The COVID 19 pandemic has been testing the resilience of healthcare workers around the globe. With increased patient loads, the constant threat of getting infected, and ordeal of treating the critically ill, there have been increased burnouts and mental health issues. The safety of Healthcare workers is, therefore, a real concern that needs to be addressed carefully and decisively. With lessons from the MERS-COV epidemics in Saudi Arabia, Aster Sanad leaders saw the evidence of an emerging public health crisis and did their best to plan accordingly. The health and safety of the staff have always been paramount. Hence, safeguarding them during this challenging time was of utmost priority. Dedicated clinicians, nurse leaders, administrators, and infection control preventionist were assigned to support and strengthen the safety of staff. For illustration we are using the Systems Engineering Initiative for Patient Safety (SEIPS) framework which places health-care workers at the center of the work system. All other system components like healthcare work tasks, technologies and tools, environmental factors, and organizational conditions, serve to enable the health-care worker to perform their role and determine the quality of the outcomes, may it be job effectiveness or occupational health and safety.

• Healthcare Work Task
• Well delegated work tasks was vital to minimize the risk of exposure and transmission amongst staff and vigorous well designed Rota system became essential. We segregated staff to handle suspected and confirmed cases. Alternative staffing plans were developed to ensure the availability of workforce. This also minimized the risk of cross-infection of patients.
• Technologies and Tools:
• Every tool is a weapon if we hold it right. The COVID 19 pandemic made us realize the importance of the use of an appropriate tool (PPE). Based on the various work task and using credible references we rolled out a policy on appropriate use of PPE which included eye protection, disposable gown, gloves, and universal masking. For all high-risk procedures, Level 4 PPE with N95 mask was made mandatory. Virtual Audits were implemented to improve compliance of PPE usage. Staff was engaged in transparent communication and feedback through virtual team huddles and exchange of daily situation reports, multidisciplinary virtual rounds to all departments as well as staff accommodations. Bedside activities were bundled to reduce the exposure of our staff. Telecommunications were initiated for more frequent interactions with our patients.
• Risk Assessment and Symptom monitoring: To identify staff who are at considerable risk, we conducted a staff risk assessment for all departments including outsourced services, and reorganized the assignments. Vulnerable staff with chronic diseases, pregnant women and breastfeeding mothers were engaged by work from home facilities and backend work which prevented direct exposure. Daily temperature and symptom screening was initiated for all staff before entering the hospital and before using hospital transport service. HODs initiated a daily symptom tracker log at each department. Staff returning from travel were screened and isolated as per MOH protocol.
• Diligent Contact Tracing, Free testing, Hospitalization, and Sick leave: Risk of contracting COVID 19 from exposure to a positive case and increasing community transmission prevailed, in spite of adherence to IPC measures. The infection control team was trained to perform contact tracing interviews which were reviewed on a daily basis by a corporate representative and MOH to ensure safety and control transmission. Staff occupational health clinics and ER provided 24/7 free access to all staff to get COVID 19 testing and consultation. Those suspected were quarantined or hospitalized according to the condition ensuring no monetary loss due to leaves. The senior leaders ensured well-being and provided encouragement, self-care tips and psychological first aid to those in need by connecting regularly via videoconferencing, these interventions at the personal level strengthened the resilience of our frontline staff. All training and departmental meetings are conducted virtually. The only mock drills done in various departments were regarding “COVID 19 safety protocols during BLS and ACLS”.

These initiatives were sometimes felt as unpleasant, uncomfortable but were important steps as part of risk reduction of cross-infection among healthcare staff and also in order to preserve the business continuity of the hospital.

3. Environmental factors

With limited resources, implementing social distancing measures in our staff accommodation and transport vehicles were our greatest challenges leading to cross infections. To curb the spread we analyzed each staff apartment. A number of occupants were reshuffled, we got approvals to rent out a few more apartments for isolation, quarantine of suspected cases and post-discharge staff. To maintain immunity it was important for staff to have clean and nutritious food, the kitchen department ensured timely dispatch of food to all apartments in disposable packings. Social distancing protocols, hand sanitizers, increased cleaning frequency, more washing machines, extra linen, adequate disinfectants were ensured for staff accommodation. CCTV was installed in front of isolation flats to ensure compliance. Transport vehicle frequency was increased. Education material and awareness posters were displayed at the accommodations. We identified one champion from each apartment to support us to monitor compliance using a checklist and provide feedback for improvements.

