Personal protective equipment: Shortage or waste?

Abstract

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

Compliance of healthcare workers to the proper use of personal protective equipment during the first wave of COVID-19 pandemic

“…As the case in many other countries-even with higher socioeconomic status [ 3 , 21 , [29] , [30] , [31] , [32] ], most of our participants (82.4%) complained of shortage in PPE supplies (which showed statistical correlation with noncompliance). During the first wave, Egypt witnessed a serious shortage in gloves and mask [ 33 ] which caused wide-scale discussions in both; the medical community and the media.…”

“…When IPC practitioners and employers attempted to optimize the use of respirators, they faced the HCWs’ lack of trust and tendency to demand respirators for every encounter. The same issue had also been highlighted in literature [ 21 , 39 , 40 ]. However, the consumption of authentic imported respirators and intensive awareness campaigns organized by all relevant authorities have eventually led to anincrease in HCWs’ awareness.…”

“…One study in Egypt, assessed the application of recommended PPE in a tertiary care facility based on a questionnaire, in which, authors reported only 31.8% of SARS-CoV-2 infected HCWs as compliant [ 20 ]. In Brazil, researchers observed the compliance rate of HCWs to proper PPE use -in a special unit for suspected and confirmed COVID-19 cases-and found it to be 31.5% [ 21 ]. Also, low rate of consistent PPE use was reported in Congo [ 22 ].…”

“…According to our results, receiving prior training on the proper use of PPE exposure to patients with COVID-19, and performing procedures that pose HCWs at high risk of exposure to SARS-CoV-2 represented the most significant predicting factors for compliance to PPE use. This finding was not astonishing; bearing in mind HCWs substantial fear and anxiety, that led to unnecessary overuse of some items [ 21 , 29 ]. It is also worth noting that in Egypt the steady rise in cases had not started until June 2020.…”

Donning and doffing technique for coverall personal protective equipment, is it safe?

“…1,2 An observational compliance study regarding specific precautions for COVID-19 patients showed that among improper PPE use, 193 of 322 (60.%) were classified as wasteful practices that contributed to the shortage of these products. 3 The lack of gowns has ignited a search for alternative PPE such as coveralls. The World Health Organization (WHO) guideline did not recommend coveralls as alternative PPE.…”