To the Editor-With the progression of the coronavirus disease 2019 (COVID-19) pandemic, the personal protective equipment (PPE) shortage has been highlighted. 1 The sudden increase in demand for PPE due to the number of COVID-19 cases, misinformation, panic buying, and stockpiling resulted in global shortages. The World Health Organization (WHO) published a guideline for the rational use of PPE for coronavirus disease in healthcare and home-care settings during severe shortages. 2 Despite the importance of this topic, observational studies that evaluate the use of PPE during the pandemic by healthcare workers (HCWs) are scarce. A Chinese cross-sectional survey using a self-administered questionnaire included 1,357 HCWs and showed that 89% had sufficient knowledge and 89.7% followed correct practices concerning severe acute respiratory coronavirus virus 2 (SARS-CoV-2). 3 Researchers in the division of infection control and hospital epidemiology of a teaching hospital in Brazil observed compliance regarding additional transmission-based precautions in exclusive care units for patients suspect or confirmed to COVID-19 from April 1 to May 15, 2020. The institutional protocol to control the coronavirus disease was developed based on guidelines of the World Health Organization (WHO) and the National Health Surveillance Agency (ANVISA), a regulatory body of the Brazilian government. 4,5 Prior to the onset of observations, healthcare professionals (HCPs) received face-to-face or video training on SARS-CoV-2 precautions. In assistance activities, HCPs and support teams should follow contact and droplet precautions or contact and airborne precautions for aerosol-generating procedures. Compliance was considered as satisfactory when the HCPs wore all 5 proper PPE (ie, gown, eye protection, head cap, mask, and gloves) recommended for each specific procedure. During the study, 260 observations were performed and the compliance rate was 31.5% (n = 82). The compliance rate was 22% (2 of 9) among physiotherapists, 29% (15 of 52) among physicians, 31% (56 of 182) in the nursing team, and 53% (9 of 17) among all others (ie, nutrition team, occupational therapists, X-ray technicians, and cleaning staff). More than 1 improper PPE use was identified in each observation, totaling 322 failures, of which 40% (n=129) were practices that could have resulted in self-and/or environmental
