Personal Protective Equipment Guidance Research Articles

Risk assessment and the use of personal protective equipment in an emergency department: Differing perspectives of emergency and infection control clinicians. A video-vignette survey

The use of personal protective equipment (PPE) in emergency departments (EDs) is an important defense during infectious disease emergencies. However, what counts as appropriate PPE in EDs is contentious and inconsistently implemented in practice. An online scenario-based video survey was distributed through purposive sampling, and completed by 270 ED and infection prevention and control clinicians in Australia. A descriptive content analysis was performed on the data, and differences between groups were tested using Fisher exact test. Participants agreed that most items were required in both scenarios. Eye protection, mask use, and hand hygiene frequency were more contentious. Physicians were more likely than nurses, and ED clinicians more likely than infection prevention and control clinicians, to regard items or actions as optional rather than essential. Many ED clinicians, particularly physicians, regarded sequences as too time-consuming to be practical in a busy ED. Our findings likely reflect differences in professional roles, competing priorities, and risks, and highlight important contextual characteristics of EDs, such as diagnostic uncertainty, equipment inaccessibility, and resource constraints. To be feasible, practicable, and thereby effective, PPE guidance in the ED must be designed collaboratively with frontline ED staff, and reflects the complexities of their practice.

Victoria's surgical response to the COVID-19 pandemic: the first two years.

Victoria suffered three major waves during the first two years of the COVID-19 pandemic. Melbourne became the longest locked down city in the world at 267 days. This narrative review documents the chronological waves of COVID-19 in Victoria and key themes influencing the State-wide surgical response. In 2020, Victoria needed to secure supplies of personal protective equipment (PPE) and later, recognizing the importance of aerosol transmission, introduced a respiratory protection program to protect health care workers (HCWs) with fit-tested N-95 masks. It established routine preoperative PCR testing for periods when community prevalence was high and developed strategies to restrict elective surgery when hospital capacity was limited. In 2021, three short-term outbreaks were contained and eliminated whilst vaccination of HCWs and the vulnerable was taking place. A third major wave (Delta) occurred July to November 2021, succeeded by another involving the Omicron variant from December 2021. Planned surgery waiting list numbers, and waiting times for surgery, doubled between March 2020 and March 2022. In early 2022, almost 300 patients underwent surgery when infected with Omicron, with a low mortality (2.6%), though mortality was significantly higher in the unvaccinated (7.3% versus 1.4%). In conclusion, the Victorian response to COVID-19 involved tight state-wide social restrictions, contact tracing, furlough, escalating PPE guidance and respiratory protection. HCW infections were greatly reduced in 2021 compared with 2020. Pre-operative PCR testing gave confidence for emergency and urgent elective surgery to proceed during pandemic waves. Other elective cases were performed as health system capacity allowed, without compromising outcomes.

UK CoPACK Study: knowledge and confidence of healthcare workers in using personal protective equipment and related anxiety levels during the COVID-19 pandemic

Healthcare workers (HCWs) are at increased risk of coronavirus 2019 (COVID-19) infection. Personal protective equipment (PPE) and infection control guidelines help limit transmission. However, poor confidence leads to higher levels of anxiety rates and infection. We assessed knowledge and confidence in PPE among HCWs and associated anxiety. A cross-sectional, multi-centre survey using a validated questionnaire assessing actual and self-perceived knowledge on PPE was distributed among HCWs across the UK. Confidence in PPE and levels of anxiety were assessed using the General Anxiety Disorder-7 (GAD-7) tool. In total, 1,055 responses were received; 99% had familiarity with PPE guidance; however, only 15% correctly answered questions on PPE guidance; 86% and 80% had received mask-fitting and donning-doffing training, respectively; 33% indicated poor/very poor hospital communication. Confidence and anxiety were related to: profession; comorbidities; self-perceived knowledge; and PPE training and communication. Confidence in PPE was poor and anxiety was related to inadequate information and training. Thus, improved communication is required for effective response to subsequent COVID-19 waves and similar pandemics.

