Perceptions of Occupational Risk and Changes in Clinical Practice of U.S. Vitreoretinal Surgery Fellows during the COVID-19 Pandemic

Khan, M. Ali; Sivalingam, Arunan; Haller, Julia A.

Abstract Purpose To assess perceptions of occupational risk and changes to clinical practice of ophthalmology trainees in the United States during the COVID-19 pandemic. Design An anonymous, non-validated, cross-sectional survey was conducted online. Data was collected from April 7-16, 2020. Participants 2019-2020 second year U.S. vitreoretinal surgery fellows in two-year vitreoretinal surgery training programs were invited to participate. Intervention Online survey. Main outcome measures Survey questions assessed policies guiding COVID-19 response, known or suspected exposure to SARS-CoV-2, changes in clinical duties and volume, and methods to reduce occupational risk including availability of personal protective equipment. Results Completed responses were obtained from 62 of 87 eligible recipients (71.2% response rate). Training settings included academic (58.1%), hybrid academic/private practice (35.5%), and private practice only settings (6.5%). Overall, 19.4% of respondents reported an exposure to a COVID-19 positive patient, 14.5% reported self-quarantining due to possible exposure, and 11.3% reported being tested for COVID-19. In regards to PPE, N95 masks were available in the emergency room (n=40, 64.5%), office (n=35, 56.5%), and operating room settings (n=35, 56.5%). Perceived comfort level with PPE recommendations was significantly associated with availability of an N95 respirator mask in the clinic (p<0.001), emergency room (p<0.001) or operating room (p=0.002) settings. Additional risk mitigation methods outside of PPE were: reduction in patient volume (n=62, 100%), limiting patient companions (n=59, 95.2%), use of a screening process (n=59, 95.2%), use of a slit lamp face shield (n=57, 91.9%), temperature screening of all persons entering clinical space (n=34, 54.84%), and placement of face mask on patients (n=33, 53.2%). Overall, 16.1% reported additional clinical duties within the scope of ophthalmology, and 3.2% reported being re-deployed to non-ophthalmology services. 98.4% of respondents expected a reduction in surgical case volume. No respondents reported loss of employment or reduction in pay or benefits due to COVID-19. Conclusion and Relevance: Suspected or confirmed clinical exposure to COVID-19 positive patients occurred in approximately one-fifth of trainee respondents. Perceived comfort level with PPE standards was significantly associated with N95 respirator mask availability. As surgical training programs grapple with the COVID-19 pandemic, analysis of trainees’ concerns may inform development of mitigation strategies.