In general, the pandemic has overwhelmed health systems and presented unprecedented challenges for medical personnel worldwide. Surgical departments are the cornerstone of any health system, contributing to public health in both elective and emergency situations. They are very vulnerable to the spread of disease and the main source of transmission of the virus to individuals, both surgical staff and patients, and possibly their attendants, and contamination of the community at large.10–12 The nature of the transmission of COVID-19 creates significant risks in surgical wards, including maternity care, due to the close contact of medical staff with patients, the limited physical environment of the operating theater and recovery room, and the potential for shared surgical equipment, especially Equipment /aerosol production processes such as surgical sets, airway devices and electrosurgical equipment. The pandemic also presents challenges to practices in the surgical department, especially ENT, maxillofacial surgery, and anesthesia providers, as they share a high viral load.13–17 Outbreak statistics from Wuhan, China, and Italy revealed that the disease infected approximately 3.8–20% of healthcare workers, with an overall mortality rate of 0.6%.18–20 Globally, studies have reported that the impact of the pandemic on surgical departments was profound, potentially long-lasting and widespread, and had a collateral health impact on the provision of surgical care to millions of patients as a result of the near-universal disruption and cancellation of surgical services.21–28 To manage these effects, different local disease control guidelines and recommendations have been developed, which may create differences in local conditions related to the extent of COVID-19 infections within the type of practice/hospital system, availability of effective personal protective equipment (PPE) and other supplies, physical layout of workplaces, practice economy, local rules and regulations and other constraints (e.g. financial). Thus, harmonized and effective national/international guidelines for specific surgical currents during perioperative periods are appropriate to limit infection and will inevitably need to be adapted for consistent and sustainable implementation by all medical staff. The ultimate goal of tailored guidelines and recommendations is to provide correct and optimal decisions, maximize benefits for both medical staff and patients, improve patient outcomes and minimize the burden of disease on systems health care. resource utilization, routine screening for disease before surgery, and a focus on urgent treatment while postponing non-priority treatments, especially in resource-constrained countries. Standard guidelines and recommendations for perioperative surgical care of patients during a pandemic allow for doubt and caution medical personnel and health institutions to prepare for a pandemic and familiarize themselves with standard guidelines for the management of the surgical space/environment, the staff and supplies so that optimal care is provided. provided to patients through the areas of infection prevention measures, equipment handling, PPE use and patient preparation, which can be implemented to reduce disease transmission in the hospital and in the wider community. The extent of surgical patient care during the COVID-19 pandemic at Jimma Medical Center (JMC) has yet to be investigated. Therefore, the present study aimed to describe the extent of perioperative patient care, equipment handling, and operating room (OR) management during the COVID-19 pandemic at JMC, compared to standard guidelines, and to suggests adjustments for implementation.
Materials and methods
An institution-based cross-sectional study was conducted at JMC, located in Jimma Zone, Oromia Region, southwestern Ethiopia, 350 km from the country’s capital, Addis Ababa. The hospital provides health services to millions of people living in the catchment area. The standard of current hospital practice in perioperative (preoperative, intraoperative, and postoperative) surgical patient care was assessed using five-point Likert scales (0, not at all, 1, rarely, 2, sometimes, 3, most of the time, 4, often) regarding seven areas (A, infection prevention and PPE; 29 B, patient preparation/preoperative phase; 30,31 C, intraoperative phase; 32 D, equipment handling procedure and CSR status; 33 E, operating room management; 34 F, anesthesia care, 35 and G, recovery room/postoperative ICU care36) at JMC in seven surgical departments (A, ophthalmology, B, ENT/maxillofacial surgery, C, orthopedics, D, general surgery, E, gynecology/obstetrics; F, pediatrics; and G, neurosurgery). A total of 90 respondents [35 patients (five patients from each of the seven surgical departments) and 55 healthcare providers (six professionals from each of the nine units, including the center of sterility room and anesthesia)] who were available during the study period, selected by convenience sampling technique with multi-stage clustering, participated in the study. Data were collected using a structured questionnaire (Supplementary Appendix 1) through direct observation and a face-to-face interview approach (with surgical patients, healthcare providers and hospital administrators), against developed checklists for standard surgical patient care guidelines/recommendations set by different organizations .11,37–48 A letter of ethical approval was obtained from the research ethics committee/institutional review board of Jimma University (IHRPGR/152/2021). Letters of support from KYA were also collected. Verbal and written consent was obtained from all participants and their information was kept confidential (Supplementary Appendix 2). All protocols for COVID-19 precautions were maintained during data collection. Participants were informed about the purpose of the study, according to the Declaration of Helsinki. The collected data were manually checked for missing values and outliers, deleted, entered into EpiData version 4.3.1 and finally exported to SPSS version 22 for further analysis. The findings of the study were reported using tables and narrative. The mean score of practical surgical care was compared between different specialties by applying the unpaired t-test. A p value of less than 0.05 was declared statistically significant.
Results
Extent of Surgical Care Practice in the Infection Prevention Sector and Status of Personal Protective Equipment Use During the COVID-19 Pandemic at JMC
Implementation of preventive measures for COVID-19 was higher among surgical staff compared to surgical patients, as described in Table 1 for different surgical departments. Table 1 Extent of Surgical Care Practice in the Area of Infection Prevention and Use of Personal Protective Equipment (Level of Implementation of COVID-19 Precautions) During the COVID-19 Pandemic at JMC
State of Surgical Care Practice in Patient Preparation/Preoperative Phase during the COVID-19 Pandemic at JMC
Although the extent of preoperative patient care varied before and during the COVID-19 pandemic, there was variation among surgical disciplines. Preoperative care implemented during the pandemic included the implementation of telemedicine to reduce physical contacts, screening for COVID-19 with different methods, isolating high-risk patients in the ward, and using PPE depending on the patient’s condition during preoperative assessments. The practice of following pre-operative guidelines (especially isolation of high-risk patients in the ward and screening for COVID-19) was satisfactory in general surgery and gynaecology/obstetrics departments, with a mean score of 3.6 for each (where they did it most often). . , as shown in Table 2. Table 2 Status of Practical Surgical Care during Patient Preparation/Preoperative Phase at JMC
Level of hands-on surgical care in the intraoperative phase during the COVID-19 pandemic at JMC
Different guidelines/recommendations for preoperative patient care were implemented during the COVID-19 pandemic. For example, patients wore a face mask when brought to the OR, and differences in application/removal techniques, scrubbing, decontamination, use of cautery, and use of PPE were observed depending on patient condition, etc. (Table 3). Table 3 Level of Practical Surgical Care During the Intraoperative Phase at JMC
Equipment handling status in the center of the sterility room during the COVID-19 pandemic at JMC
The degree of implementation of equipment handling guidelines/recommendations was very low (none or rarely) in the JMC sterile room center as staff working in the area raised multiple barriers (especially claiming that there was no information/training to date on guidelines), as described in Table 4. Table 4 Status of handling equipment in the center of the sterile room during the COVID-19 pandemic at JMC
State of Operating Room Management Practice during the COVID-19 Pandemic at JMC
Different OR management guidelines/recommendations were implemented during the COVID-19 pandemic, for example, limiting the number of OR attendees and differences in OR cleaning patterns after patient transfer. The level of implementation of the guideline recommending separate OR entry and exit showed statistically significant differences between surgical departments and was lacking in ophthalmic…
