Personal Protective Equipment and Medical Personel Stress

The Effect of Perceived PPE Resource Strain in COVID Testing Areas on the Perceived Stress of Medical Personel.

Question: How does the perceived PPE resource strain within COVID testing zones of the Pacific Northwest affecting the perceived stress of the Testing Staff?

Researcher

Kailey Chan

Email: chankai000@stu.sumnersd.org

Class of 2021

Problem Statement

There is a problem within hospital managment. Despite guidelines that have been revised in order to lessen stress and increase safety levels, ensuring as much as possible that personnel aren’t at risk for contracting COVID-19, hospital supply management in local health systems don’t have a full picture understanding of staff stress levels at COVID testing sites, according to Lloyd Bird a director for Pierce County testing sites . This problem is negatively impacting medical personnel working directly with COVID patients. As stress levels go unchecked it is possible that they become less effective in their work and of course allow for higher levels of anxiety promoting unhealthy mental health. According to Harrell, Selvaraj, and Edgar who paraphrased Zhen, Health workers who worked during the 2003 SARS epidemic who had high anxiety related to fears of contracting the disease, were lead down a dangerous mental path, causing the death of 5 medical workers. A possible cause of this lack of communication of stress levels associated with fears of contracting the disease due to PPE access between hospital management and medical staff workers might be due to the unprecedented nature of this pandemic and lack of preparation both globally and nationally, leading other issues within the larger pandemic problem to be swept to the side. Perhaps a study which investigates the stress levels of local COVID-19 testing staff would help to bridge that gap of communication.

Significance and Value of Study

This valuable information for the current situation as at the beginning of this it was quite obvious from headlines that hospitals were experiencing some of the PPE shortages which wasn’t good as they weren’t able to keep employees safe or treat patients to the best of their ability. This would be a reflection on whether newly implemented procedures within the medical community are actually effective and whether or not healthcare professionals are still feeling a strain. It would also be valuable to the next a pandemic or an outbreak occurs on this scale or a slightly smaller one so that healthcare professionals might refer back to the process that work to keep workers safe. Since I haven’t seen anyone look at PPE shortages via a county testing site I also thought that would be something of value, especially to each individual county, as they interpret the overarching PPE guidelines differently based on their needs.

Definitions & Hypothesis

Hypothesis: My current hypothesis is that the COVID-19 testing staff within the testing community will have higher PSS scores when surveyed about their stress and PPE correspondence. I believe that there stress levels due to PPE access will be high as the current case count rises " 2,863 cases per day, an increase of 7 percent from the average two weeks earlier" (Washington Coronavirus Map and Case Count, 2020). The staff will be under immense pressure as these cases keep rising, "192,413," at current count (The Department of Health & Microsofts AI Health Team, 2020). During the closest pandemic outbreak to our current, SARS 2003 medical workers were "adversely affected by fear of contagion and of infecting family, friends and colleagues" (Maunder et al., 2003). Therefore I believe that due to the similarity of the SARS siutation and the current COVID-19 situation the fear of contagion that medical personell have would also be similar, along with the increase of cases and of course knowledge of previous PPE shortages I would hypothesis that medical personnell stress levels will register high on the PSS scale, showing that their stress levels are high.

Definitions:

Personal Protective Equipment (PPE): medical equipment that is used to prevent or minimize the dangers or hazards of working with COVID-19 mainly to prevent contracting the virus. Includes: N95 respirators, facemasks, gowns, eye protection, and gloves
Medical Personnel: Staff that physically perform tests on possible COVID-19 patients: ie; swabbing their nose through the drive-through testing.
Perceived Stress Scale (PSS/PSS-10): A scale developed by Sheldon Cohen in order to measure stress or how situations affect stress. It has subjects determine questions about stress or situations that affect stress by having them choose between 0 = Never, 1 = Almost Never, 2 = Sometimes, 3 = Fairly often, 4 = Very often.

