key: cord-352925-abry6oz3
authors: Lim, Jia Yin; Lie, Sui An; Yian, Ong Yee
title: Hardware versus heartware: The need to address psychological well-being among operating room staff during the COVID-19 pandemic
date: 2020-05-21
journal: J Clin Anesth
DOI: 10.1016/j.jclinane.2020.109891
sha: 
doc_id: 352925
cord_uid: abry6oz3

nan

Months into the coronavirus disease (COVID-19) pandemic, healthcare workers continue the fight against an increasing disease burden worldwide. This requires mental resilience and perseverance to function under challenging working conditions, sometimes with limited resources and risking personal safety. Operating rooms (OR) are high risk areas for respiratory viral transmission, given the emergent nature of some surgeries, multidisciplinary involvement, and performance of aerosol generating procedures such as airway manipulation and intubation. Outbreak response measures often focus on the "hardware" -implementing administrative, environmental and engineering controls, recommending infection control precautions, and appropriate use of personal protective equipment (PPE). [1] What often gets overlooked is the "heartware", such as addressing burnout, anxiety of perceived risks, moral injury [2] and the resultant long-term psychological impact that may impair performance and compromise staff and patient safety.

In a global health crisis, healthcare workers may react positively or negatively, depending on whether one views the crisis as a threat or a challenge. Each staff brings along their own personal experiences and training, and hence mental resilience, into their responses. This sets into motion diametrically opposed cascades of emotions, thoughts and behaviors that may result in either constructive or harmful responses. With a positive response, it enables one to act cautiously and direct all resources to remove the threat. On the other hand, with fear and anxiety of the unknown, individuals may act in extreme and perhaps irrational ways. This then leads to impaired executive function such as tunneled vision, tendency to errors and inability to make decisions. [3] These short-term responses may have long-lasting ramifications. As observed from a survey three years after the Severe Acute Respiratory Syndrome (SARS) experience in 2003, about 10% of healthcare workers reported post-traumatic stress (PTS) symptoms. Staff who had been quarantined, worked in high-risk locations or had friends and relatives who contracted SARS were two to three times more likely to develop high PTS symptoms. [4] In this current pandemic, a considerable proportion of healthcare workers in China reported symptoms of depression, anxiety, insomnia, and distress, signifying the need for psychological support or interventions. [5] With these in mind, we recognized the need to prepare our anesthesia department staff for the threat and associated challenges when managing COVID-19 patients. As part of a multidisciplinary team, we formulated anesthesia clinical care guidelines and workflows for safe perioperative care of COVID-19 patients. These were done in consultation with senior staff who have gone through the outbreaks of SARS, influenza A(H1N1) and the Middle East J o u r n a l P r e -p r o o f Respiratory Syndrome (MERS), adding to psychological reassurance. Effective ongoing communication, situation updates, education on COVID knowledge helped allay anxiety and uncertainty. We conducted process oriented in-situ simulation to identify and mitigate latent safety threats within the system. PPE and powered air purifying respirator (PAPR) failure drills helped enhance individual preparedness and allay uncertainty over effectiveness of protection. The presence of a COVID OR coordinator and buddy system of PPE checks during donning and doffing further safeguarded infection control measures and helped instill confidence among staff that their wellbeing is being looked after. Debriefs and discussions after every case served as a platform to discuss challenges (including emotional and social) of caring for the patient. At the hospital level, peer support programs and psychological support are also available.

Every staff is a valuable resource in this pandemic fight. It is important to have measures in place to safeguard their mental and physical wellbeing before they take a toll on the individual and the organization, as we continue to provide vital healthcare during this pandemic.

Infection prevention and control during health care when novel coronavirus (nCoV) infection is suspected

Managing mental health challenges faced by healthcare workers during covid-19 pandemic

Psychology of Crisis

The psychological impact of the SARS epidemic on hospital employees in China: exposure, risk perception, and altruistic acceptance of risk

Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease