A Reflection on Covid-19 from an Irish Neonatal Nurse Perspective
Colette Cunningham, Senior NICU Nurse, UHW, Waterford, Ireland
Covid-19 first hit the shores of the Republic of Ireland on the 29th February 2020, and within three weeks, it had spread to all 32 counties. By the 12th of March, the Government of Ireland had closed all schools, colleges and childcare facilities, and for the first time in the history of the Republic, St. Patrick’s Day festivities were called off. On the night of the 17th March, the Taoiseach Leo Varadkar, instead gave a nation’s address, and suddenly the severity of this global pandemic was plain to see. It’s potential for destruction to life as we knew it was all too apparent. Life as I knew it, as a neonatal nurse in a large “Level 2” NICU, meant the potential for catastrophe for the vulnerable ill term and preterm infants in my care.
In that first week after Covid-19 reached our country, and indeed our county, the management and infection control teams (ICT) in our regional hospital swung into action. The hospital was put on an “infectious disease” lock down, and only one parent of paediatric inpatients were allowed to stay with their child. No other visitors were allowed in any other area of the hospital, except in the Neonatal ICU/SCBU. In the early days of uncertainty, it was decided amongst our ICT and senior management, that the mother of each infant in the NICU could visit for one hour every day. This hour was to be decided in advance of the visit, so the 2 metre distancing could be respected amongst staff and parents. Too many visitors at once jeopardised the likelihood of this being a reality. Mothers were asked to wear aprons and masks and to wash their hands thoroughly before entering the unit. The handwashing was something they were all too familiar with, the masks in 25 to 27 degree Celsius heat, was not. Priority was given to breastfeeding mothers, and a mother and baby room was made available for those trying to establish breastfeeding on the road to discharge home. An isolation bay was quickly turned into a receiving area for those infants at high risk of being Covid-19 positive, or of those born to a positive mother. We were in good shape for all potential isolation needs, a luxury we knew that was not afforded to the larger tertiary centres or smaller “Level 1” facilities across our region.
It has been decided in recent weeks to encourage visiting of either mother or father for one hour every day in our NICU. Those infants of breastfeeding mothers may also have a paternal visit once a week. This visiting is always carefully planned so as to not overcrowd the unit and to minimise risk to other infants, parents and staff. The visiting policy will be reviewed on a regular basis and the input of our ICT, management and Government guidelines will always be taken into consideration. The possibility of virtual visiting is also being explored, and is something we hope to achieve in the very near future.
As professionals we are striving to be ready and fully equipped to deal with the consequences of Covid-19 positive infants, positive mothers, positive colleagues and positive family members. We have designated “grab and go” sets of PPE for potential emergency and unforeseen resuscitations on the labour ward, which may involve aerosol generating procedures. This minimises the time it takes us to don the PPE before we reach the infant on the labour ward. We have a Covid-19 folder of updates on our desktop which we read during our shift to keep ourselves updated. Any immediate or new procedures that have been recommended to us are handed over at the start of every shift, to allow us to be fully informed and follow a general consensus of practices within our NICU. It has also become routine practice in our unit to decontaminate the telephone, the desktop and the external intercom after each use. We also keep personal diaries of those we have worked with, been in close contact with during a prolonged procedure, and the bed numbers of the infants we have looked after. This makes the possibility of contact tracing more reliable, should the need arise. Parents are encouraged to place their mobile phones in clear plastic bags provided by us, to allow them to take pictures of their infants, but also to reduce the risk of potential transmission of a multitude of micro-organisms to their infant and the immediate surroundings.
As a nurse in a NICU, the uncertainty of the times is palpable. Foremost on my mind is the welfare and the protection of the infants, my colleagues and indeed my own family at home. My mind is a flurry of mantras…stay 2 metres away, don’t forget your mask, are you handwashing at every appropriate opportunity? As NICU nurses, the WHO moments of hand hygiene are ingrained into our everyday practice. The social distancing and care of infants and mothers with masks and gloves however, is not. Staying 2 metres away from vulnerable mothers without any reassurance of touch, was and still is, extremely alien to me. But even more difficult is the handling and nurturing and developmental care of ill term and preterm infants with gloved hands. The reassurance of positive touch is still there, but the warmth and love of a human hand is not. I prioritise the provision of positive touch and skin to skin care between mother and baby, wherever and whenever possible in my working day. This “visiting hour” is carefully planned, and with the infant’s permission and affirmative cues, I provide this basic nurturing and healing contact for infant and mother. Every effort by staff and parents is being given to try to diminish the possibility of the contraction of this devastating virus in our NICU. Although it is against our usual nurturing and encouragement of parental involvement, we hope and strive for this to be a short term solution to the potential spread of this virus. Our priority right now is to protect the vulnerable infants in our care, to the best of our ability, within our given resources. Reassurance is now given with exaggerated nods and thumbs up. Muffled conversation through masks is also maintained with smiling eyes…at least I hope my eyes are smiling.