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   Table of Contents      
ORIGINAL ARTICLE
Year : 2021  |  Volume : 7  |  Issue : 2  |  Page : 115-119

Impact of COVID-19 on the Work Performance of Healthcare Workers in Neurosurgery Operation Theater at a Tertiary Care Institute: A Pilot Study


1 Department of Neurosurgery, GB Pant Institute of Postgraduate Medical Education & Research (GIPMER), New Delhi, India
2 Neurosurgery Operation Theatre, GB Pant Institute of Postgraduate Medical Education & Research (GIPMER), New Delhi, India

Date of Submission07-Mar-2021
Date of Decision24-May-2021
Date of Acceptance03-Jun-2021
Date of Web Publication27-Aug-2021

Correspondence Address:
Dr. Katyal Abhishek
GB Pant Institute of Postgraduate Medical Education & Research (GIPMER), New Delhi-110002
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mamcjms.mamcjms_30_21

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  Abstract 


Background: The novel corona virus disease 2019 (COVID-19) pandemic had a massive impact on healthcare systems, increasing the risks of psychologic distress in health professionals in response to chronic emotional and interpersonal stressors on the job; especially associated with surgical care. Aims and Objectives: To assess the impact of COVID-19 on the psychologic health and work performance of healthcare workers (HCWs) in operation theaters (OTs). Methodology: A questionnaire-based survey study was conducted among health professionals associated with neurosurgery OT. Results: Sixty-five HCWs (including doctors, nursing staff, and other HCWs) participated in the survey. The fear of spread of COVID-19 infection to family members was found in majority of HCWs especially nursing staff (96%). The fear of COVID-related death was least among the other HCWs (8%). Majority of the HCWs followed COVID protocols at work place. Transportation issues were a major complaint by other HCWs (67%), whereas majority of the HCWs (71%) were of the opinion that donning and doffing practices affected their daily work routine. Conclusion: Fears and stigmas associated with COVID −19 had an impact on the psychosocial health of HCWs in the neurosurgery OT and affected their workplace performance.

Keywords: COVID-19, healthcare workers, mental health


How to cite this article:
Abhishek K, Parth M, Neeraj R, Daljit S. Impact of COVID-19 on the Work Performance of Healthcare Workers in Neurosurgery Operation Theater at a Tertiary Care Institute: A Pilot Study. MAMC J Med Sci 2021;7:115-9

How to cite this URL:
Abhishek K, Parth M, Neeraj R, Daljit S. Impact of COVID-19 on the Work Performance of Healthcare Workers in Neurosurgery Operation Theater at a Tertiary Care Institute: A Pilot Study. MAMC J Med Sci [serial online] 2021 [cited 2021 Nov 30];7:115-9. Available from: https://www.mamcjms.in/text.asp?2021/7/2/115/324741




  Introduction Top


In modern history, the novel corona virus disease 2019 (COVID-19) has emerged as an unprecedented international public health emergency. There has been a widespread media coverage and several directives and advisories by the government to control the spread. COVID-19 has generated fears and also had an impact on social practices. Adherence to the government directives and public perspective is a challenge more among the healthcare workers (HCWs). Due to the increased risk of exposure to the virus especially during intubation and surgical procedures, the frontline doctors, nurses, and HCWs have increased fear of contracting COVID-19 themselves and transmitting the disease to family members. These thought processes along with the physical limitations associated with the usage of personal protective equipment (PPE) for long periods have resulted in subsequent physical and mental fatigue.

With this background, the present survey was conducted to assess the perspective and behavior of HCWs in the neurosurgery operation theater (OT) and their adherence to the government directives in COVID-19 period.


