Personal protective equipment and intensive care unit healthcare worker safety in the COVID-19 era (PPE-SAFE): An international survey

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Abstract

Purpose

To survey healthcare workers (HCW) on availability and use of personal protective equipment (PPE) caring for COVID-19 patients in the intensive care unit (ICU).

Materials and method

A web-based survey distributed worldwide in April 2020.

Results

We received 2711 responses from 1797 (67%) physicians, 744 (27%) nurses, and 170 (6%) Allied HCW. For routine care, most (1557, 58%) reportedly used FFP2/N95 masks, waterproof long sleeve gowns (1623; 67%), and face shields/visors (1574; 62%). Powered Air-Purifying Respirators were used routinely and for intubation only by 184 (7%) and 254 (13%) respondents, respectively. Surgical masks were used for routine care by 289 (15%) and 47 (2%) for intubations. At least one piece of standard PPE was unavailable for 1402 (52%), and 817 (30%) reported reusing single-use PPE. PPE was worn for a median of 4 h (IQR 2, 5). Adverse effects of PPE were associated with longer shift durations and included heat (1266, 51%), thirst (1174, 47%), pressure areas (1088, 44%), headaches (696, 28%), Inability to use the bathroom (661, 27%) and extreme exhaustion (492, 20%).

Conclusions

HCWs reported widespread shortages, frequent reuse of, and adverse effects related to PPE. Urgent action by healthcare administrators, policymakers, governments and industry is warranted.

Graphical abstract

Highlights

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Wide variability in what PPE is available for ICU staff caring for COVID-19 patients.
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More than half report at least one PPE item missing or out of stock.
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Adverse effects of wearing PPE reported by 80% of health care workers.
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Adverse effects related to duration of a shift wearing PPE without taking a break.

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Most cited references 8

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A Novel Coronavirus from Patients with Pneumonia in China, 2019

Na Zhu, Dingyu Zhang, Wenling Wang … (2020)

Summary In December 2019, a cluster of patients with pneumonia of unknown cause was linked to a seafood wholesale market in Wuhan, China. A previously unknown betacoronavirus was discovered through the use of unbiased sequencing in samples from patients with pneumonia. Human airway epithelial cells were used to isolate a novel coronavirus, named 2019-nCoV, which formed a clade within the subgenus sarbecovirus, Orthocoronavirinae subfamily. Different from both MERS-CoV and SARS-CoV, 2019-nCoV is the seventh member of the family of coronaviruses that infect humans. Enhanced surveillance and further investigation are ongoing. (Funded by the National Key Research and Development Program of China and the National Major Project for Control and Prevention of Infectious Disease in China.)

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Critical Supply Shortages — The Need for Ventilators and Personal Protective Equipment during the Covid-19 Pandemic

Megan Ranney, Valerie Griffeth, Ashish Jha (2020)

New England Journal of Medicine

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Association of Public Health Interventions With the Epidemiology of the COVID-19 Outbreak in Wuhan, China

An Lian Pan, Li Liu, Chaolong Wang … (2020)

Was there an association of public health interventions with improved control of the COVID-19 outbreak in Wuhan, China? In this cohort study that included 32 583 patients with laboratory-confirmed COVID-19 in Wuhan from December 8, 2019, through March 8, 2020, the institution of interventions including cordons sanitaire , traffic restriction, social distancing, home quarantine, centralized quarantine, and universal symptom survey was temporally associated with reduced effective reproduction number of SARS-CoV-2 (secondary transmission) and the number of confirmed cases per day across age groups, sex, and geographic regions. A series of multifaceted public health interventions was temporally associated with improved control of the COVID-19 outbreak in Wuhan and may inform public health policy in other countries and regions. Coronavirus disease 2019 (COVID-19) has become a pandemic, and it is unknown whether a combination of public health interventions can improve control of the outbreak. To evaluate the association of public health interventions with the epidemiological features of the COVID-19 outbreak in Wuhan by 5 periods according to key events and interventions. In this cohort study, individual-level data on 32 583 laboratory-confirmed COVID-19 cases reported between December 8, 2019, and March 8, 2020, were extracted from the municipal Notifiable Disease Report System, including patients’ age, sex, residential location, occupation, and severity classification. Nonpharmaceutical public health interventions including cordons sanitaire , traffic restriction, social distancing, home confinement, centralized quarantine, and universal symptom survey. Rates of laboratory-confirmed COVID-19 infections (defined as the number of cases per day per million people), across age, sex, and geographic locations were calculated across 5 periods: December 8 to January 9 (no intervention), January 10 to 22 (massive human movement due to the Chinese New Year holiday), January 23 to February 1 ( cordons sanitaire , traffic restriction and home quarantine), February 2 to 16 (centralized quarantine and treatment), and February 17 to March 8 (universal symptom survey). The effective reproduction number of SARS-CoV-2 (an indicator of secondary transmission) was also calculated over the periods. Among 32 583 laboratory-confirmed COVID-19 cases, the median patient age was 56.7 years (range, 0-103; interquartile range, 43.4-66.8) and 16 817 (51.6%) were women. The daily confirmed case rate peaked in the third period and declined afterward across geographic regions and sex and age groups, except for children and adolescents, whose rate of confirmed cases continued to increase. The daily confirmed case rate over the whole period in local health care workers (130.5 per million people [95% CI, 123.9-137.2]) was higher than that in the general population (41.5 per million people [95% CI, 41.0-41.9]). The proportion of severe and critical cases decreased from 53.1% to 10.3% over the 5 periods. The severity risk increased with age: compared with those aged 20 to 39 years (proportion of severe and critical cases, 12.1%), elderly people (≥80 years) had a higher risk of having severe or critical disease (proportion, 41.3%; risk ratio, 3.61 [95% CI, 3.31-3.95]) while younger people (<20 years) had a lower risk (proportion, 4.1%; risk ratio, 0.47 [95% CI, 0.31-0.70]). The effective reproduction number fluctuated above 3.0 before January 26, decreased to below 1.0 after February 6, and decreased further to less than 0.3 after March 1. A series of multifaceted public health interventions was temporally associated with improved control of the COVID-19 outbreak in Wuhan, China. These findings may inform public health policy in other countries and regions. This population epidemiology study examines associations between phases of nonpharmaceutical public health interventions (social distancing, centralized quarantine, home confinement, and others) and rates of laboratory-confirmed COVID-19 infection in Wuhan, China, between December 2019 and early March 2020.