Proper environmental control measures were important for both patients and staff to fight COVID19. A well-equipped 33 bedded special COVID ward was created within the facility. 2 new isolation rooms were added to the ER. 14 portable HEPA filters and 6 ultraviolet devices were purchased to ensure all areas had adequate safety measures. Air exchanges across the facility were maintained as per recommendations from authoritative resources.

Community spread has also been a major threat to health workers safety, to minimize this risk we implemented:

• Restricted entry points with a mandatory triaging and strict precautionary measures
• No visitor policy, restricted companions for essential services, and pediatric services.
• Dedicated patient flow routes and lifts for potential cases
• Social distancing measures in lifts, cafeteria, staff pantry, waiting areas
• Fiberglass windows at all receptions
• Showers installed in change rooms
• Restriction of nonessential programs
• Strengthened infection prevention and control measures
• Declaration from staff to ensure compliance during post duty hours and off-hours.
• Cessation or postpone all elective surgeries that require deep sedation or general anesthesia with the exception of an emergency,
• All perioperative patients were clinically screened for symptoms of COVID-19
• Transport personnel was kept the same from transport origin to destination.
• Strict OT protocols and clear signs to discourage unnecessarily entry
• Use of additional bacterial viral filters in anesthesia machine circuit
• Use of Rubber dams to minimize the production of saliva- and blood-contaminated aerosol or spatter in dental units
• Cleaning and disinfecting high-touch surfaces areas and equipment with Environmental Protection Agency approved hospital disinfectant
• Enhanced Fumigation and terminal cleaning

4. Organizational Conditions: 

To minimize the risk of exposure, cross-department visits were suspended and kept limited for the essential task. Mealtimes were staggered.

 We kept receiving a barrage of e-mails from regulatory authorities along with corporate communications which was overwhelming information. Nurse quality managers and clinical instructors were made in charge to summarize, organize, and prioritize this information for the staff with a focus on patient safety and quality of care. Timely training, upskilling, availability of updated guidelines empowered the staff with the knowledge and skills required to deal with the situations. Rapid decision-making and the use of innovative technologies helped us improve our efficiency and outcomes.

The global impact on the supply chain affected the availability of PPE. However effective planning, stockpiling, replenishment of supplies, collaboration with governmental authorities, daily monitoring, and rational use strategies (for PPE) helped us to have required essential resources which were basics for staff safety.  

Ensuring Psychological PPE: Without our workforce, we cannot serve patients. Hence, our top priority was keeping staff safe from the psychological effects of this pandemic and ensure good mental health and wellbeing. Aster DM healthcare launched the Serenity app –partnered with WYSA to bring all our staff free access to 24x7 clinically approved A I tools that helped us manage the emotional challenges faced while fighting the battle against COVID19. Multiple sessions were organized for all staff on mental health considerations based on WHO guidelines. We reached out to each department and staff accommodation virtually and engaged staff to discuss their wellbeing and required support and feedback. A feedback survey was conducted to hear their concerns and suggestions. Incident reporting was encouraged for continuous improvements. All staff desktops wallpapers/screensavers were used to provide useful Tips titled “Do not take COVID Home”

Being away from families and working constantly under the threat of COVID 19 it was important for them to feel supported. Clear directions from leadership and a collaborative team spirit created conducive work conditions and helped reduce tensions. Our Corporate monthly newsletter spoke about the blood donations from the nursing team who went beyond the call of duty, saving lives while fighting the battle with COVID. Our Senior Leadership at headquarters launched the initiative- "Aster Salutes Everyday Heroes" to celebrate the people who are at the forefront of the war against COVID and nominated the Aster Sanad team for brilliantly upholding our brand promise "We'll Treat You Well".

This is my first blog and I am very thankful to ISQua and Caroline for giving me this opportunity.

I wish to acknowledge the support and great efforts of all the frontline workers and administrative teams at Aster especially the entire nursing team.

Lastly, this article would not have been possible without the encouragement of my daughter Riya.”

Dr. Neesha Nair, Senior Manager Medical Affairs and Quality Aster DM Healthcare.

Mr. Ihab Alawour, Chief Nursing Officer, Aster Sanad Hospital.