Experiences of personal protective equipment and reasons for non-compliance

Background:The COVID-19 pandemic created challenges in prehospital care. Paramedics have been required to adhere to strict protocols regarding infection control and the use of personal protective equipment (PPE). These protocols have evolved as the pandemic progressed. Understanding the experiences of paramedics in using PPE and their reasons behind not adhering to recommended guidelines should improve the limited evidence base and assist healthcare organisations to form tailored PPE guidance, enabling better protection of paramedics.Aim:This study aimed to analyse evidence on paramedics' experiences of using PPE and explore the reasons behind non-compliance to inform PPE policies.Methods:Searches of five key databases identified papers relating to frontline practitioners' experiences of using PPE; frontline was defined as working in patient-facing roles in prehospital, emergency department or critical care settings. Articles were then subject to thematic analysis as part of this narrative review.Results:Three themes emerged: physical and emotional wellbeing; impact on patient care and clinical effectiveness; and PPE fatigue. The evidence explores health professionals' experiences of working in this difficult environment but very little data exist regarding the impact of PPE, specifically on UK paramedics or their reasons for not adhering to PPE protocols.Conclusion:PPE affects wearers in a variety of ways. Factors behind non-adherence are multifactorial. A paucity of literature exists regarding paramedics' experiences of using PPE.

Stewardship of Personal Protective Equipment (PPE) During a Pandemic

BackgroundThe use of PPE is fundamental in protecting healthcare workers (HCWs) from being exposed to SARS-CoV2. The pandemic caused global PPE shortages forcing institutions to address appropriate utilization and conservation. Initial efforts to limit PPE distribution to avoid misuse and frequent changes in public health guidance created confusion and apprehension amongst HCWs.MethodsInfection Prevention and Control (IP&C) implemented a PPE stewardship initiative, consisting of daily rounds on patients positive or suspected of COVID-19. Principles included: 1.) supporting HCWs caring for these patients, 2.) assure implementation of infection prevention principles for a safe environment, 3.) advise on appropriate PPE and isolation precautions with respect to patient acuity, and 4.) promote best practices aligning with the most up-to-date guidance.Rounds addressed questions and concerns regarding PPE availability and utilization. We partnered with Nursing and Respiratory Therapy to alleviate demands on IP &C. The "PPE Spotters" team, monitored and optimized PPE utilization, supply, and distribution; provided training on donning/doffing, PAPR use, PPE reuse; and provided general support to HCWs for questions.ResultsWe measured number of isolation days of confirmed or suspected patients with COVID-19 and the numbers of N95 masks distributed to units during the 4-week period before (18.2 mask per isolation day) and the 8-week period after (3.0 masks per isolation day) the PPE Spotter team was formed. Our PPE stewardship efforts successfully limited N95 misuse as community COVID-19 burden increased.ConclusionsThis multi-disciplinary resource, particularly during periods of evolving PPE guidance and supply chain insecurity, was vital. Additionally, it expanded the pool of staff to advocate for HCW safety and IP&C principles.All HCWs can benefit from learning about this novel model that can be adapted to any institution and various scenarios. We recently adopted this model to support staff in psychiatry with an influx of patient volumes and their needs.

424. The Impact of COVID-19 Response on Infection Prevention Programs and Practices in Southeastern United States

BackgroundEarly assessments of COVID19 preparedness reported resource shortages, use of crisis capacity strategies, variations in testing, personal protective equipment (PPE), and policies in US hospitals. One year later, we performed a follow-up survey to assess changes in infection prevention practice and policies in our diverse network of community and academic hospitals.MethodsThis was a cross-sectional electronic survey of infection preventionists in 58 hospitals within the Duke Infection Control Outreach Network (community) and Duke/UNC Health systems (academic) in April-May 2021 to follow-up our initial survey from April 2020. The follow-up survey included 26 questions related to resource availability, crisis capacity strategies, procedures, changes to PPE and testing, and staffing challenges. ResultsWe received 54 responses (response rate, 93%). Facilities reported significantly fewer PPE and resource shortages in the follow-up survey compared to our initial survey (Figure 1, P< 0.05). Only 32% of respondents were still reprocessing N95 respirators (compared to 73% in initial survey, P< 0.05). All hospitals performed universal masking, universal symptom screening on entry, and 30% required eye protection. In 2020, most hospitals suspended elective surgical procedures in March-April, and restarted in May-June. Approximately 92% reported in-house testing for SARS-COV-2 by April 2020, at least a third of which had a weekly capacity of >100 tests. Almost 80% performed universal pre-operative testing, while 61% performed universal preadmission testing for SARS-COV-2. Almost all hospitals switched from test-based to time-based strategy for discontinuing isolation precautions, majority in August-September 2020. Twenty-five percent hospitals reported infection prevention furloughs, staffing cuts, and or reassignments, while 81% reported increased use of agency nursing during the pandemic.ConclusionOur follow-up survey reveals improvement in resource availability, evolution of PPE guidance, increase in testing capacity, and burdensome staffing changes. Our serial surveys suggest increasing uniformity in infection prevention policies, but also highlight the increase in staff turnover and infection prevention staffing shortages.Disclosures Sonali D. Advani, MBBS, MPH, Nothing to disclose David J. Weber, MD, MPH, PDI (Consultant)

