key: cord-1053255-ba3daosr authors: Ismail, Mansoura; Joudeh, Anwar; Al-Dahshan, Ayman; Nur, Muna Ahmed; El Aguizy, Fayrouz Hamed; Selim, Nagah title: Primary healthcare physicians’ satisfaction towards work safety and personal protective equipment during the COVID-19 pandemic in Qatar: A cross-sectional study date: 2021-12-21 journal: Infect Dis Health DOI: 10.1016/j.idh.2021.12.002 sha: 21f30a9f16c0bc9b239f9a890dae77cc97674de1 doc_id: 1053255 cord_uid: ba3daosr BACKGROUND: During COVID-19 pandemic, healthcare workers are experiencing unprecedented pressure from stressors including enormous workload, virus exposure, and inadequate PPE. This study aimed to assess primary healthcare physicians’ satisfaction towards work safety and personal protective equipment and their predictors during early stages of COVID-19 pandemic in Qatar. METHODS: A cross-sectional web-based survey was conducted in 27 primary healthcare centers in Qatar from 1st June to 30 July 2020. Descriptive and analytical statistics were used when appropriate. A multivariable linear regression analysis was done to identify predictors of satisfaction among participants. RESULTS: A total of 262 participants completed the questionnaire with a response rate of 58.2%. 51.9% were males and 68.3% were family physicians. Only 14.9% and 17.2% of respondents were satisfied or highly satisfied about the overall safety of work and the clinical guidelines on the use of PPE in the context of COVID-19 respectively. Participants who were general practitioners were significantly more likely to be satisfied with maintaining work safety and local PPE guidelines compared to family physicians by 2.93 scores (95% CI 1.43, 4,43 p -value <0.001), and 2.82 scores (95% CI 1.19, 4,44 p -value 0.001) respectively. Also, physicians who had more than ten years of experience in practice were significantly more likely to be satisfied with the PPE use guidelines compared to those who had fewer years of experience by 1.93 scores (95% CI 0.45, 3.41 p -value 0.011). CONCLUSION: Overall satisfaction of participants with the safety of work and PPE clinical practice guidelines was low. The world has comprehensively changed once the World Health Organization (WHO) announced the Novel Coronavirus SARS-CoV-2 (COVID-19) as a pandemic outbreak on the 11 th of March, 2020 1 , which have had continuously affecting the economy, governments, and healthcare systems. COVID-19 virus is transmitted between people through close contact, droplets and through airborne transmission. Healthcare workers who are in close contact with a COVID-19 patient or who care for COVID-19 patients are at significant risk of getting the infection 2 . Consequently, it is mandatory to protect them and prevent transmission in the work setting by using appropriate personal protective equipment (PPE). Multiple global, international, and local health authorities issued recommendations on safety protocols for healthcare workers [3] [4] [5] . Universally, as the Novel Coronavirus (SARS-CoV-2) pandemic has evolved, there has been a shortage of PPE availability to the healthcare workforce 6, 7 . Meanwhile, since the WHO has warned about the beginning of the pandemic in March, basic protective equipment and safety protocols have not been always available in many medical institutions dealing with COVID-19 patients. Lack of PPE has left frontline healthcare workers unprotected while caring for their patients 8 . Since the start of the pandemic, guidance on the usage of such equipment has continued to evolve and has emphasized the conservation of resources rather than optimizing the protection of workers 9 . One of the biggest physical and psychological challenges for physicians while responding to COVID-19 was PPE, including repeated donning and doffing of equipment and J o u r n a l P r e -p r o o f 2 prolonged hours wearing an uncomfortable, unsuitable PPE, challenges communicating with the health team and patients while wearing PPE 10 . Healthcare workers, who have been trained on how to don and doff PPE to maximize protection from infection, have had to make ad hoc adjustments on what piece of equipment to use and when that are not reflected in any training they have received because of PPE shortage 11 . During the COVID-19 pandemic, healthcare workers are experiencing unprecedented pressure from stressors including but not limited to enormous workload, virus exposure, and inadequate PPE 12, 13 . Statistics from countries with the highest mortality rates indicate that healthcare workers are considered at greater risk of being infected with COVID-19, ranging from 15% to 20% of the infected population, and are therefore at a disproportionate risk to the rest of the population 14, 15 . The Ministry of Public Health in Qatar has developed an emergency action plan in response to the outbreak of COVID-19 in March 2020, including access to PPE, alongside strict infection control guidelines and measures for healthcare facilities, staff, patients, and visitors. As a result, infection rates for healthcare staff were contained at 6.5%, which allowed maintenance of sufficient healthcare workforce 16 . Primary Health Care Corporation (PHCC) is publicly run and serves a population of 2.8 million throughout a network of 27 primary health care centers covering all of Qatar 17 . PHCC responded rapidly to the pandemic by assessing suspected COVID-19 cases and by tracing the contacts of positive patients. They suspended nonessential services, implemented telemedicine, and maintained urgent services and walk-in clinics. Laboratory services, pharmacy, and diagnostics were all operated to support the walk-in patients 18 . J o u r n a l P r e -p r o o f 3 Workforce satisfaction is the cornerstone of well-functioning health systems. Prior to the pandemic, studies