Gezahegn Tesfaye Mekonin

Background: Emerging of anesthetics opens a new era to medical discipline in relieving patients’ pain and stress when undergoing surgery but simultaneously exposes the healthcare personnel working in areas of anesthetics exposure to many adverse health effects including reproductive outcomes effects. Thus, this study aimed to assess the effect of inhalational anesthetics exposure on reproductive outcomes and its predictors among health care personnel in hospitals of Jimma zone public hospitals. Methods: A comparative cross-sectional study was conducted from May 01 to 30, 2021. We approached 483 healthcare personnel in Jimma zone public hospitals to partake in this study. Of this number, we recruited 292 healthcare personnel, comprising 146 exposed healthcare personnel and 146 unexposed healthcare personnel. Structured questionnaires were used to assess the reproductive outcomes. Data were entered into EPI-data version 4.6.1 and exported to SPSS version 24 for analysis. Binary logistic regressions were carried out to identify associated factors with reproductive outcomes. Statistical significance was declared using a p value < 0.05. Results: The overall prevalence of bad reproductive outcome status was high (30.8%) and the prevalence was much higher among exposed HCPs (20.9%) when compared to unexposed HCPs (9.9%). Among a total of 292 HCPs the likelihood of occurred bad reproductive outcomes was higher among an exposed group (AOR=3.17, 95% CI: 1.40– 7.16) and those who smoke cigarettes (AOR=8.44, 95% CI: 1.93– 36.91). The occurrence rate of bad reproductive outcome was higher among 30– 45h/week exposure (AOR=11.94, 95% CI: 1.25– 24.95) if separately analyzed among exposed and age of couple above 41 years among unexposed (AOR=5.87, 95% CI: 1.56– 22.06) were significantly associated with bad reproductive outcomes. Conclusion: Prevalence of bad reproductive outcomes was higher among exposed HCPs. Hence, it requires attention to create awareness about the danger of anesthetics exposure in the study setting, suggesting the need to further minimize the exposure.

Background: The nature of COVID-19 transmission creates significant risks in surgical departments owing to the close contact of medical staff with patients, the limited physical environment of the operating room and recovery room, the possibility of shared surgical equipment and challenges in the delivery of surgical care in all surgical departments. Globally, studies have reported that the effects of the pandemic on surgical departments are profound, potentially long-lasting and extensive. To manage these effects, different local guidelines and recommendations have been developed, with potential differences in their effectiveness and implementation. Therefore, harmonized and effective national/international guidelines for specific surgical departments during perioperative periods are pertinent to curtail the infection, and will inevitably need to be adapted for consistent and sustainable implementation by all medical staff. The pattern of surgical patient care during the COVID-19 pandemic at Jimma Medical Center (JMC), Ethiopia, has not been explored yet. The present study aimed to describe the pattern of perioperative surgical patient care, equipment handling and operating room management during the COVID-19 pandemic at JMC. Methods: A cross-sectional study was conducted to describe the pattern of perioperative surgical patient care, equipment handling and operating room management during the COVID-19 pandemic at JMC, using five-point Likert scales (0, not at all; 1, rarely; 2, sometimes; 3, most of the time; 4, frequently). A total of 90 respondents [35 patients (five patients from each of seven surgical departments) and 55 healthcare providers (six professionals from each of nine units, including the center of sterility room and anesthesia)] who were available during the study period, selected by a convenience sampling technique with multistage clustering, participated in the study. Data were collected using a structured questionnaire via direct observation and face-to-face interviews with patients undergoing surgery, healthcare providers and hospital administrators, against the standard surgical patient care guidelines. The collected data were manually checked for missing values and outliers, cleared, entered into EpiData (v4.3.1) and exported to SPSS (v22) for analysis. The mean score of practice was compared among different disciplines by applying the unpaired t-test. The findings of the study were reported using tables and narration. A p-value of less than 0.05 was declared as statistically significant. Results: Despite the surgical care practice having changed during the COVID-19 pandemic in all service domains, it is not implemented consistently among different surgical departments owing to different barriers (lack of training on the updated guidelines and financial constraints). The majority of surgical staff were implementing the use of preventive measures against COVID-19, while they were practiced less among patients. The guidelines for surgical practice during the preoperative phase were well applied, especially screening patients by different methods and the application of telemedicine to reduce physical contacts. But, against guidelines, elective patients were planned and underwent surgery, especially in the general surgery department. The implementation of recommended guidelines in the center of sterility room in handling surgical equipment was not very different before and during the pandemic. The extent of practice for anesthesia care, operating room management and postoperative care in the recovery room also changed, and the guidelines were sometimes applied. Conclusion and Recommendations: Although perioperative surgical care practice differed before and during the pandemic, the standard guidelines were inconsistently implemented among surgical departments. The implementation of recommended guidelines in the center of sterility room in handling surgical equipment was not very different before and during the pandemic. Thus, the authors developed safe surgical care guidelines throughout the different domains (infection prevention and PPE use; preoperative care, intraoperative care, operating room management, anesthesia care, equipment handling process and postoperative care) for all disciplines and shared them with all staff. We recommend that all surgical staff should access these guidelines and strictly adhere to them for surgical service during the pandemic.