Article Notes
- Hospitals are frequent sources of outbreaks, among both staff, patients and the wider community.
- The quality of PPE evidence is low. Most evidence must be contextualised in consideration of expert opinion, and of the similarities between SARS-CoV-2 and SARS (SARS-CoV-1), MERS and influenza.
- Droplet-vs-airborne spread is a conceptual simplification and not a simple dichotomy. It is best understood as a spectrum of transmission risk.
- Time-exposed may be a more important consideration, especially in indoor, poorly ventilated spaces.
- PPE supply is globally limited, and so a pragmatic approach must be taken to its use, considering individual risk scenarios.
- Training, simulation and fit testing are critical for effective use of PPE.
- There are specific steps in the PPE donning & doffing workflow that are frequently associated with breaches exposing HCWs to infection. These require extra attention.
- Beyond cost, increasingly complex PPE (eg. PAPR, hoods, intubation boxes etc.) also increase the opportunity for PPE failure and exposure if users have not had adequate training in their use, and some PPE has been demonstrated to make intubation more difficult.
- The superiority of N95/P2 respirator masks over standard surgical masks for personal protection is unclear and unproven.
- N95 mask fit-testing and fit-checking; notably shaving facial hair to ensure a face-mask interface seal.
- Use of extended-cuff gloves with gown cuff tucked securely into glove.
- Time management: PPE donning should never be rushed, even in critical medical emergencies.
- Glove removal is a high-risk step. When removing the second, inner glove, ensure as little contact as possible with the glove sleeve by the ungloved hand.
- Gown removal is the next highest risk step. Do not touch the front of the gown, especially with ungloved hands.
- Mask removal avoid touching front of mask; avoid any snapping of straps.
- Perform alcohol-based hand-hygiene after each article is removed.
This growing collection of articles focuses on the evidence and expert guidance relating to the use of personal protective equipment (PPE) and the SARS-CoV-2 / COVID pandemic, with specific focus on PPE use by anaesthesiologists and anaesthetists.
More articles can found found via the PPE topic index.
What we know:
Daniel Jolley
Toronto anaesthesiologists Muñoz-Leyva & Niazi share observations from PPE training simulations, identifying the 'high risk' moments where frequent exposures and PPE failures are seen.
Why is this important?
For all the understandable concern over adequate access to PPE and discussion of appropriate levels of protection, HCW safety is entirely dependent on the effective use of this protective equipment.
Identifying common areas of 'biosafety breach' allows both clinicians and PPE supervisors to apply added attention to these steps. These areas can be conceptualised as offering a disproportionate safety benefit for the time and resources deployed in ensuring compliance at these moments.
Which areas did they identify as most important?
Donning
Doffing
Daniel Jolley