824 UK CoPACK Study: Health Care Workers Knowledge and Confidence in Using Personal Protective Equipment (PPE) And Related Anxiety Levels During The COVID-19 Pandemic

AimThe COVID-19 pandemic has resulted in significant pressures on the NHS. Healthcare workers (HCWs) are at increased risk of infection. Personal protective equipment (PPE) lowers the risk of infection transmission. However, during the early phases of the pandemic, the information available regarding COVD-19 and the use of PPE has been unclear, with constantly changing guidelines. The aim of this study was to determine the knowledge and confidence about PPE usage among HCWs, in addition to measuring their anxiety levels during the COVID pandemic.MethodA validated questionnaire was distributed among HCWs in as many UK hospitals as possible, during April 2020. The questionnaire consisted of 13 questions regarding demographics, knowledge on PPE guidance, HCW training and confidence levels in PPE usage and finally anxiety levels measured using the GAD-7 psychometric tool.Results1055 responses were received. Nurses (49%), Healthcare Assistants (HCA - 20%), Doctors (17%), Physios (8%) and other (6%). 99% of respondents indicated they were familiar with PPE guidance, but only 1.6% answered all 3 questions on PPE guidance accurately. 86.4% of respondents received mask-fitting checks. 79.7% received donning-doffing training. Despite this, only 46.8% were confident on their familiarity with PPE. 32.5% felt that their hospital communication regarding PPE policy during COVID-19 pandemic was poor or very poor. 30% HCWs experienced severe anxiety.ConclusionsNational guidance and local training on PPE usage during the COVID-19 pandemic has been unsatisfactory, leading to higher anxiety among HCWs. Improved information delivery and training are essential in preparation for the second wave and future pandemics.

Emerging Science, Personal Protective Equipment Guidance, and Resource Scarcity: Inaction and Inequity for Workers in Essential Industries.

Emerging Science, Personal Protective Equipment Guidance, and Resource Scarcity: Inaction and Inequity for Workers in Essential Industries.

Adherence to Public Health England (PHE) guidance for the use of personal protective equipment (PPE) in north Wales mental health unit- a regional audit

AimsTo ensure that the PPE guidance is strictly adhered to.To ensure that patient care is not compromised.To help us in areas of need in order to educate the staff regarding the techniques of PPE and thus ensure patient and staff safety and care during the pandemic.MethodNovel coronavirus 2019 was first described in December 2019 in Wuhan in China. Since those initial few cases, it has rapidly proliferated to a global pandemic, putting an inordinate amount of strain on healthcare systems around the world. We believe that the technique of donning and doffing if followed as per PHE guidelines would be of help in both preventing the infection and improve the care and safety of both patients and staff.This Audit includes both In-patient and Out-patient units in Psychiatric services across North Wales. Data were collected from 19 units out of 39. We observed covertly 325 staff members belonging to various cadres. Apart from the Donning and Doffing techniques, we also observed the availability of designated areas for this purpose and the availability of PPE as well.Data collection was by junior and senior doctors from various sites of the mental health unit in North Wales. A proforma was provided, the standards were based on PHE guidelines.ResultIt was noted that just about 50% of the staff followed donning as per guidance. Amongst all three sites, the Central team showed a better adherence with 85% of them donning PPE correctly. whereas only 22% adhered to donning in the West team.Only 21% of them managed to doff PPE as per guidance amongst all 3 centres in North Wales.It was also noted that there are no designated areas to Don and Doff in outpatient units. Staff, in general, seem to not adhere to the guidance of utilising a mask, especially when within 2 meters distance of other staff.ConclusionWe will be presenting the Audit at the regional meeting. After discussion with the infection prevention control team and Health and safety lead, we intend to improvise the wards with designated areas for donning and doffing. Teaching sessions for the staff in all three sites, reminders in various areas of the community mental health units and inpatient units.We are hoping that these recommendations will help us in achieving our aim of health and safety during this pandemic.

