Emerging from the pandemic: leadership charts a way forward

1.5 million COVID-19 screenings; no viral outbreaks at the hospital

With vaccines for coronavirus becoming widely available, we can see a light at the end of the tunnel. The NIH Clinical Center has come a long way from the start of the pandemic, when even procuring enough personal protective equipment (PPE) was a challenge. But the Clinical Center rose to the challenge – adapting to make clinical rounds virtually and operate with the trifecta of COVID-19 prevention: masking, physical distancing and hand hygiene.

The Clinical Center completed one million COVID-19 screenings at the building's entrances in early 2021 and 1.5 million screenings in June. These milestones could not have been achieved without the vision and planning of a team of hospital staff who developed systems to protect the health and safety of patients and employees during the ongoing COVID-19 pandemic.

Keeping the Hospital Open During a Pandemic

In early January 2020, the Clinical Center established a COVID-19 Crisis Taskforce to help prepare the hospital for the potential intake of people with the virus.

Because ensuring the safety of staff and patients begins with securing the entry to the hospital, the team to assessed all 165 entry points of the Clinical Center and consolidated them into four entrances. In a matter of days, the hospital implemented screening stations equipped with personal protective equipment, medical supplies and signage. A team of nursing staff and Public Health Service officers were assembled and trained to operate the entry points 24 hours a day, every day of the week.

The hospital also developed a sustainability plan to ensure there was an ongoing process for staffing the screening areas to continue to keep patients, visitors and staff virus-free inside the Clinical Center.

"Job 1A has been protecting the patients and job 1B has been protecting each other," said Dr. James K. Gilman, CEO of the Clinical Center, during his April Town Hall presentation. "The Clinical Center has been one of the safest places to work during the pandemic."

To ensure that the Clinical Center remained a safe place to care for patients with known or suspected COVID-19, the Nursing Department collaborated with Hospital Epidemiology, Facilities, the Office of the CEO and others to set up four dedicated units in the hospital. This involved construction, placement of plastic barriers, changing air flow systems to negative pressure and procuring equipment. A system was created for in-patients to receive COVID-19 testing upon arrival and to receive rapid testing at any time with a nurse coming to the patient's room to conduct the rapid test and keeping patients in clinical isolation from employees and other patients until test results were available.

To staff these new units, nearly 100 employees were trained on proper donning and doffing procedures for PPE, staff were trained to care for COVID-19 patients and address the demand of critical hospital systems to ensure skilled, safe patient care delivery in these isolation environments.

With patient care strategies underway, the Clinical Center developed a process for employee asymptomatic testing. After planning key components, including managing the flow, a dedicated path for safe social distancing and training staff for this new service, the testing area opened in May 2020. By the end of October 2020, the testing process grew from only Clinical Center staff to all NIH staff. The number of daily tests increased with over 35,000 employee specimens collected by the end of October 2020 and over 100,000 specimens collected by April 2021.

Bringing More Staff Onsite

As the Clinical Center has continued to operate throughout the pandemic, many caregivers and researchers have continued to report to work onsite, taking additional precautions to keep themselves and those they have contact with safe.

And for the most part, staff have been able to do exactly that. There have been cases of COVID-19 among staff, but transmission of the virus within the Clinical Center has been close to non-existent.

Hospital leaders have begun discussing when and how to bring back workers who have been telecommuting, while continuing to focus on how to keep everyone safe. Subtle changes, such as the evolution of the NIH Coronavirus Response into the NIH Coronavirus Response and Recovery Team signal this change.

Despite the low transmission-rate within the Clinical Center, the hospital doesn't exist in a bubble. School, public transit and general public diligence, all play a factor in keeping the Clinical Center staff and patients healthy.

Another wildcard is the patients themselves. The Clinical Center has been very cautious administering vaccines to patients because of various logistical and safety concerns. The hospital also brought in a very restrictive visitor policy in the Spring of 2020 and hospital leaders are assessing how and when to relax that policy while keeping patients and staff safe.

"The first policy we will change is the visitor policy. Waiting and being cautious is the right thing to do, but it is time to review this policy," stated Dr. Gilman. In May 2021, the Clinical Center relaxed its visitors policy.

General concerns about safety have made leadership cautious not to have remote staff return prematurely. Each step is taken slowly and monitored carefully, with the caveat that any decision can be stopped or retracted if data suggest it is prudent.

The Clinical Center's mission is to provide high reliability and the safe delivery of patient-centric care in a clinical research environment. This includes being relentless in anticipating preventable harm, applying a systems approach to eliminate risks whenever possible, and mitigating those risk that remain. Keeping the Clinical Center free from COVID-19 outbreaks requires vigilance and personal accountability from everyone to wear masks at all times, practice hand washing and social distancing.

Surpassing the milestone of one million virus screenings at the hospital's entries and no onsite outbreaks of COVID-19 underscores the impact of the hospital's screening and testing operations to keep patients safe while receiving medical care at the Clinical Center and to keep staff safe at work while providing direct clinical care and research.

"I couldn't be happier or more proud of the response of the Clinical Center staff during the COVID-19 pandemic," said Dr. Gilman.

There are a number of resources available to get information about the Clinical Center's operating status and procedures. The Office of the Director has been posting about Covid safety conscientiously - including weekly emails from NIH Director Dr. Frances Collins that go out each Friday – town halls and a dedicated site (NIH only) providing guidance on the coronavirus.

- Daniel Silber and Lester Davis