showed that physicians' professional satisfaction is associated with achieving higher quality of care, greater patients' satisfaction, and better levels of treatment adherence 19 . Moreover, during this critical time of the pandemic, physicians' satisfaction proved to be an essential motivational source to reduce physicians' burnout and to retain the medical workforce 13 . Therefore, healthcare policy makers need to identify primary healthcare physicians perception toward their safety at work and their satisfaction on PPE supply and regulations. This study aimed to assess the satisfaction towards work safety and personal protective equipment and their predictors among primary healthcare physicians during COVID-19 pandemic management in Qatar. A cross-sectional web-based survey was conducted from June 1st to July 30 th ,2020 in PHCC. The study was reviewed and approved by the Institutional Review Board at Primary Health Care Corporation in Qatar with a reference number PHCC/DCR/2020/04/036. All Primary healthcare physicians (PCPs) were invited through email to participate in the study with a link containing anonymous, self-administered questionnaires using SurveyMonkey software. The email also provided information about the aim of the study, a confidentiality agreement, and consent for voluntary participation. An updated list of working PCPs was obtained from the PHCC operation office which provided a total of 450 PCPs who were mainly general practitioners ( medical doctors with no specialty certification or post-graduate training) and family physicians (certified in family J o u r n a l P r e -p r o o f 4 medicine), in addition to a few PCPs specialized in internal medicine, pediatrics, ophthalmology, and Ear, Nose, and Throat physicians (ENT). PCPs who were only providing administrative work or were on leave during the data collection period were excluded from the study. The questionnaire was developed based on expert opinion of primary care physicians currently working in PHCC and a review of the relevant literature. It was pretested with a convenient sample of the study population. Respondents who were included in pretesting were excluded from the final data analysis. Some questions were modified based on the feedback and the questionnaire was reviewed by three senior consultant researchers. The questionnaire contained the following sections: (1) participants' background characteristics including; age, gender, years of clinical experience, and qualifications, (2) PCPs' satisfaction with maintaining their safety at the workplace using the question "How satisfied or unsatisfied are you with the followings aspects of work environment safety in your health center", and (3) PCPs' satisfaction with PHCC clinical practice guidelines on the use of PPE using this question: "Regarding PHCC clinical practice guidelines on the use of PPE in the context of COVID-19, how satisfied or unsatisfied are you on the following aspects". The response to each question in the questionnaire was devised using a Likert scale that provides 5-options for respondents (1= highly unsatisfied; 2= unsatisfied; 3= neutral; 4= satisfied; 5= highly unsatisfied) 20 . Likert scale was considered in this study to avoid nonresponse to the questions. The data were analyzed using the IBM SPSS Statistics for Windows (version 23, IBM Corp., Armonk, N.Y., USA). Both descriptive and analytical statistics were applied. For descriptive J o u r n a l P r e -p r o o f 5 statistics, frequency distribution tables and percentages were used for categorical variables, while mean and standard deviation (SD) were used for numeric variables. For analytical statistics, univariable and multivariable linear regression analyses were performed to identify the predictors of overall satisfaction with maintaining the safety of work at PHC centers as well towards PPE guidelines. Statistical significance was considered at p < 0.05. Among the 450 PCPs who were invited to participate in this survey, 262 PCPs completed the questionnaire with a response rate of 58.2%. As shown in table 1, around half of the respondents were males (56.5%) and aged between 41 and 50 years old (51.9%). Most of the respondents (77.9%) had more than ten years of experience in general practice, and more than two-thirds were specialized in family medicine (68.3%). Only 14.9% of PCPs who responded to our survey were satisfied or highly satisfied about the overall safety of work in their respective health centers. However, looking closely at the components of the questionnaire, we found that two-thirds of the respondents were satisfied or highly satisfied with their training on PPE, donning, and doffing, whereas around half of them were satisfied or highly satisfied with their accessibility for significant incidence reporting as well as the safety of the physical environment of the health center (56.8% and 53.5% respectively). 45.6% and 42.7% of the respondents were satisfied or highly satisfied with the quality and availability of PPE provided (Table 2) . Similarly, 17.2% of respondents were overall satisfied or highly satisfied with PHCC-Infection Prevention and Control (IPAC) guidance on the use of PPE. Nevertheless, around half of the respondents were satisfied or highly satisfied with the scientific background and clarity of these J o u r n a l P r e -p r o o f 6 guidelines (54% and 51.2% respectively), and the recommended type of PPE used by patients and staff (48.9% and 47% respectively). 