Multidimensional dynamic healthcare personnel (HCP)-centric model from a low-income and middle-income country to support and protect COVID-19 warriors: a large prospective cohort study

Abstract

ObjectivesHealthcare personnel (HCP) are at an increased risk of acquiring COVID-19 infection especially in resource-restricted healthcare settings, and return to homes unfit for self-isolation, making them apprehensive about COVID-19 duty and transmission risk to their families. We aimed at implementing a novel multidimensional HCP-centric evidence-based, dynamic policy with the objectives to reduce risk of HCP infection, ensure welfare and safety of the HCP and to improve willingness to accept and return to duty.SettingOur tertiary care university hospital, with 12 600 HCP, was divided into high-risk, medium-risk and low-risk zones. In the high-risk and medium-risk zones, we organised training, logistic support, postduty HCP welfare and collected feedback, and sent them home after they tested negative for COVID-19. We supervised use of appropriate personal protective equipment (PPE) and kept communication paperless.ParticipantsWe recruited willing low-risk HCP, aged <50 years, with no comorbidities to work in COVID-19 zones. Social distancing, hand hygiene and universal masking were advocated in the low-risk zone.ResultsBetween 31 March and 20 July 2020, we clinically screened 5553 outpatients, of whom 3012 (54.2%) were COVID-19 suspects managed in the medium-risk zone. Among them, 346 (11.4%) tested COVID-19 positive (57.2% male) and were managed in the high-risk zone with 19 (5.4%) deaths. One (0.08%) of the 1224 HCP in high-risk zone, 6 (0.62%) of 960 HCP in medium-risk zone and 23 (0.18%) of the 12 600 HCP in the low-risk zone tested positive at the end of shift. All the 30 COVID-19-positive HCP have since recovered. This HCP-centric policy resulted in low transmission rates (<1%), ensured satisfaction with training (92%), PPE (90.8%), medical and psychosocial support (79%) and improved acceptance of COVID-19 duty with 54.7% volunteering for re-deployment.ConclusionA multidimensional HCP-centric policy was effective in ensuring safety, satisfaction and welfare of HCP in a resource-poor setting and resulted in a willing workforce to fight the pandemic.

Perception and Challenges of Preventive Measures of COVID-19 Among Nepalese Frontline Health Professionals: An Unexplored Realism

“…About two-thirds (72.4%, n = 176) of the participants said they faced challenges at all levels (personal, institutional, technology, and policy) in adopting the change in health strategy amended due to COVID-19. The government (MOHP) should take this as a matter of seriousness and support the frontline HCPs in a more effective implementation model ( 34 ). Telemedicine and digital health service delivery are considered a boon for the health system, specifically in conditions like the COVID-19 pandemic ( 35 ).…”

Personal protective equipment implementation in healthcare: A scoping review

“…Study settings were mainly hospitals. 18,20−26,28, 30,31,33,37−39,43,47−52,55,56,59−64,67,68,70,71,73,74,79,80,82−84,86−89 Methods most frequently used to collect and report data were intervention proposals, 22,25,37,39,40,47,48,54,57,59,65,66,[70][71][72]74,76,80,82,85,86,89,90 surveys, 18 −21,24,26,41,45,46,51,58,61,68,69,79,81,83 practices/actions implementation description 31,32,36,[42][43][44]49,63,78,87,88 and interviews, 23,27,28,[33][34][35]38,50,52,55,56,60,62,…”

“…69,70 Implementation interventions: To improve personal well-being and minimize adverse effects of PPE both HF and HW should co-design and co-produce implementation and sustainability strategies. Adjustments in the duty area like temperature control, 23 improvement ventilation in the building, 69 and limiting time spent in the clinical zone 23,35 are recommended. In addition, comfort should be taken into consideration when PPE is selected and purchased.…”

“…35 Education was reported to reduce unnecessary PPE use and waste. 47 PPE reprocessing systems can be operated during extreme conditions 22,23,35,51,77,81 with improved implementation of PPE stock control and supply procedures. 51,52 Identification and tracking of reprocessed PPE and return to stock and entry into the HF inventory was advised.…”

Lessons from the frontline: The COVID-19 pandemic emergency care experience from a human resource perspective in the Pacific region

“…‘Healthcare personnel-centric’ COVID-19 care policies – aiming to reduce risk of HCW infection, ensure HCW welfare and safety, and improve HCW willingness to present for duty – are lauded as complementing traditional ‘patient-centric’ pandemic management approaches. 5 Reports from Africa, 6 the Middle East, 7 , 8 Asia 9 , 10 , 11 and Latin America and the Caribbean 12 , 13 , 14 reinforce how HCWs operating in diverse systems and settings are putting their physical and mental health and wellbeing – and lives – on the line to counter COVID-19 outbreak, transmission, morbidity and mortality in local populations. The ethical, place-based tensions, stigma, and moral conflict overstretched HCWs face are increasingly documented.…”