Keeping patients safe by keeping healthcare workers safe

The theme of this year’s World Patient Safety Day aims to raise awareness about the importance of health worker safety and its link to patient safety, among others. — Photos: AZHAR MAHFOF/The Star

World Patient Safety Day will be commemorated globally on Thursday (Sept 17, 2020) with the theme Health Worker Safety: A Priority For Patient Safety.

The World Health Organization (WHO) stated that: “The Covid-19 pandemic is presently among the biggest challenges and threats to face the world and humanity, and healthcare is living its greatest crisis in patient safety ever!

“The pandemic has exerted unprecedented pressure on health systems worldwide.

“Health systems can only function with health workers, and a knowledgeable, skilled and motivated health workforce is critical for the provision of safe care to patients.”

The objectives of this year’s (2020) World Patient Safety Day, which is the second one to be observed after the inaugural Day last year (2019), are to:

  • Raise global awareness about the importance of health worker safety and its interlinkages with patient safety.
  • Engage multiple stakeholders and adopt multimodal strategies to improve the safety of health workers and patients.
  • Implement urgent and sustainable actions by all stakeholders that recognise and invest in the safety of health workers as a priority for patient safety.
  • Provide due recognition of health workers’ dedication and hard work, particularly amid the current fight against Covid-19.

In urging all stakeholders to speak up, WHO stated: “The Covid-19 pandemic has highlighted the huge challenges health workers are currently facing globally.

“Working in stressful environments exacerbates safety risks for health workers, including being infected and contributing to outbreaks in the healthcare facility; having limited access or adherence to personal protective equipment (PPE) and other infection prevention and control measures; and inducing errors, which can potentially harm patients and health workers.

“In many countries, health workers are facing increased risks of infections, violence, accidents, stigma, illness and death.”

Death and fear

At one point, Malaysia was so short of PPE that medical staff were doubling as seamstresses to make their own.At one point, Malaysia was so short of PPE that medical staff were doubling as seamstresses to make their own.

Reports and data on the sacrifices of healthcare workers (HCWs), many of whom have died, have been increasing worldwide.

China reported that as of Feb 24 (2020), 3,387 of 77,262 (4.4%) patients with Covid-19 were HCWs; 23 had died as of April 3 (2020).

And as of May 1 (2020), 100 doctors in Italy had died from Covid-19.

A review of the characteristics of 120 doctors who died from Covid-19 in 11 countries in western Europe and Asia-Pacific reported that 90% were men, 30% were general practitioners (GPs) and 11.6% were physicians.

Another review of 1,004 reported deaths among health workers worldwide, reported that 55% of those who died were doctors as of May 13 (2020).

Doctors in general practice/family medicine/primary care accounted for 26.2% of the deaths, followed by 5.5% in internal medicine, 4.7% in emergency medicine/critical care, 4.7% in paediatrics and 4.0% in obstetrics and gynaecology.

The Pan American Health Organization (Paho), which serves as the regional office of WHO in the Americas, reported that there were 569,304 Covid-19 cases, including 2,506 deaths, in 19 of its member countries as of Aug 19 (2020).

In HCWs, 72% of the patients were females, with the highest frequency in the 30-49-years age group.

Covid-19 has also put considerable physical and emotional strain on HCWs.

This is because they face a greater risk of exposure, increased workload, dilemmas providing care and having to deal with a continuously changing work environment, e.g. visual consultations replacing face-to-face and shifting care guidelines.

The risk factors that contribute to psychological issues include the lack of PPE, being quarantined and personal health fears.

The consequences are fatigue, anxiety, depression, burnout, lack of professional fulfilment, and even leaving the profession.

Stats in Malaysia

As of March 21 (2020), 24 local HCWs were Covid-19 positive.

On April 22 (2020), Health director-general Tan Sri Dr Noor Hisham Abdullah stated that 45 private GPs had tested positive for Covid-19.

The next day, he reported that 325 ministry HCWs were positive.

In its last report to mention HCWs on June 19 (2020), the Health Ministry stated that there were then 363 Covid-19 positives of 28,512 staff screened, i.e. a 1.27% positive rate.

On Aug 24 (2020), Parliament was informed that four HCWs have died from Covid-19, three of whom contracted the disease abroad.

It was reported separately that the one who contracted it locally was a close contact of another Covid-19 patient.

Then on Sept 9 (2020), Dr Noor Hisham said that 53% of ministry staff who were positive contracted Covid-19 from their colleagues, 22% from the community and 17% from patients whose test results were then unknown.

The number of staff who were positive was not stated.

As of Sept 10 (2020), there has been no further published analysis of Covid-19 cases among Malaysian HCWs.

Physical and mental protection

A constant refrain from HCWs globally has been the lack of available PPE.Improvised PPE was made out of various materials, including plastic sheets (seen here), garbage bags and stationery. — REMAR NORDIN/The StarImprovised PPE was made out of various materials, including plastic sheets (seen here), garbage bags and stationery. — REMAR NORDIN/The Star

Malaysia was no exception at one time. On April 13, Dr Noor Hisham stated that its PPE supply would only last another two more weeks.

The situation was summarised succinctly at a forum organised by local civil society organisations coalition CSO Platform for Reform on June 2: “There has to be – this is one area where I’d think to look back – somewhere a central document file of necessary equipment, whether it’s PPE or ventilators or what have you, (and) a central distribution system, because at one time, it was almost like every man for himself.”

It is now increasingly recognised globally that psychological PPE is also needed by HCWs, i.e. individual and system-level actions to safeguard and support the mental health and well-being of HCWs.

The US Institute for Healthcare Improvement (IHI) has issued recommendations based on a review of evidence for interventions that protect staff mental health in extreme working conditions like natural disasters, terrorist attacks and previous pandemics.

The psychological PPE of Malaysian HCWs is unlikely to have been promoted by work issues like delays in receipt of salaries and allowances, non-extension of contracts for some, and limited or no opportunities for specialisation.

Care for them

Doctors and nurses provide care to patients with many conditions, including Covid-19, on a daily basis.

As they care for everyone, society also has to care for their safety.

Actions to protect HCWs have to be based on scientific evidence.

The sharing of data with all HCWs will also help to better track viral spread and build their confidence in the measures to ensure their physical and psychological safety.

HCWs have often been termed frontliners, which is a misnomer.

A more accurate term is society’s “last line of defence” against Covid-19 and other diseases.

If and when HCWs’ safety is affected, the consequences may be a shortage of trained personnel to provide adequate and safe healthcare.

Readers who are in a position of authority to do so, are requested to help light up a building or significant landmark in orange, which is the signature mark of World Patient Safety Day, on Sept 17 (2020) as a representation of the public’s recognition of HCWs’ efforts globally to provide safe healthcare every single day for their patients.

Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. For more information, email The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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