Trending Clinical Topic: PPE

Ryan Syrek

Disclosures

April 10, 2020

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As the COVID-19 pandemic spreads and worsens in some areas, concern about the availability of personal protective equipment (PPE) has become the top trending clinical topic. Worry about shortages has led many healthcare workers to speak out, sometimes at the cost of harassment or firing. A nurse in Oklahoma was reportedly fired because he wore a surgical mask while inserting an IV line in a patient. A memo issued by the California Nurses association and National Nurses United stated that nurses at Kaiser Permanente were told they could be fired on the spot for wearing their own N95 masks.

In an editorial, Eric Topol, MD, described the lack of support for healthcare workers in the United States as a betrayal, comparing the lack of PPE as similar to sending soldiers to war without ammunition. Although some are continuing to voice their concerns, many hospitals are instructing doctors and nurses to remain silent on the issue. Dozens of doctors in Italy have died during the COVID-19 pandemic. The fear is that a shortage of PPE will put even more lives at risk.

In assessing the shortage, a survey conducted by the Association for Professionals in Infection Control and Epidemiology (APIC) found that nearly half (48%) of the US healthcare facilities that responded are already out or almost out of respirators for treating patients. Of the respondents, 20.4% reported having no protective respirators and 27.8% said they were almost out. Medscape has published an online survey asking users across all countries to report whether they currently have adequate PPE supplies. A memorial page that acknowledges the lives of healthcare workers who have died of COVID-19 was also recently published.

For those institutions considering crisis strategies regarding PPE, the Centers for Disease Control and Prevention (CDC) has issued guidance. The recommendations include approaches specific to eye protection, isolation gowns, facemasks, and respirators. A “Burn Rate Calculator” for PPE use has also been provided. The CDC’s National Institute for Occupational Safety and Health (NIOSH) has released strategies for the extended use and reuse of disposable filtering faceplate respirators (FFRs). The CDC has published a detailed review of possible decontamination and reuse approaches.

In terms of PPE use by the general public, initial recommendations anticipated a shortage of PPE. Thus, much guidance in the United States in particular strongly discouraged mask use in the community or by healthcare workers when not directly working with a symptomatic individual. Whether or not face coverings are strongly effective in protecting individuals from acquiring COVID-19, many feel that the practice helps asymptomatically infected individuals from spreading disease to others. The CDC recently recommended cloth face coverings in public settings where other social distancing measures are difficult to maintain, such as grocery stores and pharmacies, especially in areas of significant community-based transmission.

As the pandemic continues, concerns related to equipment used to protect those on the frontlines are only likely to increase. PPE and related subjects will remain trending clinical topics until the crisis finally begins to wane.

Read more clinical information about COVID-19.

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