Taking A Multi Pronged Approach to Healthcare worker Safety During Covid -19

As the SARS-CoV-2 outbreak continues healthcare workers (HCW) continue to play a crucial role in the diagnosis and treatment of Covid- 19 positive persons. In many countries, including Jamaica, healthcare workers have also become infected by the virus. This underscores the need for measures to be taken in order to limit the number of HCWs who become infected at work. 

Infected HCWs decrease the response of the public health system to provide service during the Covid- 19 pandemic. As many health facilities across the world are already understaffed, human resource has become a scarce commodity in need of appropriate protection methods. 

When the outbreak first started in Wuhan, China, early incidences of HCW infections were thought to be due to inadequate protection, as the virus was new and not completely understood. Several months have passed and there are now many international guidelines and recommendations on preventing HCW Covid- 19 infections. 

Occupational Safety and Health plays a key role in protecting HCWs. The World Health Organization has identified multifactorial hazards that put HCWs at risk of Covid- 19, these include exposure to the pathogen, long work hours, psychological distress, occupational burnout, stigma and physical and psychological violence. This then highlights the point, that protecting HCWs goes beyond just having adequate personal protective equipment (PPE) but also using a model that considers the HCW as a whole person. 

Responsibility is placed on employers and employees in the prevention of Covid- 19 infection. Each healthcare facility requires protocols that are evidence based and up to date to properly protect staff. In a Journal of Hospital Infection article entitled ‘Preventing the Transmission of Covid- 19 Amongst Health Care Workers’ by L.F. Tan, it references Singapore’s policies. Travel is discouraged and HCWs that do travel must quarantine for 14 days, screening and reporting is done twice daily. No one is allowed to work with respiratory symptoms and given a minimum of 5 days sick leave. Covid- 19 and non covid- 19 teams are separated and there are designated clean and covid contact areas. This is an admittedly strict guideline adopted by them, and serves as an example of what can be done- however each place must understand the context of their staffing limitations and number Covid- 19 infections in their country. 

The World Health Organization and Centres for Disease Control and Prevention have both put out guidelines and recommendations that aim to capture all possible realities- especially for developing countries. Infection Prevention and Control Committees also play a crucial role in balancing the needs of the country and the needs of HCWs. 

Prevention of HCW Covid – 19 infection is a multi pronged approach. HCWs will need, not only adequate PPE, but also proper training on its use. Clinical staff must be fit tested for appropriate respirators. As shortages are global, recommendations on how to maximise on PPE will have to be taken seriously. The CDC offers a PPE Burn Rate Calculator so that healthcare facilities can be aware of their PPE use as well as how it can be reduced. 

Staff should be screened and encouraged to call in if they are unwell. Adequate space should be given for social distancing, especially in changing areas and break rooms. Universal use of PPE, where at minimum there is eye, nose and mouth protection, should be enforced. 

While staff shortages is a real problem, the mental wellbeing of physicians should be prioritised. Burnout can cause more harm than good to both the HCW and the public health system, as it can lead to substandard care, resignations, accidents and self harm. HCWs must continue to have appropriate breaks while working. 

When a HCW does become positive for covid 19, there needs to be a clear algorithm that is followed. Testing and results for HCWs become prioritised as to prevent understaffing as best as possible. This is also the time to look at the risk assessments and see what pitfalls occurred and how they can be addressed. 

Universal precautions, proper PPE use and social distancing remain the best ways to prevent Covid- 19 infections. And continue to be used in the World Health Organization and Centres for Disease Prevention and Control guidelines and recommendations. The use of which PPE and where should be clear, up to date and evidenced based. HCWs, especially clinical staff, should avoid using cloth masks as their means of source control and should only engage with patients and their relatives/ guardians once they also have source control with a mask, unless one cannot be tolerated. Distance should be maintained between patients and workers, as well as, between each other in the work place. Consideration should be given to having separate teams and designated clean and covid- 19 areas.

Administration and senior staff must focus greatly on staff morale at this time, and create a space where HCWs can openly voice their concerns and suggestions, as well as, be able to maintain a healthy physical and mental wellbeing. 

Samantha C. Johnson

References and additional resources

 WHO. (n.d.). CORONAVIRUS DISEASE (COVID-19) OUTBREAK: RIGHTS, ROLES AND RESPONSIBILITIES OF HEALTH WORKERS, INCLUDING KEY CONSIDERATIONS FOR OCCUPATIONAL SAFETY AND HEALTH (Publication). Retrieved https://www.who.int/docs/default-source/coronaviruse/who-rights-roles-respon-hw-covid-19.pdf?sfvrsn=bcabd401_0

 WHO. (n.d.). CORONAVIRUS DISEASE (COVID-19) OUTBREAK: RIGHTS, ROLES AND RESPONSIBILITIES OF HEALTH WORKERS, INCLUDING KEY CONSIDERATIONS FOR OCCUPATIONAL SAFETY AND HEALTH (Publication). Retrieved https://www.who.int/docs/default-source/coronaviruse/who-rights-roles-respon-hw-covid-19.pdf?sfvrsn=bcabd401_0

 Center for Disease Prevention and Control. (2020, July 15). Interim Recommendations for Emergency Medical Services (EMS) Systems and 911 Public Safety Answering Points/Emergency Communication Centers (PSAP/ECCs) in the United States During the Coronavirus Disease (COVID-19) Pandemic. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-for-ems.html

 Wang, J., Zhou, M., & Liu, F. (2020). Reasons for healthcare workers becoming infected with novel coronavirus disease 2019 (COVID-19) in China. The Journal of hospital infection, 105(1), 100–101. https://doi.org/10.1016/j.jhin.2020.03.002 

Optimising PPE PPE Burn Rate Calculator by CDC