ICU Beset by Strep Throat, Other Respiratory Infections

landspítali hospital

A wave of serious strep throat infections combined with other respiratory infections has brought the intensive care unit to a breaking point, RÚV reports. The ICU has not seen as many inpatients since the beginning of the coronavirus pandemic.

Headed towards a state of emergency

There are as many patients at the National University Hospital’s intensive care unit today as there were during the pandemic, RÚV reports. A senior physician told the National Broadcaster that the ICU was headed for a state of an emergency; respiratory infections, such as strep throat (an infection of the upper respiratory tract, caused a bacterium known as Streptococcus pyogenes), have run rampant recently.

As of yesterday, 19 patients were staying in the intensive care unit (22 were staying in the ICU at its peak last weekend). There are only fourteen beds. The ICU has not seen such numbers for a long time.

“Not since the first wave of COVID-19,” Kári Hreinsson, Manager of Surgery, Anaesthesia, and Intensive Care Services at Landspítalan Hospital, told RÚV yesterday. “It’s been close in the past, with nearly 20 patients in total, but we’ve not exceeded these numbers.” He emphasised that none of this would have been possible were it not for the diligence and hard work of the staff.

Kári points out that a state of emergency was declared when 27 people were admitted to the intensive care unit with COVID-19. He says that it has been discussed whether a state of emergency needs to be declared, but the situation has not yet become that bad.

“This is not something that passes in two or three days, this respiratory infection epidemic that has been going on for quite some time and we don’t quite see it coming to an end yet.”

A series of serious streptococcal infections, in combination with the other respiratory infections that seem to be spreading throughout society, has added insult to injury.

“It makes for a much more dangerous disease and more difficult to treat,” Kári stated.

When there are not enough beds, intensive care patients are transferred to the post-surgical care unit (vöknunardeild). When asked if this affected other patients or elective surgeries, Kári stated that this was not the case yet. “But it’s something that could happen in the next few days.”

Sixteen Middle Managers at Landspítali Hospital Dismissed

Landspítali

Sixteen middle managers employed at the National University Hospital of Iceland received letters of termination yesterday, RÚV reports. The terminations stem from the adoption of a new organisational chart intended to improve the hospital’s operations.

Improved service, efficiency

A new organisational chart will come into effect at the National University Hospital on January 1. According to director Runólfur Pálsson, the organisational chart is intended to simplify the hospital’s operations and make them more efficient.

“The main purpose is to get a handle on the hospital’s management and operations, to strengthen our clinical services, and to harmonise other key services,” Runólfur remarked in an interview with RÚV. Over the past months, questions concerning the sustainability of the hospital’s operations have come to the fore.

When asked if these changes would be felt by the public, Runólfur replied: “I hope it’ll translate into a stronger hospital, that we’ll be able to improve our service: improve our emergency services, the flow of patients while also strengthening our surgical department. If we’re successful in this regard, then the public will certainly feel it.”

The hospital’s organisational chart was introduced to the Minister of Health today. The changes imply a decrease in the number of middle managers and increased responsibility among front-line managers. “Six directorial positions will be cut, but there are two positions that are bound by law, namely the directorship of nurses and medicine – but the other six will be cut alongside all of the ten managerial positions,” Runólfur remarked.

As reported by RÚV, the sixteen individuals holding the aforementioned positions received a letter of notice yesterday. Runólfur added that because the organisational chart had yet to be implemented, it remained to be seen whether it would result in increased efficiency.

“These are big changes, and we must be aware that changes to the organisational chart, in themselves, are not enough to improve our output – there are other things that must work out as well,” Runólfur stated. “But the purpose of these changes is to get a better handle on and harmonise our clinical services. In the near future, we will aim to overhaul all of the clinical organisational units in the front line and strengthen its management affording them greater responsibility.”

Patients Wait in Ambulances Due to Lack of Beds in ER

All of the beds in Landspítali’s emergency room at Fossvogur were full on Friday night, forcing patients to wait in ambulances until beds became available in the ER, RÚV reports.

According to the duty officer at the Metropolitan Fire Department, which also oversees capital-area ambulance transportation, it’s not unusual for patients to wait for a bed in the ER, although the duty officer was careful to say that Friday’s situation is not a common problem. Rather they stressed that paramedics provide patient care to those waiting to be admitted to the ER and room is always made for priority patients.

See Also: Mass Resignations at the University Hospital

Fourteen nurses resigned from the ER at the end of August, largely due to stress within the department.