  Materials and Methods Top


After approval from the departmental scientific committee, a questionnaire-based study was conducted involving the HCWs associated with the neurosurgery OT at our tertiary care center over a period of 2 months (July and August 2020). The participants were divided into three categories, viz., doctors, nurses, and other HCWs (including OT technicians, nursing orderly, and OT sweepers). The convenient sample size comprised of 85 HCWs associated with neurosurgery OT; however, 65 HCWs who reverted back to the questionnaire were included in the study (including 25 doctors, 28 nursing staff members, and 12 other HCWs). A structured questionnaire in the form of hard copy was circulated among the participants of the study [Table 1]. As it was a survey of HCWs, a response was taken as an implied or implicit consent. The participants were explained about the intent of the survey and an assurance was given that strict anonymity and confidentiality of data will be maintained. The questionnaire had five question domains with subcategories, viz., fears related to COVID-19 (subcategorized as fear of self-infection, family spread, hospitalization, vaccination, and death). Fear of vaccination was prior to the launch of vaccination program in India. Other question domains that were asked were those related to social effects of COVID-19, practicing COVID discipline (at work place and home), how the day to day activities were affected by donning doffing practices and question regarding availability of PPE kits. The responses were recorded as Yes/No/Can’t say/Special comments (if any).
Table 1 Questionnaire used in the survey

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  Results Top


A total of 65 responses were received during the period of data collection, all of which were included in the survey. Out of these, there were 25 doctors, 28 nurses, and 12 other HCWs. The results were based on the positive responses given by the participants [Table 2],[Table 3],[Table 4],[Table 5],[Table 6].
Table 2 Fears associated with COVID-19 among the healthcare workers

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Table 3 The impact of COVID-19 on the social life of healthcare workers

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Table 4 The COVID-19 discipline of healthcare workers

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Table 5 Issues associated with donning/doffing techniques

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Table 6 Issues associated with usage of personal protective equipments

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Regarding the fears and stigma associated with COVID-19, the fear of spread to family members was found in majority (88%) of all the HCWs; the fear being maximum among the nursing staff (96%). The fear of COVID-related death was least among the other HCWs (8%), when compared with doctors (48%) and nurses (46%). This was rather surprising to us. Plausible explanation to this can be the ignorance of severity and impact of COVID-19 among other HCWs.

About 48% of the HCWs complained of transportation problems faced by them; however, it was the major issue faced by other HCWs (technicians, etc.) (67%). Family members getting infected was the issue which least affected the social life of HCWs (28%).

Majority of the HCWs (89%) followed COVID discipline and protocols at work place. Strict COVID discipline at work place was followed maximally by other HCWs (92%), whereas that at home was followed maximally by nursing staff (86%).

Majority of the HCWs (71%) were of the view that donning and doffing practices affected their daily work routine. Hesitancy in following donning/doffing practices was observed mainly in the nursing staff subgroup (71%). Probable reasons for this as quoted by the participants were poor quality of PPEs initially leading to excessive discomfort associated with sweating, dehydration, suffocation, poor visibility with face shields, and goggles, size issues of PPE kits and episodes of fainting (if worn for long periods of time).

About 24% of the HCWs held the opinion that they had shortage of PPE kits in the hospital. The opinion was shared by minority of doctors (28%) and nursing staff (29%).


  Discussion Top


Along with the general population, the HCWs are also at an increased risk of physical and psychosocial distress during this pandemic. The greatest fears observed among the health professionals in this study were those of self COVID infection and its spread to the family members. The increased anxiety and psychologic stress have greatly affected the surgical practice where the decisions have to be made fast including surgical management and decisions to postpone the procedures when a patient or staff test positive; all these while being on limited resources.[1] In view of the lockdown imposed by the Government of India, and restricted traffic protocols, the major issue faced by the HCWs was transportation difficulties to reach the hospitals. This along with issues such as COVID-related morbidity or mortality in family or friends or neighborhood also had an impact on the social and psychologic mental status of HCWs. In the early rapid expansion phase of the severe acute respiratory syndrome outbreak, similar to the current course of COVID-19 pandemic, healthcare professionals reported feelings of extreme vulnerability, uncertainty, and threat to life, alongside somatic and cognitive symptoms of anxiety.[2]

