Achieving zero COVID-19 cross infections: A Vietnam hospital shares how

Vietnam’s Cho Ray Hospital shares how setting up a dedicated audit team has ensured safety and epidemic prevention regulations compliance.

In the fight against COVID-19, strict infection control measures at hospitals are paramount, to ensure the safety of hospital staff and patients. However, while it is one thing to establish such measures, it is another matter to ensure they are enforced and followed by all.

For Vietnam’s Cho Ray Hospital, the solution to this is setting up a dedicated unit whose key responsibility is to conduct regular monitoring and audits of all safety practices at the hospital. Named the Patient Safety Patrol Unit, unit members were also tasked to analyse the root causes behind any safety lapses or risks, suggest action plans to resolve those issues and monitor plan implementation by the respective departments.

Dr. Nguyen Tri Thuc
Dr. Nguyen Tri Thuc

“PSPU was created with the desire to have a professional and experienced unit in expertise and management skills, monitoring and evaluating patient safety activities. The members of this group are the ones who can both supervise and implement improvement and remedial activities at their department,” said Dr. Nguyen Tri Thuc, Director of Cho Ray Hospital

Regular thorough audits to ensure compliance

Set up in January 2020 at the start of the pandemic outbreak, the PSPU consists of 26 staff members from various departments in the hospital, including doctors, nurses, engineers, pharmacist, and Quality Assurance staff. They are led by Associate Professor Dr. Pham Thi Ngoc Thao, Deputy Director of the hospital, and were selected for their expertise and experience in monitoring and evaluating patient safety.

Over the past 1.5 years, the unit has conducted weekly monitoring of all departments, referencing checklists of environmental safety factors and infection control safe practices. These include ensuring compliance with the accurate use of protective gear and equipment, and proper disinfection of medical equipment, surfaces and common areas (such as door handles, vehicles, toilets and corridors). In addition, the unit keeps a close watch on the levels of supplies, equipment and medicine, ensuring they are sufficient in case of an outbreak.

The PSPU also makes observations on compliance by patients, including maintaining safety distancing while waiting and providing medical declarations, and engages them to raise awareness of COVID-19 prevention measures. Outsourced service staff are similarly audited and trained so they are able to follow the infection control measures closely.

PSPU meeting
A meeting of PSPU members

Based on these audits, the unit then provides regular updates to hospital management via the hospital’s reporting software system or internal chat group. Monthly, they produce a safety assessment report, which rates the hospital’s safety levels based on compliance with the checklist items (where a rating above 85% means high safety levels), and proposes solutions for issues identified.

The value of a dedicated safety audit team

Such thorough safety monitoring has been crucial amidst COVID-19, said Dr Nguyen. “The PSPU plays a key role in monitoring the safety of the hospital environment, detecting risks, and keeping the hospital safe from the COVID-19 pandemic,” he said. “I am very grateful for the valuable activities of the PSPU and appreciate the PSPU’s contributions in patient safety, especially during the pandemic when patient safety is a global issue of particular concern to all hospitals.”

One of the largest hospitals in Ho Chi Minh City, Cho Ray receives over 5,000 outpatient visits per day with more than 2,000 inpatients, and takes on COVID-19 patients in critical condition. This means it faces a proportionately higher risk in cross infection and spread. The fact that there has been no cross-infection in the hospital till now is an achievement largely contributed by PSPU’s monitoring activities, says the hospital. In recognition of their efforts, the hospital presented them with the Excellence in Patient Safety Award last year.

Their role may be even more crucial now, as cases in Vietnam have started to rise in recent days – the 7-day average case count stood at 203 cases as of 25 May. Dr Nguyen has called on hospital staff to step up their guard and practice strict compliance with the guidelines and measures, also named the “5K compliance” in Vietnamese (Khoảng cách, Khẩu trang, Khử khuẩn, Không tập trung, Khai báo y tế) – or 5S in English: Separation, Safety masks, Surface disinfection/Sterilisation, Social distancing and Strict declaration.

To achieve strict compliance, the hospital noted that there are areas of improvement for the PSPU unit: for example, PSPU members are taking on their audit roles on a voluntary basis while managing their own work duties, and as compared to the size of the hospital, the number of members is still lacking. This means currently they are only able to take random samples for each assessment, rather than cover all practices. In addition, compliance with patient safety practices such as hand hygiene are still relatively weak; while some departments are not well coordinated in taking swift action to correct their non-compliance issues. delaying in taking actions to correct the problems.

The aim moving forward is to recruit more members, divided into specific specialised groups such as environmental safety assessment, infection control, and so on, to provide comprehensive monitoring; and from there develop specific regulations and policies to be established. Cho Ray also hopes to exchange their experience and learn from other Vietnamese or international hospitals on this front. With the strong commitment to safety, solid track record and close collaboration between staff and audit teams so far, patients can be assured of the quality and safety of care they will receive at the hospital.