Ventilators to testing: Here's a look at Iqaluit's hospital during the pandemic

CBC News visited the Qikiqtani General Hospital to see its new COVID-19 testing process and learn how staff are taking precautions with personal protective equipment.

Anyone sick enough to be in hospital would be medevaced south, says chief of staff

Medical laboratory technician Caroline Gauthier with the new BioFire testing machine in Iqaluit. The machine will be used to test COVID-19 swabs from the Qikiqtaaluk region. (Travis Burke/CBC)

In the lab at the Qikiqtani General Hospital in Iqaluit, medical laboratory technician Caroline Gauthier shows how a COVID-19 swab is prepped for testing in the territory's new BioFire machine.

With her hands inside a biosafety cabinet — only Iqaluit and Rankin Inlet have them — she puts liquid from a test vial into a cartridge. 

While there are no positive cases of COVID-19 confirmed in Nunavut, operations at the hospital are functioning as if a case could happen any day. 

CBC News visited to see the new BioFire testing process, which the government announced was ready for use this week, and to learn how staff are taking precautions with personal protective equipment. 

If the vial Gauthier is working with was a COVID-19 sample, there would be a cotton swab in the vial with the patient's sample, placed in the coloured liquid, and then put into the cartridge. 

Once that cartridge is in the BioFire machine, it takes 45 minutes to get results. If it's not COVID-19, the machine will say what respiratory illness a person does have, if any. A GeneXpert machine, which is also used for COVID-19 tests and tuberculosis detection, won't identify other illnesses. 

A liquid that has been in a vial with the swab is put into a cartridge like this one. (Travis Burke/CBC)

More 'back-up' ventilators arrived 

Upstairs, in the respiration centre of the hospital, respiratory therapist Colleen Herley explains what ventilators Nunavut has. 

There are 12: some are big, others are small and portable. 

Previously, health staff said Nunavut had seven respirators, but five smaller "back up" respirators are on hand as well. They could be sent to communities if there is an outbreak. 

Dr. Francois de Wet, chief of staff for Nunavut's Department of Health, says anyone sick enough to need a ventilator can't stay in the territory. 

Dr. Francois de Wet is territorial chief of staff for Nunavut's Department of Health. He says hospitals in the South are prepared to take patients from the territory if there is an outbreak of COVID-19. (Beth Brown/CBC)

"Our go-to with COVID-19 has been to try, once we have identified a patient who is sick, sick enough to be in a hospital, that we are going to transfer that patient to one of our southern partners," he said. 

"Both the Ottawa hospital and the Winnipeg Regional Health Authority have done a lot of work to prepare for the first wave that we're still in right now." 

Patients could also be flown to Yellowknife. De Wet said he's not concerned about a lack of space in southern hospitals for Nunavut patients. 

Respiratory therapist Colleen Herley says this would be the main ventilator used at the hospital if one was needed for a COVID-19 patient. (Travis Burke/CBC)

A 'clean' side and 'dirty' side

Because the Iqaluit hospital is small, it doesn't have space to isolate a lot of patients. Any COVID-19 patient would be kept in a single bedroom to isolate. 

The hospital is working to keep a "clean" and a "dirty" side within its primary spaces. That means, places where the hospital acts like there could be COVID-19, and places where no one in contact with COVID-19 patients would go.

Right now, that means the maternity ward is screened off from regular traffic using white dividers, to keep mothers and babies safe. 

There are five small ventilators like this one. (Beth Brown/CBC)

In the emergency ward, whenever an unconscious patient is coming in, health staff are relying on paramedics to call in advance so the nurses have time to put on their added personal protective equipment. 

It takes time to put on the safety equipment, but de Wet says this communication helps avoid delays in response times to patients. 

Anyone who needs to be resuscitated is treated as if they could have COVID-19, de Wet said. 

"Resuscitation has been identified as one of the highest risk procedures that we perform in a hospital because of the close contact with the patient, as well as the ability to generate droplets while you're doing resuscitation," he said. 

Health staff have done drills to practise using the added personal protective equipment. There is also a person tasked with making sure the safety gear is being used correctly during an emergency. 

"The highest risk of contaminating yourself is actually in taking it off," de Wet said.

These hospital dividers are being used to screen off the maternity ward. (Travis Burke/CBC)

No N-95 masks thrown away

In case of a shortage, all N-95 masks used at the hospital are being kept and sanitized to use again. Staff put their names on the masks. 

"The person that used the mask originally would be the same person that it goes back to," de Wet said. 

An N-95 mask can be sanitized up to three times, "after that we're not sure that it's safe," he explained.

For regular hospital appointments, the clinic side of the hospital is closed off and being treated like a separate building, so you can't walk into the clinic and through to the emergency ward anymore. The hospital cafeteria is also closed to the public. 

A lot of appointments are being moved to Telehealth, which uses video conferencing to connect patients with health-care providers. In communities, health staff can now video chat with doctors in Iqaluit. 

Another BioFire machine is expected to be ready for use in Rankin Inlet next week, the health department said.

It's doing a pilot project in hopes to get test results between three and five days for all Baffin communities.

N-95 masks are sanitized in a machine like this one. They will only be reused if there is a shortage. (Travis Burke/CBC)


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