Multidimensional dynamic healthcare personnel (HCP)-centric model from a low-income and middle-income country to support and protect COVID-19 warriors: a large prospective cohort study
Mini P Singh,
Sanjay Jain,
Gurmeet Singh,
Ashok Kumar,
Pankaj Malhotra,
Manisha Biswal,
Inderpaul Singh Sehgal,
Ritesh Agarwal,
Swapnajeet Sahoo,
Muralidharan Jayashree,
J S Thakur,
Vipin Koushal,
Vikas Suri,
Rakesh Kochhar,
Usha Dutta,
Jayanta Samanta,
Madhumita Premkumar,
Arnab Ghosh,
Narayana Yaddanapudi,
Ritin Mohindra,
Ashish Bhalla,
Anurag Sachan,
Tulika Gupta,
Sandeep Grover,
Sugandhi Sharma,
P V M Lakshmi,
Shweta Talati,
Babita Ghai,
Rajesh Chhabra,
Bhavneet Bharti,
Pankaj Arora,
Sunita Malhotra,
Rashmi Ranjan Guru,
Navin Pandey,
Ranjitpal Singh Bhogal,
Arun K Aggarwal,
Kapil Goel,
Pranay Mahajan,
Rakesh Sehgal,
Arunaloke Chakrabarti,
Goverdhan Dutt Puri,
Jagat Ram
Affiliations
Mini P Singh
Department of Virology, PGIMER, Chandigarh, India
Sanjay Jain
1Post Graduate Institute of Medical Education and Research, Chandigarh, Internal Medicine, Chandigarh, India
Gurmeet Singh
Department of Critical Care Medicine, Department of Surgery, Division of Cardiac Surgery, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
Ashok Kumar
5 Dr.A.V. Baliga Memorial Trust, New Delhi, India
Pankaj Malhotra
1 Clinical Hematology and Medical Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Manisha Biswal
2 Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
Inderpaul Singh Sehgal
Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Ritesh Agarwal
Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Swapnajeet Sahoo
Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Muralidharan Jayashree
Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
J S Thakur
Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Vipin Koushal
Department of Hospital Administration, PGIMER, Chandigarh, India
Vikas Suri
Postgraduate Institute of Medical Education and Research, Chandigarh, India
Rakesh Kochhar
3 Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Usha Dutta
Postgraduate Institute of Medical Education and Research, Chandigarh, India
Jayanta Samanta
Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Madhumita Premkumar
Department of Hepatology, Postgraguate Institute of Medical Education and Research, Chandigarh, India
Arnab Ghosh
1Memorial Sloan Kettering Cancer Center, New York, NY, USA
Narayana Yaddanapudi
Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Ritin Mohindra
Postgraduate Institute of Medical Education and Research, Chandigarh, India
Ashish Bhalla
Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
Anurag Sachan
Department of Gastroenterology, PGIMER, Chandigarh, India
Tulika Gupta
Department of Anatomy, PGIMER, Chandigarh, India
Sandeep Grover
3 Center for Human Genetics, Universitatsklinikum Giessen und Marburg - Standort Marburg, Marburg, Germany
Sugandhi Sharma
Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
P V M Lakshmi
professor
Shweta Talati
Department of Hospital Administration, PGIMER, Chandigarh, India
Babita Ghai
Department of Anesthesia, PGIMER, Chandigarh, India
Rajesh Chhabra
Department of Neurosurgery, PGIMER, Chandigarh, India
Bhavneet Bharti
Department of Pediatrics, PGIMER, Chandigarh, India
Pankaj Arora
Department of Hospital Administration, PGIMER, Chandigarh, India
Sunita Malhotra
Department of Dietetics, PGIMER, Chandigarh, India
Rashmi Ranjan Guru
Department of Hospital Administration, PGIMER, Chandigarh, India
Navin Pandey
Department of Hospital Administration, PGIMER, Chandigarh, India
Ranjitpal Singh Bhogal
Department of Hospital Administration, PGIMER, Chandigarh, India
Arun K Aggarwal
Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
Kapil Goel
Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
Pranay Mahajan
Department of Hospital Administration, PGIMER, Chandigarh, India
Rakesh Sehgal
Department of Parasitology, PGIMER, Chandigarh, India
Arunaloke Chakrabarti
Department of Microbiology, PGIMER, Chandigarh, India
Goverdhan Dutt Puri
Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Jagat Ram
Department of Ophthalmology, PGIMER, Chandigarh, India
Objectives Healthcare personnel (HCP) are at an increased risk of acquiring COVID-19 infection especially in resource-restricted healthcare settings, and return to homes unfit for self-isolation, making them apprehensive about COVID-19 duty and transmission risk to their families. We aimed at implementing a novel multidimensional HCP-centric evidence-based, dynamic policy with the objectives to reduce risk of HCP infection, ensure welfare and safety of the HCP and to improve willingness to accept and return to duty.Setting Our tertiary care university hospital, with 12 600 HCP, was divided into high-risk, medium-risk and low-risk zones. In the high-risk and medium-risk zones, we organised training, logistic support, postduty HCP welfare and collected feedback, and sent them home after they tested negative for COVID-19. We supervised use of appropriate personal protective equipment (PPE) and kept communication paperless.Participants We recruited willing low-risk HCP, aged <50 years, with no comorbidities to work in COVID-19 zones. Social distancing, hand hygiene and universal masking were advocated in the low-risk zone.Results Between 31 March and 20 July 2020, we clinically screened 5553 outpatients, of whom 3012 (54.2%) were COVID-19 suspects managed in the medium-risk zone. Among them, 346 (11.4%) tested COVID-19 positive (57.2% male) and were managed in the high-risk zone with 19 (5.4%) deaths. One (0.08%) of the 1224 HCP in high-risk zone, 6 (0.62%) of 960 HCP in medium-risk zone and 23 (0.18%) of the 12 600 HCP in the low-risk zone tested positive at the end of shift. All the 30 COVID-19-positive HCP have since recovered. This HCP-centric policy resulted in low transmission rates (<1%), ensured satisfaction with training (92%), PPE (90.8%), medical and psychosocial support (79%) and improved acceptance of COVID-19 duty with 54.7% volunteering for re-deployment.Conclusion A multidimensional HCP-centric policy was effective in ensuring safety, satisfaction and welfare of HCP in a resource-poor setting and resulted in a willing workforce to fight the pandemic.