Hair today, gone tomorrow: How personal protective equipment guidance changed doctor's facial hair during the COVID-19 pandemic.

ObjectivesTo investigate how personal protective equipment (PPE) guidance altered the facial hair of hospital doctors and explore the wider impact and implications of these changes.MethodsA single site uncontrolled before‐after survey study examining change in facial hairstyles, and wider implications on doctor's cultural, religious, and personal wellbeing. Outcome measures included change in facial hair between January and April 2020 and whether these changes adhered to guidance set by Public Health England. Participants were also asked about the wider impact of these changes which were thematically analyzed using an inductive approach.ResultsOf those who completed the survey, 257 participants met the inclusion criteria. 68% (n = 67) of doctors who could grow facial hair changed their facial hairstyle during the COVID‐19 pandemic and 96% (n = 64) reported that the change was in response to PPE guidance. The odds of having a facial hairstyle that complied with PPE guidance before the pandemic was 0.32, which rose to 2.77 after guidance was released, giving an odds ratio of 8.54 (95% CI 4.49‐16.23, P < .001). When compared to those who sported a shaven face prepandemic, the odds ratio of a change in style for those with prepandemic full beards was 37.92 (95% CI 7.45‐192.8, P < .001), for goatees was 7.22 (95% CI 1.076‐48.47, P = .04), for moustaches was 4.33 (95% CI 0.207‐90.85, P = .345), and for stubble was 9.06 (95% CI 2.133‐38.49, P = .003). Qualitative analysis revealed multiple themes, including skin irritation, loss of identity, and a significant impact on participants required to maintain a beard due to religious or cultural reasons.ConclusionsFacial hairstyles have changed significantly at our hospital during the COVID‐19 pandemic. Facial hair can impact upon doctors' cultural, religious, and personal wellbeing and these factors need to be considered with policy and provision of PPE.

908 Personal Protective Equipment (PPE) Guidance During A Global Pandemic: A Statistical Analysis of National Perceived Confidence, Knowledge, And Educational Deficits Amongst U.K. Based Doctors

IntroductionMarch 11th, 2020 saw the World Health Organisation declare a global pandemic following the eruption of the novel coronavirus disease 2019. Unprecedented global demand for personal protective equipment (PPE) was complicated by limited availability and conflicting guidance from healthcare bodies. This study aimed to assess perceived confidence and knowledge of Public Health England’s PPE guidance amongst doctors of varying specialties and grades.MethodA nationwide 11-point survey comprising of multiple-choice questions (MCQs) and a Likert scale assessing perceived confidence (1=not confident, 5=very confident) was disseminated to U.K. based doctors using multiple platforms.ResultsData collated from 697 respondents revealed average perceived confidence was low. Notably, 59% felt they had received insufficient education regarding up-to-date guidance, with 81% advocating further training. Anaesthetics and ophthalmology were the highest and lowest scoring specialties in knowledge based MCQs, achieving 59% and 31% respectively. Subsequent statistical analysis revealed significant differences between specialties."ConclusionsEnsuring consistency in published PPE guidance and education can develop doctor’s confidence and knowledge of appropriate PPE use. The absence of a unified consensus and global education regarding the use of PPE poses significant ramifications for patient and healthcare professional (HCP) safety whilst risking further depletion of already sparse resources.

Personal protective equipment guidance during a global pandemic: A statistical analysis of National perceived confidence, knowledge and educational deficits amongst UK-based doctors.

