Newsletter July 2020: Training and safety of healthcare professionals during COVID-19 pandemic

Ana Luísa Vieira, Cândida Infante, Eunice Mendes, Mafalda Castro, Mariana Asseiro, Pedro Camões, Gustavo Norte

Anaesthesiology Residents, Department of Anaesthesiology, Coimbra University Hospital Center, Coimbra,  Portugal.


Coronavirus disease 2019 (COVID-19) is caused by the novel coronavirus that is called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and first emerged in December 2019 in Wuhan, Hubei province, China.1,2 Due to its progressive worldwide expansion, on March 11th 2020, COVID-19 was declared a pandemic by the World Health Organization.3

In a public health crisis, hospital staff are the frontline in the response of the healthcare system. As part of the job, they face a high-risk context due to the lack of knowledge and understanding of this new virus, fighting and putting themselves at risk of contracting this disease. Individual protection should be a priority in order to guarantee the balance of the healthcare system.4,5

Measures for infection prevention are categorised according to the routes of transmission of the infectious agent. In the case of COVID-19, precaution measures against contact and droplets should be taken, also with aerosol-generating procedures, since airborne spread could be a driver of transmission.6

Correct dressing, use and undressing of personal protection equipment (PPE) facing COVID-19 need to be practised because it is a new working routine for the majority of the staff.  Training the staff allowed us to implement basic precautions for the prevention and control of the infection based on the transmission dynamics.7

During the COVID-19 pandemic, anaesthesiology residents (AR) took a central role in health promotion and education as well as for securing healthcare workers safety. AR was part of the formation team from the Department of Anaesthesiology (COVID-19 formation team) from a Medical University Center. AR created cognitive resources, adapted and homogenised procedures for all anaesthesiologists in the hospital and taught how and when to correctly use  PPE.

Staff training session
Staff training session


In terms of cognitive resources, algorithms for choosing the right PPE were developed, also protocols and checklists for the correct use of different levels of PPE; illustrative and plasticised posters for display; registration forms for incidents during dressing and undressing of PPE; audiovisual support for the procedures (dressing and undressing PPE) and a website with all the important information gathered.

Concerning staff training, although our primary endpoint was to train anaesthesiologists and operating room nurses, after that, it was extended to different healthcare professionals (physicians from other departments, nurses, technicians and health assistants). 248 healthcare professionals were trained: 98 anaesthesiology doctors, 15 doctors from other departments, 75 nurses, 30 health assistants and 40 technicians (fig 1 and 2) during a two-month period.

The COVID-19 outbreak changed radically the world and consequently the reality for healthcare staff, who have a high risk of contracting the infection.8 This new life represents a huge challenge in terms of biological safety: the need of rescaling and restructuring departments, creating independent circuits and preparing healthcare professionals, not only for the use of PPE but most importantly for the better use of each PPE. Evidence shows that the correct use of PPE reduces the transmission rate and protects the team, so it is of paramount importance that each of those involved plays their vital role in  decreasing the spread of the disease.9

Use of PPE demonstration
Use of PPE demonstration


Anaesthesiologists have always been among the very pioneers on the culture of patient safety.  In fact, Leape et al (Methangkool E, 2018), laud anaesthesiology as providing “an outstanding example of how a high level of safety can be achieved in healthcare”, this speciality should be involved in the process of hospital decision making regarding professionals’ and patients’ security. Since the beginning of this pandemic, it has seemed to us fundamental to standardise and clearly define the rules and include in the training all the teams who work with anaesthesiologists.10

The role of AR in the training and education of the teams in the struggle against COVID-19 pandemic was extremely valuable for the staff who are daily fighting on the frontline. Thus, they were provided with all the necessary and appropriate knowledge and tools, ensuring success in the treating process of the patients. These formations with different groups of healthcare professionals have also allowed a fruitful discussion not only on how to select and use PPE but also on adequacy of behaviours and manners in common areas and in clarifying any doubts.

In addition to the active and essential role on the battle against this pandemic dealing directly with infected patients, anaesthesiologists have had substantial involvement in the process of training professionals, thus contributing to the reduction of the infection and spread of the disease with a substantial increase in overall safety.



  1. Temas da saúde. https://www.sns24.gov.pt/tema/doencas-infecciosas/covid-19/#sec. Accessed 20th May 2020.
  2. Novel coronavirus – China. http://www.who.int/csr/don/12-january-2020-novel-coronavirus-china/en/(Jan 12, 2020). Accessed 19th May 2020.
  3. Director-General’s opening remarks at the media briefing on COVID-19. https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19—11-march-2020 (11 March 2020). Accessed 19th May 2020.
  4. Adams JG, Walls RM.. JAMA. 2020 (Online). doi:10.1001/jama.2020.3972.
  5. Hoe Gan W, Wah Lim J, Koh D..  Saf Health Work. 2020 (Online). doi:10.1016/j.shaw.2020.03.001.
  6. Norma 7: Prevenção e Controlo de Infeção por SARS-CoV-2 (COVID-19): Equipamentos de Proteção Individual (EPI). https://www.dgs.pt/directrizes-da-dgs/normas-e-circulares-normativas/norma-n-0072020-de-29032020-pdf.aspx. Accessed 18th May 2020.
  7. Odor PM, Neun M, Bampoe S, et al. Br J Anaesth. 2020;S0007-0912(20)30200-2. doi:10.1016/j.bja.2020.03.025.
  8. Delgado D, Wyss Quintana F, Perez G, et al.Int J Environ Res Public Health. 2020;17(8):2798 doi:10.3390/ijerph17082798.
  9. Cook TM.  Anaesthesia. 2020 (Online) doi:10.1111/anae.15071.
  10. Methangkool E. Revista Sociedade Portuguesa Anestesiologia. 2018, 27 (4): 87-89. doi:10.25751/rspa.15118


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