According to Soffía Steingrímsdóttir, who was an ER nurse at the Landspítali for almost eight years, the resignations were “a long time coming. We’ve been trying to call attention to stressful work conditions and the threat to the safety of our patients for years now. Over these past two years, especially – when conditions have been unacceptable.”

At the time, hospital director Runólfur Pálsson said that hospital administrators would do everything in their power to reverse this trend. “The work conditions are extremely difficult. There’s a lot of stress, which means that people resign, which leads to staff shortages, which makes things even more difficult. It’s a vicious cycle that we’ve been trying to break.”

On Friday, nurse and assistant head of the ER Hildur Dís Kristjánsdóttir weighed in, saying the ER didn’t need to employ as many nurses as it previously did, as there are fewer patients being admitted on a regular basis.

As of September 1, the hospital’s stated goal is that no more than 20 patients should be in the ER at any one time.

Mass Resignations at the University Hospital

landspítali hospital

Fourteen emergency-room nurses completed their final shift at the National University Hospital of Iceland (Landspítali) yesterday, RÚV reports. The departures are “a cause for worry,” Director Runólfur Pálsson stated, although he remains confident that brighter days lie ahead.

“A long time coming”

Speaking to RÚV yesterday, Soffía Steingrímsdóttir, who’s been employed as an emergency room nurse at the National University Hospital (Landspítali) for almost eight years, explained why she and 14 of her colleagues had decided to quit their jobs:

“It’s been a long time coming. We’ve been trying to call attention to stressful work conditions and the threat to the safety of our patients for years now. Over these past two years, especially – where conditions have been unacceptable.”

According to Soffía, the 14 nurses who completed their final shifts yesterday will not be easily replaced; experience and competence only come with time. A similar number of resignations are expected to be tendered next month.

Trying to break the vicious cycle

Speaking to RÚV, Runólfur Pálsson, Director of the National University Hospital, stated that hospital administrators would do everything in their power to reverse this trend. “The work conditions are extremely difficult. There’s a lot of stress, which means that people resign, which leads to staff shortages, which makes things even more difficult. It’s a vicious cycle that we’ve been trying to break.”

Runólfur stated that he was hopeful that resources designed for patients who have completed treatment at the hospital but cannot leave on account of disabilities would help lighten the load: “And we’ve been waiting for hospital and rehabilitation rooms, which we hope will be available in September. We have high expectations for these new facilities. They will help lighten the emergency room’s load.”

Soffía stated that the nurses were sad and disappointed that no measures were taken in response to their resignations: “I certainly hope that I haven’t completed my last shift at the emergency room, that I’ll return when an acceptable work environment has been created.”

Common for Children to be Admitted to Hospital with Nicotine Poisoning

There are several cases a week of children being admitted to the hospital with nicotine poisoning after ingesting nicotine pouches, RÚV reports. Ragnar Grímur Bjarnason, chief physician at the Children’s Hospital, says most poisonings occur at home and many parents don’t realise that nicotine is a strong toxic chemical that can have much more serious consequences for children than adults.

Snus, a moist tobacco powder, is illegal in Iceland, but nicotine pouches are very similar. These are small, hand-or premade sachets filled with loose tobacco powder and then held between the upper lip and the gum for extended nicotine release. Although cigarette smoking has declined in Iceland, nicotine pouches have seen an increased popularity in recent years, particularly among young people. In 2021, nearly a third of Icelanders aged 18-34 were using nicotine pouches on a daily or nearly daily basis.

See Also: Health Minister Presents Bill to Regulate Nicotine Pouch Sales

Nicotine poisonings among children are not a new phenomenon, says Ragnar Grímur. “Naturally, when everyone was vaping, the oils were being left out all over the place. They smelled good and were pretty colours. So at that time, we were getting a lot of those poisonings. They’re also flavoured and taste much better than cigarettes in an ashtray, which was the main cause of [nicotine] poisoning a few decades ago.”

Nicotine poisoning is very serious for children and can necessitate intensive care or even be life-threatening.

“Most people who have tried nicotine know what the most common reactions are,” says Ragnar Grímur. “There’s nausea, vomiting, dizziness, and discomfort. But in children, it can also have very serious effects on the central nervous system.”

Baby Boom in North Iceland

baby swimming

Almost 500 babies were born in the Akureyri Hospital in North Iceland last year. RÚV reports that this is an increase of nearly 26% from the year before. The announcement was made at the hospital’s annual meeting this week. There was a general increase in patient numbers: Akureyri Hospital treated 13,500 patients in 2021, up 22% from the year before.

In 2021, there were precisely 491 babies born in 488 births (three sets of twins) at Akureyri Hospital. In 2020, by contrast, there were 397 babies born in 392 births (that year, five sets of twins). This makes 2021 Akureyri’s second-most fruitful year on the books; the current record for most babies born in Iceland’s ‘capital of the north’ in one year is 515 babies in 2010.

Births were up in the actual capital as well, but not nearly as much. In 2021, 3,466 babies were born at Reykjavík’s National and University Hospital, which is just 5% over the previous year’s rate.

Akureyri Hospital CEO Hildigunnur Svavarsdóttir says the reason for the jump in birth numbers is difficult to determine with any certainty, although she readily concedes to the winking supposition that “people got bored during COVID.”

“That’s one explanation for sure, and a lot of people are giving each other knowing smiles,” she remarked. “But I have no explanation for it—I just think it’s a really joyous thing. We could do with more of us up here.”

Increase in COVID Admissions, But Infections Much Milder

Iceland National Hospital COVID-19

As many as 150 new cases of COVID-19 are being diagnosed every day in Iceland and the number of patients admitted to the hospital for COVID infection is also rising incrementally, RÚV reports. While there are a considerable number infections all throughout Iceland, however, Chief Epidemiologist Þórólfur Guðnason says that fortunately, these cases are much, much milder amongst those who are vaccinated.

Fortunate as well, says Þórólfur, is that the stress on Iceland’s health system is not nearly what it was at the height of the pandemic, when there were 88 patients in the COVID ward at once. There were only two people in Landspítali’s COVID ward at the start of May, which increased to nine patients on Thursday, and 16 on Friday. Admissions are mostly elderly patients and those with underlying conditions, but as the infections are not as acute, none of those currently in the hospital are on ventilators.

“There’s no doubt about it, of course we would have liked for the vaccine to prevent infection,” Þórólfur remarked. “It doesn’t do that, but what it does do, first and foremost, is prevent serious illness. If we didn’t have this widespread vaccination, particularly amongst older age groups, I think we’d have much worse infections and more people in the hospital.”

New Hospital Won’t Meet Bed-Demand, Report Finds

landspítali hospital

A new government report finds that the healthcare system will be significantly short of hospital beds by 2040, even with the new hospital opening on Hringbraut in Reykjavík. The Director of the new hospital hopes that the war in Ukraine won’t delay construction.

Demographic changes driving demand

On March 18, the Ministry of Health released a report on the future development of the National University Hospital of Iceland (Landspítali). The report, which was based on data from 2019, was predicated on analytical work done by the management consulting company McKinsey & Company.

Among the report’s main findings was that the need for hospital beds in Iceland is expected to rise by 80% by 2040. This need is driven mainly by demographic changes, with the average age in the country expected to increase by 9% and the total population expected to increase by 18% over the next 18 years.

Given these changes, the healthcare system would have only half of the needed hospital beds by 2040 if no significant actions were taken – even with the opening of the new hospital on Hringbraut (expected to open in 2026).

According to the report, the healthcare system can tackle the shortage by shifting long-term and primary care from Landspítali to “a more (sic) adequate healthcare setting.” The health authorities would need to create the equivalent of ca. 240 bed capacity in home-based, elderly, and rehabilitation-care facilities.

“We can’t lose any time”

In an interview with RÚV yesterday, Runólfur Pálsson, Director of the National University Hospital of Iceland, responded to the report by saying that “time was of the essence.”

“Everybody is familiar with the current facilities as far as hospital beds are concerned,” Páll observed. “Personnel shortage is also a growing concern. We should have acted sooner; the preparation time required for the construction of the new hospital was way too long.”

As noted on RÚV yesterday, the current conditions at Landspítali er still difficult, even with a decline in COVID-19 cases. There is a significant shortage of hospital beds. Every day, almost 30 people must wait in the emergency ward to be admitted into the hospital.

Furthermore, illnesses among staff, whether resulting from COVID-19 or influenza, have also made operations difficult. Many employees of the hospital have also gone on sick leave owing to work-related stress.

Construction, for the most part, “on schedule”

In an interview on Friday, Gunnar Svavarsson, Director of the New University Hospital on Hringbraut, stated that the construction of the new hospital was, for the most part, on schedule. The Russian invasion of Ukraine may cause a delay, however, as the contractors can no longer import steel from Russia.

“We hope there won’t be any delays,” Gunnar said. “As it stands, it’s looking pretty good. Some areas are behind schedule and others that are ahead of schedule.”