IntroductionOn the 11th of March 2020, the World Health Organisation (WHO) declared a global pandemic following the upsurge of the novel coronavirus disease 2019 (COVID‐19). Unprecedented global demand for personal protective equipment (PPE) resulted in restricted availability, as well as evolving guidance on use, the latter of which was complicated by conflicting guidance provided by numerous healthcare bodies.AimTo assess perceived confidence and knowledge of PPE guidance as published by Public Health England (PHE) amongst doctors of varying specialties and grades.MethodA nationwide 11‐point survey comprising of multiple‐choice questions (MCQs) and a 5‐point Likert scale assessing perceived confidence was disseminated to UK‐based doctors using multiple platforms. Statistical analysis using one‐way analysis of variance (ANOVA), Tukey's honest significant difference (Tukey HSD) and Pearson's chi‐squared test was undertaken to assess for statistical significance.ResultsData collated from 697 respondents revealed that average perceived confidence was low across all specialties and grades. Notably, 59% (n = 411) felt they had received insufficient education regarding up‐to‐date guidance, with 81% (n = 565) advocating further training. Anaesthetics and ophthalmology were highest and lowest scoring specialties in knowledge‐based MCQs, achieving scores of 59% and 31%, respectively. Statistical analysis revealed significant differences between specialty, but not grade.ConclusionEnsuring uniformity in published guidance, coupled with education may aid knowledge and subsequent confidence regarding the appropriate use of PPE. The absence of a unified consensus and sustained training not only poses significant ramifications for patient and healthcare professional (HCP) safety, but also risks further depletion of already sparse resources. Because of the novelty of COVID‐19, appropriate PPE is continually evolving leaving an absence in formal training and education. This paper reveals insight into confidence and knowledge of PPE amongst doctors of various specialities/grades during a global pandemic, highlighting key deficits in education and training.

Personal protective equipment: knowledge of the guidance.

On 11 March 2020, the World Health Organization (WHO) declared a global pandemic in the wake of the coronavirus disease 2019 (COVID-19) outbreak. The unpredictable nature of transmission of COVID-19 requires a meticulous understanding of guidance on personal protective equipment (PPE) as published by WHO and Public Health England (PHE). To assess perceived confidence and knowledge of PHE guidance relating to PPE by nursing staff. A nationwide survey was disseminated between May and June 2020 through social media platforms as well as internal mail via regulatory bodies and individual hospital trusts. Data were collated from 339 nurses. Perceived confidence as measured on a Likert scale was a mode score of 3/5, with the average score for knowledge-based questions being 5/10. Of the respondents, 47% cited insufficient training on PPE guidance, and 84% advocated further training. Conclusions: Unifying published PPE guidance and ensuring consistency in training can improve awareness, confidence, and knowledge among nursing staff.

Frontline healthcare workers’ experiences with personal protective equipment during the COVID-19 pandemic in the UK: a rapid qualitative appraisal

ObjectivesTo report frontline healthcare workers’ (HCWs) experiences with personal protective equipment (PPE) during the COVID-19 pandemic in the UK. To understand HCWs’ fears and concerns surrounding PPE, their experiences following...

Evaluation of appropriate usage of PPE among healthcare providers during COVID-19 pandemic

Background: Shortage of personal protective equipment (PPE), inadequate staff training regarding PPE usage, and confused PPE guidance led to infections and deaths among healthcare workers in many countries. Protection of healthcare workers is needed as they are delivering essential services during the pandemic time. So, the main aim of our study is to evaluate the appropriate use of PPE among healthcare providers (HCPs) during COVID-19 pandemic. Materials and Methods: An observational cross-sectional study was conducted among the HCPs of India during September and October. A 15-item self-administered questionnaire was used, and Excel 2019 and SPPS 24 were used for statistical analysis. A χ2 test was performed to determine the role of sociodemographic characteristics on appropriate usage of PPE. Results: One hundred and eighteen HCPs have participated in our study. About 44.9% of the study participants know the proper way of donning the PPE, and 38.9% of the study participants know the proper way of doffing the PPE. About 40.6% of the study participants were aware of place for PPE removal and how to dispose a PPE; 69.49% of the study participants were aware of guidelines of donning and doffing of PPE recommended by the Centers for Disease Control and Prevention and World Health Organization. Conclusion: The prevalence of breathing difficulty, headaches, suffocation, dehydration, hair problems, and skin irritation/maceration among frontline healthcare personnel using PPE during pandemic was seen. Appropriate usage of PPE is vital in safeguarding the HCPs and restriction of the spread of viral infection in the hospital setting.

