Factors responsible for delay in provision of care to suspected COVID-19 patients presenting in surgical emergency and ways to combat it

Introduction: Health care workers are found to be at three times greater risk of getting infected as compared to the general public.  Scientists and doctors all over the world have agreed upon the use of PPE including gloves, masks, head covers, face shields, goggles, and jumpsuits in protection against COVID-19. Materials and Methods: This observational prospective study was conducted in the surgical emergency of Holy Family Hospital, Rawalpindi over a period of 2 months and 21 days. Patients included all those who presented to surgical emergency with suspicion of being positive for COVID-19 and time taken by first-line health care workers in attending them. 157 patients were observed for this purpose and 23 first-line surgeons including general, orthopedic, and neurosurgeons were interviewed regarding their fears and concerns about contracting COVID-19 and infecting their families. Results: It was observed that a surgeon took on an average of 10 minutes (+/-3 minutes) in wearing all the personal protective equipment and a total of 14minutes (+/- 5 minutes) in reaching a patient in the trauma room with symptoms suggestive of COVID-19. This was in contrast to a patient presenting to a trauma room who had no respiratory symptoms or fever, in which case, the patient was seen within 3 minutes (+/- 2 minutes) of presentation to a surgical emergency. Out of 23 surgeons, 15 had reasonably aware of the disease while 7 were knowledgeable up to the mark. 17 surgeons were extremely fearful about contracting the disease and infecting their friends and families. 7 surgeons confessed to avoiding COVID-19 patients and 9 surgeons confessed that they commanded their junior surgeons to see suspected COVID-19 patients in the emergency room. Conclusion: We concluded that delay in attending trauma patients suspected of being positive for COVID-19 was a worrisome problem that needed to be addressed. Numerous local and regional circumstances served as a factor for this delay, most important of which came out to be an inadequate provision of PPE, time consumed in collecting and wearing PPE, fear of the disease, and anxiety provoked due to this fear among surgeons

Compliance on the Use of Different Types of Face Mask by Healthcare Workers and General Public in Tertiary Care Hospital of RMU during COVID-19 Pandemic

Objective: To determine the compliance on the use of different types of facemask among HCWs, patients and the general public in different hospital settings of tertiary care hospital of RMU during COVID-19 pandemic Material and Methods: Cross-sectional descriptive study was done among 397 study subjects of either gender consisting of HCWs, patients, and the general public visiting the tertiary care hospital from 6th April-6th June 2020. Subjects were enrolled through convenience non-probability sampling. Data was gathered by a self-structured proforma. The study consisted of questioning the frequency of washing hands, using hand sanitizers, practicing physical distancing, using eye protection goggles or face shields, the practice of sterilizing or changing of shoes and clothes after coming back to home, frequent use of disposable gloves, use of caps or head covers and water-repellant aprons and gowns. Data were analyzed by SPSS version 25.0. Results: A total of 397 study subjects including 206 (52%) males and 190 (48%) females were enrolled in the study. 118 (29.7%) had an underlying disease, 93 (78.8%) of them showed regular use of masks. The mean age of participants was 34.7 ± 12.2 years. 90.4% of study subjects had good compliance with using face masks in hospital settings, 25.9% study subjects used respirator type of masks while the use of homemade cloth was 4.8%. A total of 57.8% of study subjects had use of single masks, 22.5% used double masks, and 10.4% people used triple masks remaining 9.3% uses no masks at all. Among 189 HCWs 54% were using respirator type of masks and 46% were using surgical masks. The general public preferred to use locally made surgical masks or homemade cloth because they are cheap and easily available. Conclusion: The selection and use of PPE especially facemasks vary among HCWs and non HCWs. Even among HCWs usage varies according to the type of healthcare workers and the working environment. Overall compliance with the use of face masks and other PPE was considerably low among non HCWs. Our study has provided preliminary data about the usage of masks among HCWs and non HCWs. Longitudinal studies must be conducted to collect better evidence about the use of the face mask as PPE and its associated factors