• Z M Jessop, T D Dobbs, S R Ali, E Combellack, R Clancy, N Ibrahim, T H Jovic, A J Kaur, A Nijran, T B O'Neill, and I S Whitaker.
• Reconstructive Surgery and Regenerative Medicine Research Group, Swansea University Medical School, Institute of Life Science, University of Swansea, Swansea, UK.
• Br J Surg. 2020 Sep 1; 107 (10): 126212801262-1280.

BackgroundSurgeons need guidance regarding appropriate personal protective equipment (PPE) during the COVID-19 pandemic based on scientific evidence rather than availability. The aim of this article is to inform surgeons of appropriate PPE requirements, and to discuss usage, availability, rationing and future solutions.MethodsA systematic review was undertaken in accordance with PRISMA guidelines using MEDLINE, Embase and WHO COVID-19 databases. Newspaper and internet article sources were identified using Nexis. The search was complemented by bibliographic secondary linkage. The findings were analysed alongside guidelines from the WHO, Public Health England, the Royal College of Surgeons and specialty associations.ResultsOf a total 1329 articles identified, 95 studies met the inclusion criteria. Recommendations made by the WHO regarding the use of PPE in the COVID-19 pandemic have evolved alongside emerging evidence. Medical resources including PPE have been rapidly overwhelmed. There has been a global effort to overcome this by combining the most effective use of existing PPE with innovative strategies to produce more. Practical advice on all aspects of PPE is detailed in this systematic review.ConclusionAlthough there is a need to balance limited supplies with staff and patient safety, this should not leave surgeons treating patients with inadequate PPE.© 2020 The Authors. British Journal of Surgery published by John Wiley & Sons Ltd on behalf of BJS Society Ltd.

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