Episode #24 Wellness During The Covid-19 Pandemic

Hello and welcome back to the Anesthesia Patient Safety Podcast.  My name is Alli Bechtel and I am your host. Thank you for joining us for another show.

We are returning to the APSF’s Novel Coronavirus Anesthesia Resource Center. The resource center is filled with information and perioperative considerations, frequently asked questions and more. I hope that you will check it out.

Before we dive into today’s episode, we’d like to recognize Fresenius Kabi, a major corporate supporter of APSF. Fresenius Kabi has generously provided unrestricted support as well as research and educational grants to further our vision that “no one shall be harmed by anesthesia care”. Thank you, Fresenius Kabi – we wouldn’t be able to do all that we do without you!”

I also want to remind you about an exciting research opportunity.  The APSF is working with the Foundation for Anesthesia Education and Research or FAER to help promote the upcoming Mentored Research training grant. This is a two-year, $300,000 award that aims to help anesthesiologists develop the skills and preliminary data they need to become independent investigators in the field of anesthesia patient safety. If you are interested in pursuing the APSF/FAER mentored research training grant will need to submit a Letter of Intent prior to submitting a full application. The LOI submissions will open December 1, 2020 and close January 1, 2021. More information can be found on our website and I will include a link in the show notes.  There is still time, but don’t delay!

And now, let’s head back into the novel Coronavirus anesthesia Resource Center. I also want to remind our listeners that the information on the APSF website and on this podcast is provided for informational purposes and does not constitute medical or legal advice. You can get to the resource center from the APSF homepage and clicking on patient safety resources. First one down is Novel Coronavirus (Covid-19) Anesthesia Resource Center. Then scroll down because we are going to start with a review of the AORN, ASA, and APSF Clarification of Powered Air-Purifying Respirator (or PAPR) Use in the Operating Room and Other Procedural Areas in Which Sterile Fields are Present. This was published on the website on June 30, 2020. This is also related to one of the frequently asked questions in the Hospital/Facility Administration section which asked, “Our hospital administrators will not allow us to wear PAPR in the operating room. How do I address this issue?” The avoidance of PAPR use in the OR stems from the CDC statement that PAPR use in the OR has not been recommended due to lack of evidence to support safe use of this device and possible contamination of the sterile field from the exhaled air. In addition, AORN recommended the use of a fit-tested N95 respiratory since there was lack of evidence to support PAPR use.

This joint ASA, APSF, and AORN statement is important since there are hospitals in the US that misinterpreted the AORN guidelines on PAPR use and as a result anesthesia professionals and other healthcare personnel in the operating room were being told that they were not allowed to wear a PAPR in the OR. This is important since the PAPR is used by people who do not pass a fit test with an N-95 respirator. The thought was that the air leaving the PAPR could contain micro-organisms that would contaminate the sterile field and lead to increased risk of surgical site infections. Studies evaluating PAPR use in the OR show that this does not actually occur. I am going to read the clarification regarding PAPR use in the OR which states:  “When an N95 cannot be properly fit tested for use by healthcare personnel in the operating rooms and other invasive procedure areas or an N95 is not available for urgent/emergent procedures, we recommend that an interdisciplinary team including infection control, nursing, surgery and anesthesia personnel determine how PAPRs may be most safely used for respiratory protection in the perioperative environment when a sterile field is present. Each health care facility or system should develop a standardized procedure for perioperative PAPR use and protection of the sterile field from contamination, (e.g., identify portions of the sterile field to be covered; direction of the blower exhaust; and type of PAPR allowed, such as loose-fitting, full face piece, or hood style).” I will include a link to this statement in the show notes as well.

Now, while you are in the Novel Coronavirus Resource Center, if you continue to scroll down you will find the Covid-19 and Anesthesia FAQ section. We are going to look at some frequently asked questions about wellness as it relates to the pandemic. Anesthesia professionals and all healthcare personnel are often very focused on providing safe anesthesia care to patients, but wellness is a vital topic because we also know that when anesthesia professionals experience burnout, this can be a threat to patient safety. In fact, this is one of the APSF’s Perioperative Patient Safety Priorities, #11 Anesthesia Professionals and burnout.

The first questions asks, “What about health and wellness? I’m quite stressed right now along with my colleagues, and want to know what resources are available for me and my colleagues? What can I do?

