COVID-19 infection is related to differences in the use of personal protective equipment by orthopaedic specialist trainees caring for hip fracture patients during the second surge of COVID-19 in the North West of England

Abstract

Introduction Personal protective equipment (PPE) may protect health-care workers from COVID-19 infection and limit nosocomial spread to vulnerable hip fracture patients. Methods We performed a cross-sectional survey amongst orthopaedic trainees to explore PPE practice in 19 hospitals caring for hip fracture patients in the North West of England. Results During the second wave of the pandemic, 14/19 (74%) hospitals experienced an outbreak of COVID-19 amongst staff or patients on the orthopaedic wards. An FFP3 respirator mask was used by doctors in only 6/19 (32%) hospitals when seeing patients with COVID-19 and a cough and in 5/19 (26%) hospitals when seeing asymptomatic patients with COVID-19. A COVID-19 outbreak was reported in 11/13 (85%) orthopaedic units where staff wore fluid resistant surgical masks compared to 3/6 (50%) units using an FFP3 respirator mask (RR 1.69, 95% CI 0.74-3.89) when caring for symptomatic patients with COVID-19. Similarly, a COVID-19 outbreak was reported in more orthopaedic units caring for asymptomatic patients with COVID-19 where staff wore fluid resistant surgical masks (12/14 (86%)) as compared to an FFP3 respirator mask (2/5 (40%)) (RR 2.14, 95% CI 0.72-6.4). Conclusion Urgent re-evaluation of PPE use is required to reduce nosocomial spread of COVID-19, amongst highly vulnerable patients with hip fracture.

Effectiveness of face masks for reducing transmission of SARS-CoV-2: a rapid systematic review

“…Table 2 summarizes the number of studies addressing each type of comparison studied and the direction of their conclusions. There were 35 studies set in the community (three RCTs (14-16), 32 observational studies [15][16][17][18][19]48] and 40 studies situated in healthcare settings including hospitals and long-term care facilities (LTCFs) (one RCT [72], 39 observational studies [73][74][75][76][77][78][79][80][81][82][83][84][85][86][87][88]).…”

“…[ 73 ] observational Switzerland types of masks serology (CLIA or ELISA) questionnaire Mastan et al . [ 74 ] observational UK types of masks testing (method not specified) questionnaire Oksanen et al . [ 75 ] observational Finland masks for reducing transmission RT-PCR questionnaire Pan et al .…”

“…Nineteen studies compared the effectiveness of different types of masks for reducing transmission of SARS-CoV-2: four studies (two RCTs, two observational) in community settings [14,16,23,47] and 15 studies (one RCT, 14 observational) in healthcare settings [50,52,57,68,[70][71][72][73][74]78,80,[82][83][84]88].…”

Orthopaedic education: a COVID-driven evolution

“…For those wanting an update on some specific adult trauma topics, Pearce et al [ 25 ] have provided a fantastic overview on the management of atypical femoral fractures. These are increasingly common occurrences in our daily practice and can prove challenging to treat.…”