Does wearing personal protective equipment affect the performance and decision of physicians? A cross-sectional study during the COVID-19 pandemic

Abstract

Background The use of personal protective equipment (PPE) decreased the probability of viral transmission during the COVID-19 pandemic. However, some drawbacks have been observed with its extensive use, such as headaches, anxiety, and stress among physicians, which could affect decision-making processes, the performance of physicians, and consequently patients’ safety. Few articles have studied the impact of PPE on physicians from different specialties. This study assessed the effect of wearing PPE on the performance and decision-making of physicians during the COVID-19 pandemic and compared the effects of wearing PPE on physicians from different specialties. Methods A descriptive cross-sectional study was carried out through an anonymous 39-item online questionnaire. The physicians were divided according to the probability and frequency of performing invasive procedures. Group 1 included emergency medicine and critical care physicians, intensivists, and anesthetists, group 2 included physicians from different surgical subspecialties, and group 3 included physicians from different medical fields. Results This study included 272 physicians; group 1 included 54, group 2 included 120, and group 3 included 98 physicians. Approximately, 90.4% of the participants aged between 30-40 years, and 72.8% of the participants were specialists. Results indicated that the comfort, vision, and communication were significantly reduced in all groups (81.1%, 88.7%, and 75.5%, respectively). In contrast, the handling of instruments was not significantly affected in the second group only. In addition, the decision-making and the rate of complications were not significantly affected. Conclusion There was a negative impact of wearing PPE on the non-technical skills (vision, communication and overall comfort), and the technical skills of the physicians. The decision-making and patients’ safety were not significantly affected. Recommendations include additional improvement of the PPE design due to its crucial effect on both non-technical and technical skills of physicians.

Impact of wearing personal protective equipment on the performance and decision making of surgeons during the COVID-19 pandemic

“…In addition, these drawbacks may affect the physicians’ performance in a way that may negatively affect the outcome and safety of the patients [13] . Nevertheless, the literature lacks extensive discussion of the drawbacks and negative impact of using PPE on the HCWs [6,7] …”

“…[13] Nevertheless, the literature lacks extensive discussion of the drawbacks and negative impact of using PPE on the HCWs. [6,7] Counter to other medical specialties, the competence in surgical management, especially in emergencies, depends on the surgeon's ability to take a safe and right decision in a timely manner; the surgeon's appropriate technical skills based on his/ her background and experience; and the surgeon's ability to perform an appropriate history-taking and clinical examination. Yet, the surgeons have confronted a unique situation during the COVID-19 era for the first time, for instance: they have been mandated to work in different work environments as medical wards, triaging clinics, emergency rooms, and even the intensive care units; they were required to perform surgical procedures, which might carry exceptional hazards as the emergency situations may not allow time to investigate the patient's COVID-19 status; they performed minimally invasive procedures that are considered high risk procedures for aerosol-generating particles; [11,14,15] their technical and non-technical skills may be negatively affected by the prolonged wearing of the PPE; and their prompt decision making skill may be negatively affected by the observed associated overall fatigability, discomfort, anxiety due to fear of unsafety, limited movements, headache, and decrease in the visual fields, etc.…”

“…Yet, the surgeons have confronted a unique situation during the COVID-19 era for the first time, for instance: they have been mandated to work in different work environments as medical wards, triaging clinics, emergency rooms, and even the intensive care units; they were required to perform surgical procedures, which might carry exceptional hazards as the emergency situations may not allow time to investigate the patient's COVID-19 status; they performed minimally invasive procedures that are considered high risk procedures for aerosol-generating particles; [11,14,15] their technical and non-technical skills may be negatively affected by the prolonged wearing of the PPE; and their prompt decision making skill may be negatively affected by the observed associated overall fatigability, discomfort, anxiety due to fear of unsafety, limited movements, headache, and decrease in the visual fields, etc. [6,7] In this study, we focused on different aspects, during the COVID-19 era, concerning the prolonged use of the PPE by surgeons, including the surgeons' performance and decision making. The anonymous, online questionnaire was created after our previous observations and was further modified by 3 independent senior professors affiliated with multiple universities to ensure its validity and capability for generalization.…”

“…[3][4][5] However, only few studies have specifically addressed the impact of PPE on surgeons' performance. [6,7] During surgery, many aspects can be affected including technical skills (e.g., tactile movements and handling of the instruments) and non-technical skills (e.g., vision, visual field, communication, overall comfort, and fatigability). Moreover, the psychological stress (e.g., feeling of insecurity even while wearing the PPE) may alter the process of decision making and the performance while dealing with suspected or confirmed cases.…”

“…Some studies have started the discussion on the drawbacks of using PPE and its impact on the HCWs, especially with the prolonged use during the COVID-19 pandemic, such as de-novo headache and anxiety [3–5] . However, only few studies have specifically addressed the impact of PPE on surgeons’ performance [6,7] . During surgery, many aspects can be affected including technical skills (e.g., tactile movements and handling of the instruments) and non-technical skills (e.g., vision, visual field, communication, overall comfort, and fatigability).…”