This is a great question and I am sure some of you are listening to this and thinking, that sounds like me too.  So, what can we go? First, let’s review some common reactions related to the Coronavirus pandemic which may include the following:

• Fear and anxiety about you or a loved one becoming sick from this virus and repeated thoughts about the virus spreading.
• Feeling irritable or on edge
• Experiences physical reactions to the increased stress including headaches, upset stomach, or muscle tension
• Having trouble with focus or concentration due to being preoccupied with thoughts related to the virus
• Having trouble sleeping
• Feeling overwhelmed with information overload from monitoring media and websites for all of the latest news on the coronavirus pandemic.

It is a lot and it is stressful. Here are some ideas for stress relief, self-care, and coping during this health crisis. First, try to maintain perspective. One question you can ask yourself is “How real is this threat to me right now?” Next, try to continue as many of your routine activities as you can especially if this provides a source of comfort and predictability. You may feel better after talking with friends, family coworkers, or a counselor about your feelings and concerns. Get moving since participating in daily exercise can be helpful in decreasing stress levels. Try to limit daily intake of news and media related to the virus. When possible, try to participate in an activity that you enjoy to give your mind a break from worrying about the virus which may help restore a sense of balance. There are relaxation techniques that may be useful as well including deep breathing, meditation, prayer, mindfulness or other relaxation techniques. I will include links in the show notes to resources published by the American Society of Anesthesiologists and American Association of Nurse Anesthetists to help with stress management. I hope that you will check it out as well. And just like so many other aspects of life, there may be an app for that since there are several meditation apps available.

[Meditation Music from https://www.zapsplat.com]

I will include a link to a calm.com free meditation session to help with anxiety related to the uncertainty surrounding the Covid-19 pandemic. I listened to the calm together global meditation session while preparing this podcast and it was very relaxing and there are other free sessions on the website as well. Another option for resources to help manage stress and anxiety may be to talk with your primary care physician or your health care organization’s employee assistance program.

The next question asks, “Do I need to isolate myself from my family when I return home after treating Covid-19 patients?” This is another very important question and one that we have not had to consider before. The good news is that the precautions, such as wearing appropriate PPE, careful donning and doffing, hand-washing, and not touching our face or hair, that we take while providing anesthesia care can help to decrease our risk for contracting the virus and this can help decrease the risk to other people including our families at home. You may also want to consider leaving work scrubs at work, using shoe covers at work or leaving dedicated work shoes at work. When we do these things, it helps to decrease the risk of transmitting the virus to the same level as standard community-acquired spread. While at home, frequent hand washing and standard cleaning of home surfaces is likely adequate especially when no one in the home is experiencing symptoms related to Covid-19. The CDC provides recommendations for decreasing transmission of the virus at home and I will include the link and recording in the show notes.

Let’s tackle the last question in this section, “How can I practice social distancing in the OR?” Here are some recommendations that may be helpful to maintain social distancing while working in the OR and ICU.

• Minimize talking in OR and ICU rooms because phonation may generate aerosolization of respiratory and oral-nasal secretions. This may underlie community spread. Only those conversations necessary for patient care should occur.
• Only people with active duties should remain in OR and ICU rooms. Staff violating this practice should be politely asked to leave.
• Do not congregate in work areas. Patient care discussions should be done between the minimum number of providers necessary or over the telephone.
• Within OR rooms, breaks are an important part of patient safety for anesthesia professionals. Staff should continue to work collaboratively to facilitate breaks, especially those involved in prolonged surgical procedures.

Well, that’s all the time we have for today. We hope that you will check back in the APSF Coronavirus Anesthesia Resource Center to learn new information about anesthesia care during the pandemic and to help answer any questions you might have in our FAQ sections.

If you have any questions or comments from today’s show, please email us at [email protected].

Visit APSF.org for detailed information and check out the show notes for links to all the topics we discussed today.  Do you want to join the crowd and donate to the APSF?! Join the #APSFCrowd! The APSF has launched our first crowdfunding campaign and you can be a part of it! I will include a link in the show notes. You contribution will provide funding for important programs such as research grants, the APSF Consensus Conferences, and APSF.org which has over 1 million visitors a year. Most importantly, your donation will help support the APSF vision! So, donate today and then head over to twitter and join the #APSFCrowd.

Until next time, stay vigilant so that no one shall be harmed by anesthesia care.

© 2020, The Anesthesia Patient Safety Foundation