38.6% and 38.1% were satisfied or highly satisfied about PCPs' contribution to the development or modification of PPE guidelines, respectively ( Table 3) . The univariate analysis showed that age, medical specialty, and years of experience were significantly associated with overall satisfaction toward maintaining the safety of work among PCPs. After full adjustment, only medical specialty was significantly associated with overall satisfaction with maintaining the safety of work. Participants who were general practitioners and others (i.e., otolaryngologists, ophthalmologists, dermatologists) were significantly more likely to be satisfied with maintaining work safety at PHC centers compared to family physicians by 2.93 scores (95% CI 1.43, 4,43 p < 0.001) and 2.73 scores (95% CI 0.22, 5.25, p = 0.033), respectively ( Table 4) . As in Table 5 , the univariate analysis showed that age, medical specialty, and years of experience were significantly associated with overall satisfaction towards PPE guidelines. The fully adjusted regression model showed that participants who were general practitioners, internal medicine physicians, and others (i.e., otolaryngologists, ophthalmologists, dermatologists) were significantly more likely to be satisfied with the local PPE guidelines compared to family physicians by 2.82 scores (95% CI 1.19, 4,44 p = 0.001), 3.69 scores (95% CI 0.98, 6.41 p = 0.008), and 2.95 scores (95% CI 0.32, 5.58 p = 0.028), respectively. Furthermore, physicians who had more than ten years of experience in practice were significantly more likely to be satisfied with the PPE use guidelines compared to those who had fewer years of experience by 1. Physicians' satisfaction toward work safety, PPE use and regulations were variable among different health systems and settings. In Italy, a web-based survey on 516 physicians with J o u r n a l P r e -p r o o f 8 comparable age and clinical experience to the participants in the current study, found that PPE was 'always' available for 13% and 'sometimes' for 50% of respondents, and that the place of work affected PPE accessibility where adult PCPs had half the odds of getting PPE when they needed it (OR = 0.5, 95% C.I. 0.3-0.9). Moreover, around half of the respondents found the information they received on PPE use was clear (47%) or complete (54%), and only 25% were satisfied with this information. Likewise, adult PCPs had half the odds (OR = 0.5, 95% C.I. 0.3-0.9) of receiving such information compared to physicians working in a different setting 22 . In comparison to the current study, our results indicate that PCPs in Qatar had higher level of satisfaction with their training on PPE use, the availability and quality of PPE provided, as well as the scientific background and applicability of PPE use clinical practice guidelines. Regarding physicians' perception toward physical environment and safety policies, our results were similar to studies conducted in other countries. For example, a cross-sectional study in Latin America on the realities and perspectives of healthcare workers on personal safety during the COVID-19 pandemic found that participants' perception toward the role of their medical institution and public health authorities in protecting physical integrity in the workplace was around 5 ( in a 1 to 10 Likert scale) 23 which is comparable to our results. In the current study, around half of the respondents were satisfied with the health centres' physical environment safety and their accessibility to report and investigate significant incidents using PHCC risk management system. In regards to physicians characteristics, our study showed no correlation between age and gender of PCPs and the level of satisfaction towards work safety and PPE uses clinical practice guidelines. However, the previously cited study in China found that older medical staff had more worries about their own safety than younger staff and were more stressed by lack of protective J o u r n a l P r e -p r o o f 9 clothing, whereas measures like correct guidance and effective safeguards for the prevention of disease transmission eased more female staff anxiety than in male staff with a small difference 21 . Regarding physicians' professional characteristics, having more than 10 years of clinical experience correlated positively with satisfaction with the PPE guidelines, whereas PCPs who were specialized in family medicine were the least likely to be satisfied with work safety and PPE guidelines. This study has several limitations. Due to the challenges of data collection during the COVID-19 era, the response rate was lower than desired. Furthermore, due to the complex nature of assessing work safety in a healthcare setting for PCPs, it is possible that the questionnaire used was limited in scope which could be better assessed with a follow up mixed qualitative and quantitative methods study. Also, the self-reported response in this questionnaire might not represent actual or genuine answers. Director-General's remarks at the media briefing on 2019-nCoV on 11 Practical recommendations for critical care and anesthesioloy teams caring for novel coronavirus (2019-nCoV) patients. 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Available from May/Pages/HMC-achieves-ACGME-International-Accreditation-foran-additional-seven-residency-programs.aspx [Last retrieved on Physician satisfaction and burnout at different career stages A technique for the measurement of attitudes during the outbreak of coronavirus disease 2019 (COVID-19) in Hubei, China. Medical science monitor Factors associated with access and use of PPE during COVID-19: a cross-sectional study of Italian physicians. Plos one Personal safety during the COVID-19 pandemic: realities and perspectives of healthcare workers in Latin America. International journal of environmental research and public health The model assumption is fulfilled. No interactions and no multicollinearity were detected. R 2 =15.0%. * statistically significant at p ≤ 0.05. a score ranged from 12 to 36 Acknowledgment: the authors of this manuscript would like to thank the primary healthcare