Strict COVID discipline was followed and government-directed guidelines were adhered to by majority of the HCWs at our tertiary care institute. Similar observations were made by Banerjee and Banerjee in their study where majority of the participants throughout the country had awareness regarding COVID-19 and government-directed protocols were adequately followed.[3] Their findings, however, were based on general population. There was hesitancy noted in the initial phase related to donning and doffing techniques among the HCWs predominantly in the nursing staff. Probable reasons behind this maybe discomforts related to PPE kits in the initial phase and fears or stigmas associated with unintentional breach in the biosafety protocols in the HCWs. The donning/doffing practices, however, improved with due course of time with adequate training and orientation programs carried out for the HCWs associate with OTs. Details regarding possible faults in the donning/doffing techniques were identified by Mumma et al.[4] and their recommendations were helpful in training programs at institute. These techniques along with regular usage of PPE kits affected the daily work routine of HCWs especially doctors due to increased physical exhaustion owing to increased sweating, poor visibility due to mandatory use of face shields and protective goggles as well as difficulty in breathing associated with PPEs[5]; hence making it difficult for them to carry out prolonged surgeries. Increased episodes of burnouts can contribute to surgeon fatigue and can pose difficulty in safe use of high-speed electronic drills which are commonly used in neurosurgical practice. Similar observations of increased physical and emotional burnouts among the HCWs in the COVID-19 era have been made by Khasne et al. in their study.[6]

It is important to highlight the emotional and psychosocial issues associated with health professionals involved in surgical care. The need for psychoeducation, counseling, and regulated working hours for HCWs cannot be overemphasized. Moreover, it is imperative to provide training and demonstration programs for complex donning/doffing techniques. It is suggested to prioritize acute cases, postponement of chronic elective cases with adequate time allocation between two surgical cases to avoid undue physical exertion on HCWs. Institutional online support group meetings involving psychologists can be organized periodically, where the HCWs are free to express their opinions and their psychologic issues related to COVID-19 can be discussed.

The study had a few limitations. It was a pilot study with a small sample size conducted at the level of a single tertiary care institute and involved only the HCWs associated with neurosurgery OTs. The observations, however, corroborated with other studies conducted at larger levels.


  Conclusion Top


Based on the observations of the study, it is notable that majority of the HCWs have awareness regarding the COVID protocols and COVID discipline was strictly followed. The fears most commonly encountered by HCWs during the pandemic times were those of self-infection and spread to family members which affected their social and professional lives. Adherence to biosafety techniques associated with PPE kits also affected the work ethics of HCWs. Hence, adequate strategies focusing on improving physical, mental, and social wellbeing of HCWs need to be incorporated for optimum patient care in COVID times. The above said observational findings are not extensive enough to provide conclusive results; however, they can serve as supporting groundwork for further studies conducted at larger levels to formulate COVID-19-related policies and guidelines.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Tsamakis K, Rizos E, Manolis AJ et al. COVID-19 pandemic and its impact on mental health of healthcare professionals. Exp Ther Med 2020;19:3451-3.  Back to cited text no. 1
    
2.
Chong MY, Wang WC, Hsieh WC et al. Psychological impact of severe acute respiratory syndrome on health workers in a tertiary hospital. Br J Psychiatry 2004;185:127-33.  Back to cited text no. 2
    
3.
Banerjee R, Banerjee B. Public perspective and adherence to government directives in the face of COVID-19 situation in India. MAMC J Med Sci 2020;6:90-6.  Back to cited text no. 3
  [Full text]  
4.
Mumma JM, Durso FT, Casanova LM et al. Common behaviors and faults when doffing personal protective equipment for patients with serious communicable diseases. Clin Infect Dis 2019;69(Suppl 3):S214-20.  Back to cited text no. 4
    
5.
Ornell F, Halpern SC, Kessler FHP, Narvaez JCM. The impact of the COVID-19 pandemic on the mental health of healthcare professionals. Cad Saúde Pública 2020;36:e00063520.  Back to cited text no. 5
    
6.
Khasne RW, Dhakulkar BS, Mahajan HC, Kulkarni AP. Burnout among healthcare workers during COVID-19 pandemic in India: results of a questionnaire-based survey. Indian J Crit Care Med 2020;24:664-71.  Back to cited text no. 6
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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