Some hospitals have decided not to put a ban on human contact between patients affected by the virus hospitalized in these wards and their families, considering hugs, caresses, kisses, words and live looks an integral part of the treatment. An example is the Covid intensive therapy of the Cisanello Hospital in Pisa directed by Paolo Malacarne. The presence of a therapeutic wife, husband, child or friend reduces stress and the drug burden. For a patient with a ventilatory helmet, the idea of meeting a loved one every day helps to better tolerate the device he is wearing, which is very annoying, alienating and noisy. The appointment gives him strength when he would like to abandon himself to discouragement. The intubated patient – continues Malacarne – when we reduce his sedation for a few days he remains disoriented and agitated, if instead there is a family member next to him he will feel less confused and we can significantly reduce the dose of the drug.
The benefits are evident and by adopting all the risk protection measures you do not run them. Since November, when we left, no outsider has ever become infected – underlines the expert -. We do not ask for tampons, but anyone who enters must be equipped with a gown, shoes, visor, cap, three pairs of gloves and an ffp2 mask. one of our operators is required every time to guarantee the safe dressing and undressing procedure. In any case, the entrances are limited to a maximum of four relatives per day (equal to half of the beds), who can access the structure only in the afternoon, for one hour each. Intensive care dedicated to non-Covid patients but with different rules also remains open, Malacarne specifies: No longer twelve hours a day as before the pandemic but only four, and access allowed to only one relative, no longer up to four, to avoid gatherings.
The opening to visits and the modality of entry also depend on the logistical conditions of the hospitals. At the San Camillo hospital in Rome, Luigi Tritapepe, head of Covid intensive care, explains that since the patients are placed in an open space area, the relatives are welcomed in turn, based on the alternating arrangement of the beds, so as not to create crowds. We ask everyone for a molecular swab before entering and putting on protective devices. The visit – explains Tritapepe – is also an important moment for the family member, who is anxious because the patient has been transferred to us from a suburban hospital and has not seen him for days. And it strengthens the alliance with healthcare professionals. When they see us committed to treating those who cannot breathe, they too realize the difficulty, they become participants in our activity, this serves to reassure them and to have more confidence. In any case, the team informs the family twice a day, over the phone or via video call, about the state of health of the patient.
The ASL City of Turin, which includes four hospitals, adopted a protocol last November that governs external visits even in intensive care units reserved for those who have contracted the Sars-Cov-2 infection. Here, too, there are anti-crowding entrance shifts lasting one hour and every other day. However, the narrow and uncomfortable spaces have not slowed down the doctors’ will to protect the needs of patients. This is testified by Marco Vergano, anesthetist at the San Giovanni Bosco hospital: The two resuscitation wards for Covid patients were obtained from an operating block. Intensive care can become a factory of nightmares, especially if the only light is the artificial one that is always on in the operating room. Even if we have equipped ourselves with video calling systems, human contact is irreplaceable and the advantages are enormous. The patient is calmer, more present to himself and more cooperative. Meetings are especially favored for the most critical or dying patients, even if they have lost consciousness, so that they do not go out in the solitude of a hospital bed but amid the affection of their loved ones, says Vergano. Whoever enters, continues the doctor, is subjected to a rapid swab and temperature control, wears a gown, visor, gloves, ffp2 mask and signs an informed consent in which he declares that he has not had risky contacts and that he has no symptoms.
Vergano announces that the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (Siaarti), of which he coordinates the bioethics study group, is preparing a document with recommendations to be followed for organizing family visits in intensive care units during the pandemic. Today almost all Covid departments are armored, yet we know how harmful isolation is for the patient, concludes the expert.
There is no danger of bringing harmful bacteria from the outside to these frail patients. The most dangerous infections are indeed those that can be caught in the hospital or caused by germs already present in the patient’s body, underlines Davide Mazzon, head of the anesthesia and resuscitation department of the Belluno hospital. Here family members and patients do not touch each other live but greet and talk to each other from a window (which runs along an annular corridor) with the help of a telephone. Upon request we can bring them closer adds Mazzon. The intensive care for the other pathologies has instead been transferred to the surgical block: The number of visits are reduced because the room is smaller, you enter one at a time. If the patient is dying, we allow the relative to be with him all night long.
Alberto Giannini, who directs that of the Civil Hospitals of Brescia, tells the experience of a pediatric intensive care open at the time of Covid. The child is supported by a parent throughout the hospital stay. For greater safety we ask that the person is always the same, or the mother or the father in general, who every time he enters makes the molecular swab and is barded with all the protective devices. On the clinical front – explains Giannini, member of the ethics committee of Siaarti and one of the major promoters of the concept of open intensive care, before and after Covid – one of the main causes of suffering during the hospitalization period is the absence of a loved one next to him. . This also applies to those staying at home. One in three family members experiences post-traumatic stress, which manifests itself as anxiety, depression, and sleep disturbance, even after the patient is discharged. Therefore, opening intensive care is a balm that relieves everyone of a harmful inner fatigue, without compromising the activity of doctors and nurses, indeed increasing the trust and appreciation of the family towards the team they see at work under their eyes. The road is all uphill. Giannini takes stock: Just two per cent of Italian intensive care for adults is open 24 hours a day. The pediatric ones stop at 23 percent. On average in our country two hours of visits per day are allowed in the first and eight hours in the second.
April 3, 2021 (change April 3, 2021 | 15:54)