This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Objectives: To evaluate PPE-preparedness across intensive care units (ICUs) in 6 Asia-Pacific countries. PPE-preparedness was defined as the adherence to guidelines, training HCWs, procuring PPE stocks and responding appropriately to a suspected case (transportation and admission to hospital). Design: Cross-sectional web-based survey. Setting: ICUs in Australia, New Zealand (NZ), Singapore, Hong Kong (HK), India and Philippines with a 24/7 Emergency/Casualty Department, and capable of mechanically ventilating patients for more than 24 hours. Interventions: Questionnaire sent to intensivists in 633 Level II/III ICUs in 6 Asia-Pacific countries by email, WhatsApp and text messaging. Main outcome measures: 263 intensivists responded, of whom 231 were eligible for analysis. Response rates were 68%-100% in all countries except India, where it was 24%. 97% either conformed to or exceeded WHO recommendations for PPE-practice. 59% employed airborne precautions irrespective of aerosol-generation-procedures. There were variations in negative-pressure room use (highest in HK/Singapore), training (best in NZ), and PPE stock-awareness (best in HK/Singapore/NZ). High-flow-nasal-oxygenation and non-invasive ventilation were not options in most HK (66.7%, 83.3% respectively) and Singapore ICUs (50%, 80% respectively), but were considered in other countries to a greater extent. 38% reported not having specialized airway teams. Showering and buddy-systems were underutilized. Clinical waste disposal training was suboptimal (38%). Conclusions: Most intensivists from six Asia-Pacific countries appeared to be aware of the WHO PPE-guidelines by either conforming to/exceeding the recommendations. Despite this, there were widespread variabilities across ICUs and countries in several domains, particularly related to PPE-training and preparedness. Standardising PPE guidelines may translate to better training, better compliance and policies that improve HCW safety. Adopting low-cost approaches such as buddy-systems should be encouraged. More importantly, better pandemic preparedness and building systems with deeply embedded culture of safety is essential to ensure the safety and well-being of HCWs during such pandemics.

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Background: Clinical guidelines on infection prevention strategies in healthcare workers (HCWs) play an important role in protecting them during the SARS-CoV-2 pandemic. Poorly constructed guidelines that are not comprehensive and are ambiguous may compromise HCWs safety. We aimed to develop and validate a tool to appraise guidelines on infection prevention strategies in HCWs. Methods: A 3-stage, web-based, Delphi consensus-building process among a panel of diverse HCWs and healthcare managers was utilised. We validated the tool by appraising 40 international, specialty-specific and procedure-specific guidelines along with national guidelines from countries with a wide range of gross national income. Results: Overall consensus (>75%) was reached at the end of three rounds for all six domains included in the tool. The chosen domains allowed appraisal of guidelines in relation to general characteristics (domain-1), recommendations on engineering (domain-2) and administrative aspects (domain 4-6) of infection prevention, as well as personal protection equipment (PPE) use (domain-3). The appraisal tool performed well across all domains and inter-rater agreement was excellent. All included guidelines performed relatively better in domains 1-3 compared with domains 4-6 and this was more evident in guidelines originating from lower income countries. Conclusion: The guideline appraisal tool was robust and easy to use. Recommendations on engineering aspects of infection prevention, administrative measures that promote optimal PPE use and HCW wellbeing were generally lacking in assessed guidelines. This tool may enable health systems to adopt high quality HCW infection prevention guidelines during SARS-CoV-2 pandemic and may also provide a framework for future guideline development.

This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.