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Author and article information

Contributors

Alexis Tabah

Journal

Journal ID (nlm-ta): J Crit Care

Journal ID (iso-abbrev): J Crit Care

Title: Journal of Critical Care

Publisher: Published by Elsevier Inc.

ISSN (Print): 0883-9441

ISSN (Electronic): 1557-8615

Publication date PMC-release: 13 June 2020

Publication date (Electronic): 13 June 2020

Affiliations

[a ]Faculty of Medicine, Intensive Care Unit, University of Queensland, Redcliffe Hospital, 4019, Redcliffe, Brisbane, Queensland 4029, Australia

[b ]Intensive Care Units, Caboolture and Prince Charles Hospitals, School of Medicine, University of Queensland, The George Institute for Global Health, University of New South Wales, Sydney, Queensland, Australia

[c ]Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Queensland University of Technology, Brisbane, Queensland, Australia

[d ]INSERM IAME, U1137, Team DesCID, Paris, France

[e ]Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.) Section of Anesthesia, Analgesia, Intensive Care and Emergency Policlinico Paolo Giaccone University of Palermo Palermo, Italy

[f ]Faculty of Health and Social Care Education, Kingston & St George's University of London, UK

[g ]Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK

[h ]Centre for Human & Applied Physiological Sciences (CHAPS) and School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK

[i ]Anesthesiology and Critical Care Medicine Department, DMU PARABOL, Bichat – Claude Bernard Hospital, HUPNVS, AP-HP, Paris, France

[j ]Faculty of Medicine, University of Tripoli, Libya

[k ]Sao Francisco Xavier Hospital, CHLO, NOVA Medical School, CHRC, New University of Lisbon, Lisbon, Portugal

[l ]Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria

[m ]Servicio de Terapia Intensiva, Hospital Interzonal de Agudos San Martin de La Plata, La Plata, Buenos Aires, Argentina

[n ]Intensive Care Center, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands

[o ]Division of Scientific Affairs-Research, European Society of Intensive Care Medicine, Brussels, Belgium

[p ]Infectious Diseases Clinic, Department of Health Sciences, University of Genoa, Genoa and Hospital Policlinico San Martino-IRCCS, Genoa, Italy

[q ]Brisbane, Australia

[r ]Department of Critical Care Medicine, Ghent University Hospital, Gent, Belgium

Author notes

[* ]Corresponding author at: Intensive Care Unit, Redcliffe Hospital, Anzac Avenue, Redcliffe, QLD 4020, Australia. a.tabah@ 123456uq.edu.au

[1]

The PPE-safe contributors: Ali Ait Hssain,Qatar; Alba Llorens,Spain; Leonardo Pagani,Italy; Jordi Rello,Spain; Lowell Ling,Hong Kong; Gentle Sunder Shrestha,Nepal; Seyed Mohammadreza Hashemian,Iran; Kostoula Arvaniti,Greece; Pietro Bertini,Italy; Luca Buetti,Switzerland; Luisa Nobile,Switzerland; Graziella Rodosti,Switzerland; Bruno Sousa,Portugal; Joanne White (BCUHB - Critical Care),United Kingdom; Rafael Sierra,Spain; Tomasz Torlinski,United Kingdom; Faustina Excel Adipa,Ghana; bhagyesh shah,India; Caroline Dallongeville,france; Clarice Wee Li-Phing,Singapore; Marc Danguy des Déserts,France; Wael Awada,Saudi Arabia; Anatilde Diaz,Argentina; Dong Liu,China; Mansoor Masjedi,Iran; Dimitrios Papadopoulos,Greece; Felipe de Jesus Montelongo,Mexico; Tharwat Aisa,Ireland; Aleksandra Gutysz-Wojnicka,Poland; Kollengode Ramanathan,Singapore; Jumana Yusuf Haji,India; Prashanth Kumar,India; Peter Lai,Hong Kong; Kiran Shekar,Australia; Jose Garnacho Montero,Spain.

Article

Publisher ID: S0883-9441(20)30592-X

DOI: 10.1016/j.jcrc.2020.06.005

PMC ID: 7293450

PubMed ID: 32570052

SO-VID: ac9a00ba-1643-4cf0-b8b4-d8dc7f694663

License:

Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

Personal protective equipment and intensive care unit healthcare worker safety in the COVID-19 era (PPE-SAFE): An international survey

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Abstract

Purpose

Materials and method

Results

Conclusions

Graphical abstract

Highlights

Related collections

Novel Coronavirus Disease COVID-19

Most cited references 8

A Novel Coronavirus from Patients with Pneumonia in China, 2019

Critical Supply Shortages — The Need for Ventilators and Personal Protective Equipment during the Covid-19 Pandemic

Association of Public Health Interventions With the Epidemiology of the COVID-19 Outbreak in Wuhan, China

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Contributors

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