome measure may include mortality and length of hospital stay.