Prevention and control: Introducing new protocols to stop the spread of disease through best practice

Kirsty Scott

3 December 2020

This is an article from the CSC Development Theme: Strengthening health systems and capacity

…when you have limited resources, perhaps the mindset is a little different. You have to attack this thing now. We cannot wait for a massive surge. So, we clearly had to get staff in, get them in the buy-in from very early, with the necessary training in infection prevention and control. I must mention though, that it was the Fellowship that started to open my eyes to a broader view of infection prevention and control.

Joel Jerawno Myers

Commonwealth Alumnus Joel Jerawno Myers is the Acting Chief of Public Health for the parish of Manchester in Jamaica, which has a population of approximately 200,000. He is responsible for the implementation and administrative management of all public health programmes in this area. With a strong background in infection prevention and control, Joel has been instrumental in the implementation of new protocols to tackle the spread of disease in institutions in his parish and raise awareness of best practice amongst citizens and key workers.

Over the last year, Joel and his team has implemented several new protocols and programmes developed by the Ministry of Health in Jamaica in response to COVID-19 to prevent the spread of the virus and protect citizens. In December 2020, Joel shared his experiences implementing COVID-19 protocols and programmes and the importance of his work more broadly in infection prevention and control in his parish.

In developing and implementing protocols to minimise the impact and spread of COVID-19 across institutions, including workplaces, health facilities, schools, and nursing homes, Joel stresses the importance of enforcing strict measures within his parish and Jamaica as a whole. Limited resources and available funding to implement new healthcare measures means there is little margin for error in implementation and adherence.

As such, understanding as many factors related to the spread of the virus is critical in implementing and communicating information to the citizens of his parish. One area of keen interest was the impact of COVID-19 on children and whether it was safe to re-open schools. At the time of sharing his experiences, Joel was managing a pilot project for the re-opening of two schools in the parish. Joel shares his findings:

“… the COVID-19 protocol for educational institutions really helps to mitigate against the spread of COVID-19 among a vulnerable population… and concerning school, there’s a huge argument about the vulnerability of children in schools. Children might not be carrying the heaviest burden of serious illness, but they can be spreaders.”

As part of the pilot, Joel and his team have continually monitored steps taken by other countries in re-opening schools, through which he has observed that where schools re-opened, many have subsequently closed. As such, the two schools taking part in the pilot, were assessed with a protocol checklist designed to test the suitability of the schools to adapt to a new set of COVID-19 responsive measures. Using the protocol, public health inspectors visited each school and assessed a range of factors, including the physical infrastructure of the schools and whether they could accommodate the installation of more handwashing facilities or hand sanitising stations, implementing physical distancing around school buildings and within classrooms, appropriate designated isolation areas, building ventilation, and accessibility of outdoor space for teaching.

Photo of child washing hands

In addition to these assessments, the protocol also addressed the extent to which schools would be able to monitor the health of staff and students. Joel highlights how schools will need to change their response to reported illness and the considerations around this.

“The incident record, a child complains of, ‘Oh, I don’t feel well’. Is that recorded? Is the health department contacted if a child is present with fever and cough? It could just be a normal thing… but it could be more than a normal thing.”

The protocols developed has been adapted and applied to other institutions, including nursing homes where those most vulnerable to the virus are living. Joel notes the cautious approach taken with all new measures and pilot programmes, but hopes this will enable him, his team, and other public health professionals in Jamaica to make the best and most informed decisions in response to the pandemic to mitigate the spread and flatten Jamaica’s epidemic curve. Joel notes that observing and learning from countries continues to be a key factor.

“What is happening in the UK? What is happening in the United States? What is happening in other countries? It is important to note and use best practices and see the trends. It is key in those countries with limited resources to observe global health trends.”

Exposed to new skills and knowledge

Joel credits his Commonwealth Professional Fellowship in exposing him to the skills and knowledge necessary to deliver public health management and responses, as well as environmental health management.

Joel cites the infection prevention and control programme in the UK. He remembers a visit to University College Hospital, London during his Fellowship and witnessing alcohol gel dispensers built into door handles.

“And I’m saying, wow, how cool? This was the first time I’m seeing this. How important is this? Very important for basic hand hygiene. You can carry things on your hands into the hospital. There are so many things that can go wrong because of that. If you cannot manage hand hygiene from the entrance, this can have great implications if somebody should come in and touch a surface, touch the patient, touch the patient bed area.”

