Impact of Personal Protective Equipment on Surgeon’s Performance during COVID-19 Crisis: Qualitative Exploration of Challenges and Solutions

Abstract

BACKGROUND: The Severe Acute Respiratory Syndrome Coronavirus 2 pandemic has exposed surgeons to hazardous working conditions, imposing the need for personal protective equipment (PPEs) use during surgery. The use of such equipment may affect their technical and non-technical skills, augment fatigue and affect their overall operative performance. This study was aimed to assess perceptions of surgeons about the impact of wearing PPEs during emergency surgery throughout the pandemic, in tertiary care settings and to explore recommended solutions to cope with these issues.

METHODS: A cross sectional survey having both qualitative and quantitative components was administered through an online survey form which was circulated around the world through emails and social media among the surgery communities. Purposive sampling with “snow-balling” was used in order to obtain quality input. Surgeons and trainees who were performing emergency and elective surgeries in these times of pandemic were included to obtain a meaningful input.

RESULTS: Responses to the survey (n=28) were received from surgeons from all over the world. The vast majority (99%) were males. Despite wearing PPEs, only 50% individuals felt safe suggesting high level of anxiety and unpredictability among surgeons.  Most of the surgeons (67.9%) felt adversely affected by PPEs in terms of their surgical performance. The four most common problems encountered were vision problems (82.1%), breathing and temperature problems (67.8% each) and mobility and comfort were the 4^th most affected as experienced by the surgeons (60.7%). Common suggestions included prioritizing emergency surgeries over elective procedures (46.42%), performing procedures 4 hours or shorter (42%), taking frequent breaks (32.1%) along with the use of alternative forms of PPEs to suit infection control and surgical performance both. Forty two percent responses showed that training for proper usage of PPEs can minimize most problems associated with its use. Few suggested avoiding use of PPEs if prior screening turned out negative; however majority still were inclined to observe the protective measures. Other suggestions included selection of individualized PPEs suited to various surgeons, adequate training to use them and counseling of peers (10.7%) to curb anxiety in operation theatres.

CONCLUSION: PPEs, although necessary for surgeon and staff safety, have adversely affected the operative performance of surgeons and surgical teams during pandemic. The use of better suited PPEs, appropriate training and following necessary protocols for infection control advised by various surgical societies can be helpful adjuncts to prevent surgeon fatigue and improve their operative performance.