Protecting perioperative patients and personnel in the era of COVID-19.

Protecting perioperative patients and personnel in the era of COVID-19.

Triaging of respiratory protective equipment on the assumed risk of SARS-CoV-2 aerosol exposure in patient-facing healthcare workers delivering secondary care: a rapid review

ObjectivesIn patient-facing healthcare workers delivering secondary care, what is the evidence behind UK Government personal protective equipment (PPE) guidance on surgical masks versus respirators for SARS-CoV-2 protection?DesignTwo independent reviewers performed...

Safety of aerosol‐generating procedures in COVID‐19 negative patients: binomial probability modelling of intubateCOVID registry data

A central response to the COVID-19 pandemic was to create NHS capacity in part by suspension of elective services, as has been described elsewhere [1]. Now that the pandemic's peak appears to have passed, attention has focused on restoring these services. Common to most hospital plans is the separation of patient pathways into COVID-19 test-positive (red) and test-negative (green) cohorts; patients in the latter also as a precaution having been in isolation for 14 days.

Exploring the challenges faced by frontline workers in health and social care amid the COVID-19 pandemic: experiences of frontline workers in the English Midlands region, UK

ABSTRACT The first cases of Coronavirus (COVID-19) were reported in Wuhan, China in December 2019. Globally millions of people have been diagnosed with the virus whilst thousands have died. As the virus kept spreading health and social care frontline workers (HSCFW) were faced with difficulties when discharging their duties. This paper was set out to explore the challenges faced by different frontline workers in health and social care during the COVID-19 pandemic. The research utilized an explorative qualitative approach. A total of forty (N = 40) in-depth one-to-one semi-structured interviews were undertaken with HSCFW who included support workers (n = 15), nurses (n = 15), and managers (N = 10). Health and social care workers were drawn from domiciliary care and care homes (with and without nursing services). All the interviews were done online. The data were thematically analyzed, and the emergent themes were supported by quotes from the interviews held with participants. Following data analysis the research study found that lack of pandemic preparedness, shortage of Personal Protective Equipment (PPE), anxiety and fear amongst professionals, challenges in enforcing social distancing, challenges in fulfilling social shielding responsibility, anxiety and fear amongst residents and service users, delay in testing, evolving PPE guidance and shortage of staff were challenges faced by frontline health and social care workers during COVID-19 pandemic. The results of the current study point to a need for adequate pandemic preparedness within the health and social care sector to protect both frontline workers and the individuals they look after.

Use of personal protective equipment during the COVID-19 pandemic.

British Journal of NursingVol. 29, No. 13 At a GlanceUse of personal protective equipment during the COVID-19 pandemicCharlotte Gordon, Abigail ThompsonCharlotte Gordon(E-mail Address: [email protected])Senior Lecturer, Adult Nursing, Northumbria UniversitySearch for more papers by this author, Abigail ThompsonInfection and Prevention Control Nurse, NHS County Durham and Darlington Clinical Commissioning GroupsSearch for more papers by this authorCharlotte Gordon; Abigail ThompsonPublished Online:10 Jul 2020https://doi.org/10.12968/bjon.2020.29.13.748AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Bovin J. PPE used incorrectly half the time. Health Leaders. 2015. https://www.healthleadersmedia.com/strategy/ppe-used-incorrectly-half-time (accessed 29 June 2020) Google ScholarBrown L, Munro J, Rogers S. 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Interim guidance. 19 March 2020. 2020c. https://tinyurl.com/qvofaf5 (accessed 29 June 2020) Google Scholar FiguresReferencesRelatedDetails 9 July 2020Volume 29Issue 13ISSN (print): 0966-0461ISSN (online): 2052-2819 Metrics History Published online 10 July 2020 Published in print 9 July 2020 Information© MA Healthcare LimitedPDF download