Alcohol gel dispenser in hospital

Following his Fellowship and return to Jamaica, the government was investing in Infection Prevention and Control and within six months of his return, Joel was promoted to the position of Parish Institutional Health Specialist with oversight of infection prevention and control in institutions across the parish. In this role, Joel developed Infection Prevention programmes, following a series of inspections undertaken at institutions to assess their needs as they related to infection prevention and control measures. This included assessing cleaning approaches and schedules, right down to the mixing ratio of the cleaning and disinfection agents used. Joel notes that the assessments undertaken at that time and improvements made because of the programme have enabled better responses to infection prevention and control during the current pandemic.

Although Joel has not been able to introduce handles with inbuilt alcohol gel dispensers in hospitals, he has taken inspiration from this practice and ensured the installation of alcohol dispensers at the entrances and within institutions in his parish. He notes, however, that more work is needed to build on the positive changes introduced.

“… certainly COVID-19 would have informed us that, hey, we need far more resources. So, even though we had some things, we still have to put more in place. But it was a foundation that was laid, our work has improved over the years and after the Fellowship. We are seeing the benefits of infection prevention and control right now.”

“If I learn from you, you learn from me”

During his Fellowship, Joel was encouraged to network with different professionals working in public health to learn about different approaches and perspectives. He also completed his Fellowship alongside two Commonwealth Professional Fellows from whom he was able to learn and cement his own understanding to develop best practice solutions to public health challenges.

“We were in the same field but had different perspectives. Those perspectives formed a basis for best practices. If I learn from you, you learn from me, and [if] we all learn from somebody else, we might be able to formulate a sustainable plan.”

Understanding the importance of networking and building these skills has been of importance in Joel’s roles after his Fellowship, where he has been required to work with a range of stakeholders, including government and independent agencies, as well as representatives from sectors across Jamaica, to understand their perspectives and requirements of public health responses. Tourism is perhaps Jamaica’s most consumed product in the global market and is important to the country’s Gross Domestic Product. He notes that understanding the COVID-19 response needs for the tourist industry helped the re-opening and safe operation of this sector.

During the pandemic, the interconnectedness of sectors has become even more apparent and critical, and in infection prevention and control, Joel has had to understand and plan for sectors to work together in minimising the spread of the virus. Joel used the transport sector as an example.

“We have what we call the route taxis. They have to be part of the programme. So, you can’t have an infection prevention and control programme for the hospital but not the taxis… because not everybody drives… Are the taxi men trained? Are the taxi women trained? Are there basic infection prevention and control features within that group?”

Whilst navigating the needs of these different groups has been challenging at times, particularly given the impact of COVID-19 on the economy and the need to resume certain activities to support this, Joel has found that the common goal of protecting citizens from the virus is easier to achieve if necessary protocols are implemented.

Teamwork and contributions

Prior to COVID-19 and following his Fellowship, Joel’s work in public health and infection prevention and control had received recognition from both his host organisation in the UK, the Chartered Institute of Environmental Health, and the University of the West Indies, who have recognised his exceptional work in community health.

A key achievement at the community level for Joel has been the organisation of the first commemoration event, Infection and Prevention Control Week, to raise awareness amongst healthcare workers and the public. To emphasise the importance of understanding infection and prevention at a community-wide level, Joel chose the theme, ‘it’s a team thing’.

As part of the commemoration, Joel organised an exhibition to share information on what infection prevention and control is and how we all contribute towards this. In particular, he focused on the important role everyone plays in a hospital environment, from medical staff to sanitation workers, from patients to visitors.

“And it’s a team thing. Your team is as strong as its weakest link… so everybody play(s) a role… because if the doctors are playing their role, the nurses are playing their role, but the visitors are not playing their role, they’re not sanitising their hands before coming in… then the team will fail.”

Following the event, Joel has developed and delivered new and more regular bespoke training to a range of hospital staff on infection prevention and control and introduced measures for accountability in the completion of tasks critical to this, including cleaning rotas, facilities management, and personal hand hygiene.

What’s next?

Looking to the future and further development and application of his professional expertise, Joel is keen to provide this wherever there is need and to develop infection prevention and control on a wider scale.

“I see myself as a significant contributor in the strengthening of health systems within the Pan-American region, not just Jamaica… I also see myself contributing to capacity building in other vulnerable countries, playing a lead role. It could be in South-East Asia, Africa… It could be in the UK. Wherever there is that need, that’s where I see myself.”

Joel Jerawno Myers is a 2015 Commonwealth Professional Fellow from Jamaica. He completed his Fellowship at the Chartered Institute of Environmental Health.