Method of Inquiry

I will be using descrpitive research and have identified through the uses of purposive sampling COVID testing personel as my subjects. I will be sending out a survey composed of a modified PSS/Q stress test that asks questions pertaining to PPE access and how access to each PPE item affects personel stress. I will also be using an open ended questionnaire to assess managment over COVID testing staff on their distribution practices and knowledge of staff stress.

Limitations

Time limit: Being constrained to only a few months I don't have time to gather and contact mutiple hospital systems or organizations that preform COVID testing the inferences will be limited to that of the individuals in my sample.

COVID-19 Restrictions: Communication for both particpates and expert advisor(s) is being preformed entirely online, in accordance to local gathering restricitions. So miscomunication or difficulty with data collection will be are forseen limitations as I won't be able to personally come down to gather data or oversee it or sort out any techniological miscommunications personally.

Findings

Out of 8 personnel who took the PSS-10
- 87.5% of personnels' scored on the low end of the stress scale.
- The other 12.5% of personnels' scored a moderate stress score.
- No personnels’ scores totaled in the higher range, scores ranging from 27-14.
- The average personnel stress level was low.
Out of 2 administrators who took a questionnaire
- The average administrator believed personnel stress level to be at a moderate level.
- Administrators figured PPE needed by personnel via census, test center numbers, previous month's usage.
- Both administrators responded PPE allocated met the amount the personnel needed (25 units or 20,000-30,000).

Conclusions and Implications

Conclusions:

Showed evidence for PPE allocation stress factor affecting personnel in the sample (8) by causing an average of low-stress levels.
Showed evidence for administration in the sample (2) having a belief that personnel stress was at a moderate level due to PPE allocation stress factor.
These two conclusions based upon sample data show evidence for a slight gap in understanding between what evidence showed personnel stress level as and what evidence showed administration believed personnel stress level to be.

Implications:

Could lead to administration action to checking up on staff stress levels in order to bridge the small gap in understanding found within this sample and perhaps verifying the findings of the sample through a more complete representative gathering of data for both populations.
Sample findings give an indication that the whole of the personnel population may feel decreased stress in association with this stress factor (PPE allocation) and that administration's new strategies of allocation are possibly effective. (Again more representative research needs to be done to verify this).
Previous research indicating that high levels of stress that lead to higher susceptibility of contracting respiratory illness is not a risk personnel in this sample need to worry about.

Key Sources

Chersich, M. F., Gray, G., Fairlie, L., Eichbaum, Q., Mayhew, S., Allwood, B., … Rees, H. (2020, May 15). COVID-19 in Africa: care and protection for frontline healthcare workers. Globalization and Health. https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-020-00574-3

Cohen, S., Tyrrell, D. A., & Smith, A. P. (1991, August 29). Psychological stress and susceptibility to the common cold. The New England Journal of medicine. https://pubmed.ncbi.nlm.nih.gov/1713648/.

Cohen, S. (1994). Perceived Stress Scale . Mind Garden. https://www.mindgarden.com/documents/PerceivedStressScale.pdf.

Doumbia, S., Sow, Y., Diakite, M., & Lau, C.-Y. (2020, September 17). Coordinating the research response to COVID-19: Mali's approach. Health Research Policy and Systems. https://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-020-00623-8.

Felice, C., Di Tanna, G. L., Zanus, G., & Grossi, U. (2020). Impact of COVID-19 Outbreak on Healthcare Workers in Italy: Results from a National E-Survey. Journal of community health, 45(4), 675–683. https://doi.org/10.1007/s10900-020-00845-5

Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. Springer.

Wollenstein-Betech, S., Silva, A. A. B., Fleck, J. L., Cassandras, C. G., & Paschalidis, I. C. (2020, October 14). Physiological and socioeconomic characteristics predict COVID-19 mortality and resource utilization in Brazil. PLOS ONE. https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0240346.

Next Steps

In future research, I hope that a larger sample size could be questioned for the administrative population and a larger sample of medical personnel could be surveyed on their percieved stress scores to establish their stress levels. Allowing for more representative data for both populations.
Also, this perceived stress scale modification strategy could be used in further research to indicate how other stress factors affect personnel stress level, replacing the questions context to match that of the new stress factor chosen in further research.

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