Mixed-Methods Survey of Healthcare Workers’ Experiences of Personal Protective Equipment during the COVID-19 Pandemic in Aotearoa/New Zealand

Abstract

There have been widespread issues with the supply and distribution of personal protective equipment (PPE) globally throughout the COVID-19 pandemic, raising considerable public concern. We aimed to understand the experiences of healthcare workers using PPE during the first COVID-19 surge (February–June 2020) in Aotearoa/New Zealand (NZ). This study consisted of an online, voluntary, and anonymous survey, distributed nationwide via multimodal recruitment. Reported domains included PPE supply, sourcing and procurement, fit-testing and fit-checking, perceived protection, trust and confidence in the workplace, mental health, and the likelihood of remaining in the profession. Differences according to demographic variables (e.g., profession and workplace) were examined. We undertook a descriptive analysis of responses to open-text questions to provide explanation and context to the quantitative data. The survey was completed in October–November 2020 by 1411 healthcare workers. Reported PPE shortages were common (26.8%) among healthcare workers during surge one in NZ. This led to respondents personally saving both new (31.2%) and used (25.2%) PPE, purchasing their own PPE (28.2%), and engaging in extended wear practices. More respondents in the public system reported being told not to wear PPE by their organisation compared with respondents in the private sector. Relatively low numbers of respondents who were required to undertake aerosol-generating procedures reported being fit-tested annually (3.8%), a legal requirement in NZ. Healthcare workers in NZ reported a concerning level of unsafe PPE practices during surge one, as well as a high prevalence of reported mental health concerns. As NZ and other countries transition from COVID-19 elimination to suppression strategies, healthcare worker safety should be paramount, with clear communication regarding PPE use and supply being a key priority.

The need to nurture Aotearoa New Zealand’s healthcare workforce

“…Alongside this negativity, positive experiences of communication were reported and recognised as critical to building trust and unity in a given organisation. 8 These findings are particularly relevant as Te Whatu Ora -Health New Zealand begins its leadership as the national organisation to deliver health services nationally. 16 One of the stated goals of this reform is to better support healthcare workers.…”

“…Recently published research shows the extent to which healthcare workers experienced anxiety and increased stress in the workplace due to inadequate access to personal protective equipment (PPE) during the first COVID-19 surge in New Zealand. 8,9 The inadequate state of New Zealand's PPE stockpile and distribution system at the beginning of the pandemic may be a far cry from our current situation, where masks are ubiquitous and supply chains restored. However, it remains a critical signal, a "canary in the coalmine", of broader ongoing challenges within the healthcare system-particularly related to healthcare worker wellbeing, stemming from persistent staffing shortages, high workloads, under-resourcing and burnout.…”

“…Unsurprisingly, respondents' comments showed links between feeling safe and protected in the workplace and feeling valued and respected as workers and as people. 8 Public health emergencies force re-examination of moral commitments and obligations, both public and private. Like the SARS epidemic of 2003 and the HIV/AIDS epidemic before that, ethicists have used the COVID-19 pandemic as an opportunity to re-examine the nature of healthcare workers' duties to continue to work and care for patients in situations of increased personal risk.…”

“…5 The "reality gap" between health management and frontline staff was amplified, with the tension of the moral aspects of frontline healthcare provision and adhering to changing workplace guidelines at times incompatible with staff wellbeing laid bare. 8 Failures in the provision of PPE were not the only factors contributing to these feelings of a reality gap, as healthcare workers also experienced increased levels of stress and anxiety related to uncertainty. A lack of transparency and honesty about stock levels and the reasoning behind PPE allocation decisions were key indications for many healthcare workers that their organisations did not trust them to use either the information or PPE appropriately.…”

“…17 This is critical given the high rates of healthcare worker burnout reported in recent surveys across Australasia. [3][4][5] The new knowledge gained from the PPE survey 8,9,15 allows us to draw robust conclusions about the impact on healthcare workers of the shortage of PPE, as well as the wider health system deficiencies that this shortage, and the organisational response to it, draws attention to. The reduction in "organisational slack" in public health services as a result of increased demand and the need for efficiency within austere funding environments already had the potential to negatively impact on healthcare worker health and wellbeing pre-pandemic.…”