SOURCE: 0000000755.

RTF

THESIS ABSTRACT

Title SEVERE Author Degree Year Location

: THE PREPAREDNESS OF BICOL REGIONAL TRAINING AND TEACHING HOSPITAL (BRTTH) ON PREVENTION AND CONTROL OF : : : : ACUTE RESPIRATORY SYNDROME (SARS) (MARCH 2004) ADRA, MARIA MARGARITA B. MASTER OF ARTS IN NURSING 2004 AQ

Severe acute respiratory syndrome (SARS) is an emerging disease. It has affected six continents and 29 countries, including the Philippines. The World Health Organization (WHO) and the Center for Disease Control (CDC) were watchful. Subsequently, the affected and not-affected countries were alerted to respond adequately to stop SARS attack. Preparedness is one of the key responses in the global, and local prevention and control of SARS. The BRTTH, designated by DOH as one of the satellite referral hospitals for SARS, had to prepare for any SARS attack. Statement of the Problem The research aimed to determine the preparedness of BRTTH in the prevention and control of SARS. Specifically, it answered the following questions: 1. What is the level of preparedness of Bicol Regional Training and Teaching Hospital (BRTTH) on the prevention and control of SARS in terms of: a) Triage, b) Advocacy, c) Isolation, d) Availability of resources, e) Training with drills, f) Infection control, and g) Management and supervision? 2. What problems have been identified by BRTTH in its preparedness? 3. What solutions are offered to improve the level of preparedness of BRTTH? 4. What program can be proposed on the prevention and control of SARS? The research focused on the level of preparedness of BRTTH on the basis of the abovementioned variables. It also identified the problems encountered by the personnel and the solutions recommended by them. Some programs were also proposed for BRTTH to consider which may fill in the gap identified by the research. Further, a training program was made for the hospital's use, hopefully. Significance of the Study The study is timely in the sense that the disease is new and has been recently discovered for it to be known thoroughly so that its spread could be prevented and controlled. Thus, it hoped to provide an impetus for BRTTH to analyze the gaps in its preparedness: the strengths, weaknesses/failures, opportunities and threats. The study was also considered to be important to the other government agencies such as the DOH, DOT, and the academic institutions, but most of all, the ultimate beneficiaries shall be the public. Finally, it may also provide some help to the training officers and researchers. Theoretical Framework

The related literatures and studies were all about the SARS' causative organism, signs and symptoms, diagnosis, treatment protocol, care, and prevention and control. Interim guidelines, executive order and memoranda were included too. Case studies of health workers and families whose children or relatives were infected, survived or died were discussed as well. Both imported and local transmissions by individuals infected by SARS were traced. Prevention of other emerging and re-emerging infectious diseases such as HIV-AIDS, bird flu, influenza and malaria were used as references. Likewise, disaster preparedness was also studied. This study was anchored on two theories. These were the Gap Analysis Theory by Montana and Charnov and the Disaster Preparedness and Response Theory by Silvestrini et al. Both of them were akin to the "STOP SARS ATTACK," a mission of the Philippine DOH. Research Design The research used the survey-descriptive design. The primary sources of data were provided by the management and support group of BRTTH, the total of which is 72. The management group included members of the Hospital SARS Committee (HSC) while the latter were the members of the Hospital SARS Team (HST). The secondary data were sourced from records and documents such as policies, standard operating procedures, minutes of meetings, purchases/donations of equipment, personal protective equipment (PPE) and training programs. The study used the questionnaire for gathering primary data. It was subjected to validation and critiquing by experts. The retrieval rate of the research instrument was 67 out of 72, which is 93%. An interview was also done to give depth to the answers provided by the respondents. Pictures were presented to show some of the activities on the hospital's preparedness. The mean was used to analyze the data of the first sub-problem of the study. The problems identified as well as the recommendations offered by the respondents were discussed. Finally, a program for the BRTTH management to consider for improving and enhancing its preparedness was also presented. Findings 1. The preparedness of BRTTH on the prevention and control of SARS using the variables were: For triage, BRTTH preparedness was rated as "almost prepared" with a mean of 3.64; advocacy was "somewhat prepared" with a mean of 3.40; isolation was "almost prepared" with a mean of 3.54; availability of resources was "almost prepared" with a mean of 3.50; training with drills was "somewhat prepared" with a mean of 3.60; infection control was "somewhat prepared" with a mean of 3.43; and management and supervision was "somewhat prepared" with a mean of 3.23. Taking all variables together, the BRTTH preparedness was rated "somewhat prepared" with a mean of 3.48. 2. The problems encountered by BRTTH in its preparedness were generally about limited manpower, limited budget or funds, inadequate facilities, supplies and materials, no written training program, and unwritten policies and SOPs. The respondents also identified their inadequate psychological and emotional preparation resulting to their inability to cooperate and be committed members of the SARS team. 3. The solutions offered by the respondents to solve the identified problems were appropriately addressed individually. Specifically, the respondents said the hospital should add more personnel and allocate funds. Cleanliness and proper waste disposal should also be maintained. The respondents also suggested that a dormitory be built for personnel for those who wished to be quarantined. Training with drills should be longer and continuous. The respondents also suggested that personnel who were under training should be freed from their duties and to intensify the training with drills and practicum. Compulsory attendance to this training of the HST and if possible all personnel should be trained was also recommended. Addressing the management, the respondents recommended that the HSC should make written policies and SOPs, disseminate them, and have a copy of this in all clinical areas. Likewise, additional salary and benefits to personnel and family were also emphasized in their suggestions. 4. The researcher proposed some programs for the benefit of the BRTTH's preparedness on the prevention and control of SARS. The preparation of the programs was based on the Gap Analysis Theory using the SWOT Technique. The identified strengths, weaknesses, opportunities and threats for each variable of the study were stated accordingly. The strengths answered the question of the degree of BRTTH preparedness. These were based on the answers of the respondents and the interview made by the researcher.

The weaknesses were the identified problems, which were the results of the ocular observations/inspections, the review of literature and studies, and from the hospital documents. The opportunities were the key result areas or the programs, which the researcher proposed, which might benefit the BRTTH, HSC/HST and the public in general. Out of the several programs, the researcher selected to make one of these for the use of the hospital: A Training Program for the Prevention and Control of SARS. It is also hoped that this training program can bridge the gap identified by this research. Lastly, the threats were identified so that the preparedness of the BRTTH on the prevention and control of SARS would come out excellently. Conclusions 1. Preparedness is a continuous process of analyzing strengths, weaknesses, opportunities and threats. In which case, the efficiency and effectiveness of the preparedness can be elevated from a lower level to a higher one. 2. Training of the staff, financial and manpower allocation are common problems encountered in any activity such as the prevention and control of diseases. For every problem there is a concomitant solution thus, the hospital has to direct its solutions towards the problems identified. However, such problems are not deterrents, rather, they become challenges to the implementers. 3. Excellence in preparedness activities in preventing and controlling highly infectious diseases like SARS requires addressing the problems identified and accepting the challenges they pose. 4. Assistance comes either from within or outside the organization. The analysis of the BRTTH preparedness activities using the SWOT technique is the external aid offered by this research to facilitate and improve it. Recommendations 1. The BRTTH has to redirect its plans to fill the gaps identified by this research. The hospital has done satisfactorily in terms of advocacy, infection control and management and supervision; very satisfactorily in terms of triage, isolation, availability of resources and training with drills. But excellence in all aspects is expected since SARS is a highly infectious disease, notwithstanding the fact that it has infected many health workers. In this regard, the DOH can also help the hospital in terms of the completion of the isolation unit and triage area. The WHO through the DOH should continue their support in terms of continuous supplies of PPE. Both the DOH, WHO and CDC should provide the hospital, and all hospitals for that matter, recent information on the prevention and control of SARS. Current guidelines and protocols should be reviewed and revised since SARS technical committees all over the world considered such interim. The public can help the hospital by maintaining cleanliness in the communities where they belong. Personal hygiene, especially hand hygiene, can help prevent the spread of infectious diseases like SARS. The academe can help in the advocacy programs of the hospital against the attack of infectious diseases. Likewise, they can also do other researches like the present study. The tourism agencies can also help prevent and control this disease by helping in surveillance tasks. The DOH can coordinate with them in the provision of leaflets, brochures and posters. The latter can also help train the surveillance officers in the airports and seaports on how to take the travelers' temperature and to fill up the surveillance forms. 2. The BRTTH leadership should look, listen to and take action on all the problems identified by the respondents. They should look at the problems as challenges that could improve their preparedness in combating SARS attack. 3. The solutions offered by the respondents to the problems encountered should be seen as objective stimulants that could propel the HSC to work harder towards excellence in its preparedness. Specifically, the hospital management should look into the quality of training offered to the SARS team, the number of manpower that will implement the activities and the budget needs of the HSC and SARS team for the improvement and sustainability of the preparedness activities. The Civil Service Commission (CSC), Department of Health (DOH) and Department of Budget Management (DBM) should think of ways and means to increase the salary and benefits of the dedicated SARS team. Undue exposure may lead to illness and/or death. Overtime pay, hazard pay and an insurance policy may be in order. When a health worker becomes ill, financial and moral support must be provided for by these agencies through the hospital management.

The Philippine Health Insurance (PhilHealth) has offered one hundred thousand pesos hospitalization insurance to any health worker who will get sick of SARS. Moreover, the BRTTH management should also provide all the medicines and other treatment needs of the infected health worker. The Infection Control Committee of the hospital should continue to monitor nosocomial infection, coordinate with Out-Patient Department (OPD) and Emergency Room (ER) for the proper triage system. They should develop a flow chart for the traffic pattern and may extend their advocacy program to those who consult at these areas. They can also do outreach advocacy activities in the schools and the communities. If death is inevitable, the church should also participate in the spiritual care. Business establishments can also intensify their social responsibilities by helping the hospitals in terms of financial support, and the public by not hoarding or increasing the prime commodities when SARS attacks Bicol. 4. The preparedness must be continuous, whether there is SARS or not. Thus, the HSC should continue doing all the activities they had began. If considered, the analysis of the gaps and the programs presented by the researcher to fill these gaps can help in the attainment of an excellent BRTTH preparedness on the prevention and control of SARS. Areas for Further Research 1. A replicate study should be done to find out the preparedness level of government and private hospitals. 2. A development of a tool to determine levels of psycho-emotional status of health workers and hospital administration when confronted with highly infectious, emerging or re-emerging diseases. 3. A study on coping mechanism of health workers exposed to communicable diseases such as HIVAIDS, SARS, hepatitis B and C, etc. 4. A study on the level of preparedness of the Barangay Health Emergency Response Team (BHERT).