With the number of patients confirmed with the infection of COVID-19 rising, state-designated hospitals treating the confirmed patients got busier. Seoul National University Bundang Hospital (SNUBH) is one of them. Since winning the state designation for the treatment of infectious diseases in 2017, the hospital has been operating nine negative pressure rooms.

A Korean man who had visited Wuhan was confirmed as the fourth case of COVID-19, and was hospitalized at SNUBH on Jan. 27. The 12th and 14th confirmed patients also got admitted to the hospital’s isolation ward on Feb. 1 and 2, respectively. The hospital also started to treat the 25th confirmed patient at the isolation ward on Feb. 9.

Healthcare workers became busier. Although the fourth confirmed patient was discharged on Feb. 9, three other confirmed patients were receiving treatment in the isolation ward. Suspected patients, waiting for the result of the coronavirus testing, also needed care, and the hospital dispatched 25 nurses for them.

When there is no critically ill patient, nurses usually work in pairs of two. But now, four nurses work as a team, working in three shifts. At night, the hospital uses another nursing staff, and five are in charge of the isolation ward. The hospital said it provided a sufficient pool of workforce to prevent any loophole in the disease control.

Physicians said the “real battle” has just begun, however. Although the hospital was using the full capacity of human resources to help doctors, it needed more meticulous measures to make the isolation ward “the safest place,” especially when local transmissions worsened, observers said.

Kwon Seon-heui, charge nurse at the isolation ward of SNUBH, emphasized that the hospital must provide sufficient workforce and offer a thorough, systematic, and repetitive training for healthcare workers, in an interview with Korea Biomedical Review.

Kwon Seon-heui, charge nurse at the isolation ward of Seoul National University Bundang Hospital

Question: Weren’t you scared when you were sent to the isolation ward?

Answer: When the government designated our hospital to treat infectious diseases in an isolation ward, I was appointed as a charge nurse at the ward. I can’t say I wasn’t scared facing the outbreak of the new coronavirus, but I accepted my role calmly. I must have been prepared because of the numerous training.

SNUBH was also prepared well for an outbreak of infectious disease, especially after the 2015 MERS (Middle East Respiratory Syndrome) epidemic. The hospital braced for a scenario where the number of infected patients could go up, and it used the reserve workforce.

I heard that during the Ebola virus outbreak, there was a lot of exposure to the virus when healthcare workers were taking off protective clothes.

It is essential to wear protective clothing and equipment. Still, medical staff can easily neglect them when there is a workforce shortage in urgent situations such as CPR (cardiopulmonary resuscitation). The hospital provided more-than-expected nursing staff to ensure that the disinfection process does not cause a workforce shortage.

Q: How have you prepared for an epidemic?

A: SNUBH has provided the basing training for working at the state-designated isolation ward. The hospital holds a workshop for nurses with interest twice a year. The hospital conducts simulation training under specific scenarios, including emergency, CPR, and death situations. Charge nurses have to spend one more day to receive intensive training. On the first day of training, we used to joke, “Can we save a patient in this situation?” Doing CPR is difficult enough, but doing it with the protective clothing in an isolated room made me question my ability.

Q: The training must have been quite demanding. How did you complete it?

A: If you don't train specifically, you'll run about in confusion in an emergency. So, we made a series of emergency scenarios and repeated the training. We trained under specific situational scenarios repeatedly, including how to quickly wear protective clothing in a sudden cardiac arrest of a patient, or who would enter the isolation room first, and who would notify the attending physician. When the patient was discharged, we reviewed and retrained. As I got adjusted to the repetitive drills, I got to think that I could save a patient in this situation.

Q: How long does it take to put on the protective wear?

A: It depends on the individual's skills. If you wear it, making sure everything is in the right position, it may take four to five minutes. We wear a pair of gloves, test the N95 face mask for leaks, and wear Level-D protective clothing. Also, when using the hood, we have to check if the machine is turned on and operates well. The equipment is not always perfect because people use it. We must do thorough checks to avoid errors.

Healthcare workers at Seoul National University Bundang Hospital get out of the isolation room after checking a patient (Credit: SNUBH)

Q: Doesn’t protective clothing make you feel stuffy a lot. What's the hardest thing?

A: When a confirmed patient gets admitted to the isolation ward, it takes about an hour to find out the patient’s basic information and explain the situation. After that, when I take off the clothing, I can smell my sweat all over my body. I have sweated as if I washed my hands.

When we take off the protective gear, we have to disinfect the clothing step by step, and sometimes we catch the ugly smell from the sterilizing alcohol. The isolation ward clearly distinguishes between sterile and non-sterile spaces. We must repeat the process of decontamination.

Q: Can you share the most memorable episode working as a charge nurse at the isolation ward?

A: Despite the repeated training, I still don’t feel used to the isolation ward because it’s not a regular ward I used to work daily. What’s still new is how we communicate in the isolation ward. Because I can’t directly hear from physicians at the isolation ward, we have to talk on the phone. Even if I try to prevent a sudden mistake of medical staff in the isolation ward, it’s not easy for me to respond quickly. If you're not used to it, you can make mistakes easily.

But now, I can tell what the physicians are thinking just by looking into their eyes. Since we are wearing masks and protective clothing, we can see our eyes each other only. But we can tell just by gestures because we’ve worked together for a long time.

Q: During the 2015 MERS outbreak, some schools refused to receive children of healthcare workers due to the fear of the spread of the virus. Isn’t your family nervous because you’re treating the confirmed patients?

A: I jokingly told my children not to tell other people that their mom works at a hospital. My mother worries about me so much, too. She feels as if her daughter is in a field hospital where bullets are flying. I told my mother that the hospital was the safest place and that there will be no problem if I wear protective clothing. Indeed, a hospital is the safest place during an epidemic.

Q: Experts are raising concerns that community spread of COVID-19 could have already started. What kind of preparations do we need?

A: After the MERS outbreak, the hospital reserved items for an epidemic. Also, the logistics team now supplies what we need at the speed of light. Things such as syringes are also used in other wards so we can borrow them if they become scarce. However, protective clothing and gears are used only in the isolation ward. So we can’t borrow them from other wards. We are indeed getting nervous as the new coronavirus outbreak does not seem to end soon. If the situation persists further, there should be sufficient procurement of goods. I think we should make preparations for this. Without protective clothing and equipment, we can’t guarantee the safety of healthcare workers.

I am also worried that the medical staff’s fatigue is accumulating. It's not something they usually do, and they can't just let go of the work. They must be exhausted. As a nurse in charge of the isolation ward, I should make sure that nurses don’t get tired. But I’m concerned I could do so. As they are in charge of confirmed patients, they always wear face masks, even after taking off protective clothing. They wear medical masks, but it's not easy to wear all day. They must do this because they work in the isolation ward, but it surely isn’t easy for them.

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