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| EDITORIAL |
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| Year : 2020 | Volume
: 13
| Issue : 2 | Page : 61-63 |
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Safety of health-care workers during COVID-19 times
RB Nerli1, Shridhar C Ghagane2
1 Department of Urology, JN Medical College, KLE Academy of Higher Education and Research, (Deemed-to-be-University), JNMC Campus, Belagavi, Karnataka, India
2 Department of Urology, Urinary Biomarkers Research Centre, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, KLES Kidney Foundation, Belagavi, Karnataka, India
| Date of Submission | 30-Apr-2020 |
| Date of Acceptance | 28-May-2020 |
| Date of Web Publication | 23-Jun-2020 |
Correspondence Address:
Dr. Shridhar C Ghagane
Department of Urology, Urinary Biomarkers Research Centre, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, KLES Kidney Foundation, Belagavi - 590 010, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/kleuhsj.kleuhsj_119_20
How to cite this article:
Nerli R B, Ghagane SC. Safety of health-care workers during COVID-19 times. Indian J Health Sci Biomed Res 2020;13:61-3 |
As on May 20, 2020, 4,999,235 persons have tested positive for the coronavirus disease 2019 (COVID-19), and 325,125 have succumbed to the deceased; 1,970,686 have recovered across the globe, and in India, 106,886 tested positive and 3303 are deceased.[1] This has put the health-care workers at the forefront of the COVID-19 outbreak response and has exposed them to hazards that put them at risk of infection. Hazards include pathogen exposure, long working hours, psychological distress, fatigue, occupational burnout, stigma, and physical and psychological violence. The World Health Organization in its interim guidance (March 19, 2020) has defined the rights, roles, and responsibilities of health workers, including key considerations for occupational safety and health.[2]
| Rights, Roles, and Responsibilities of Health Workers, Including Key Considerations for Occupational Safety and Health | |  |
The rights of a health worker include the expectation that employers and managers in health facilities:[2]
- Assume overall responsibility to ensure that all necessary preventive and protective measures are taken
- Provide information, instruction, and training on occupational safety and health
- Refresher training on infection prevention and control (IPC)
- Use, putting on, taking off, and disposal of personal protective equipment (PPE)
- Provide adequate IPC and PPE supplies (masks, gloves, goggles, gowns, hand sanitizer, soap and water, and cleaning supplies)
- Familiarize personnel with technical updates on COVID-19 and provide appropriate tools to assess, triage, test, and treat patients
- Provide appropriate security measures as needed for personal safety
- Provide a blame-free environment in which health workers can report on the incidents
- Advise health workers on self-assessment, symptom reporting, and staying home when ill
- Maintain appropriate working hours with breaks
- Consult with health workers on occupational safety and health aspects of their work, and notify the labor inspectorate of cases of occupational diseases
- Allow health workers to exercise the right to remove themselves from a work situation that they have reasonable justification to believe presents an imminent and serious danger to their life or health, and protect health workers exercising this right from any undue consequences
- Not require health workers to return to a work situation where there has been a danger to life or health until any necessary remedial action has been taken
- Honor the right to compensation, rehabilitation, and curative services for health workers infected with COVID-19 following exposure in the workplace – considered as an occupational disease arising from occupational exposure
- Provide access to mental health and counseling resources, and
- Enable cooperation between management and health workers and their representatives.
At the same time, health workers should:[2]
- Follow established occupational safety and health procedures
- Avoid exposing others to health and safety risks
- Use provided protocols to assess, triage, and treat patients
- Treat patients with respect, compassion, and dignity
- Maintain patient confidentiality
- Swiftly follow established public health reporting procedures
- Provide or reinforce accurate IPC and public health information, including too concerned people who have neither symptoms nor risk
- Put on, use, take off, and dispose of PPE properly
- Self-monitor for signs of illness and self-isolate and report the illness to managers, if it occurs
- Advise management if they are experiencing signs of undue stress or mental health challenges that require supportive interventions, and
- Report to their immediate supervisor any situation which they have reasonable justification to believe presents an imminent and serious danger to life or health.
| Personal Protective Equipment | | |
IPC measures include, among other measures: hand hygiene, PPE, and waste management materials. The protective equipment consists of garments placed to protect the health-care workers or any other persons to get infected. These usually consist of standard precautions: gloves, mask, and gown. If it is blood or airborne high infections, it will include face protection, goggles and mask or face-shield, gloves, gown or coverall, head cover, and rubber boots [Figure 1].
| Precautions for Intubating Patients in Coronavirus Disease 2019 Times | | |
The safety of the patient and the individuals who are involved in the intubation requires special consideration and precautions. Multiple articles related to the precautions of intubation in the perioperative settings have recently been published [Figure 2]. | Figure 2: Precautions for intubating patients in coronavirus disease 2019 times
Click here to view |
To avoid virus scattering, assisted mask ventilation should be avoided. If positive mask ventilation is needed based on clinical judgment, it is recommended to cover the area around the patient's mouth and nose with wet gauze to help prevent the virus from spreading. Muscle relaxants need to be used in such a situation. Tracheal intubation should be performed by an experienced anesthesiologist. The video laryngoscope should be placed as soon as muscle relaxation is achieved, and tracheal intubation should be accomplished and confirmed as soon as possible (<15–20 s). Confirming the depth of the endotracheal tube is extremely difficult using auscultation while wearing isolation suits. It is recommended instead to observe bilateral chest expansion, ventilator breathing waveform, and respiratory parameters. End-tidal CO2 is a better indicator of successful tracheal intubation, as oxygen saturation is not always increased immediately after intubation in these patients because the oxygen exchange is significantly impaired.
In a recent report related to 138 confirmed COVID-19 cases, 41.3% were considered acquired infection from the hospital, and >70% of these patients were health-care providers.[3] A high level of vigilance is necessary to prevent contracting the infection when intubation is performed. Standard Level 3 protection[3] should be worn by individuals performing the intubation. The recommended Level 3 protection process is as follows: hand disinfection → head cap → protective mask N95 1860 → surgical masks → isolation gown → disposable latex gloves → goggles → protective clothing → disposable latex gloves → shoe covers → disposable gown → disposable latex gloves → full head hood. Double masks with N95 1860 filter inside, gowns, and double gloves should be worn by the intubation team.
| Epidemic Diseases (Amendment) Ordinance 2020 | | |
On April 20, 2020, the secretary of the Ministry of Health and Family Welfare, Government of India, informed regarding the measures taken up by the government to safeguard the health of the health-care worker. An Epidemic Diseases (Amendment) Ordinance, 2020, aimed at protecting health-care professionals against violence during health crises such as the COVID-19 pandemic was signed by the President of India on April 24, 2020.[4] The ordinance makes not only attacks on health-care personnel but also those on their property, including their living and working premises, cognizable, and nonbailable offenses. The ordinance also provides for compensation for injury and damage to or loss of property in such cases. The amendment states that any commission or abetment to acts of violence shall be punished with imprisonment of 3 months to 5 years and a fine of ₹50,000–₹2 lakhs. If the attackers cause grievous hurt, they can be imprisoned for 6 months to 7 years with a fine of ₹1 lakh–₹5 lakhs. The offender will also be liable to pay compensation to the victim and twice the fair market value for damage of property.
| References | | |
| 1. | |
| 2. | World Health Organization. Coronavirus Disease (COVID-19) Outbreak: Rights, Roles and Responsibilities of Health Workers, Including Key Considerations for Occupational Safety and Health: Interim Guidance, 19 March 2020. World Health Organization; 2020.  |
| 3. | Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020;323:1061-9. |
| 4. | |
[Figure 1], [Figure 2]
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