Managing personal protective equipment in health care settings

An article in CMAJ (Canadian Medical Association Journal) provides an overview on personal protective equipment (PPE) in health care settings, including evidence on effectiveness of N95 masks, as well as the importance of including health care worker perspectives on usage of this equipment.

"Answering questions such as how aerosols are generated, how limited supply of PPE can be managed, how care can be organized to optimize PPE use, and how health care worker perspectives can be integrated into organizational decisions are central to protecting health care workers from COVID-19 and future pandemic pathogens," writes Dr. Jeanna Parsons Leigh, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, with coauthors.

The authors analyze the use of N95 masks compared with medical masks in preventing viral respiratory infections and suggest ways to manage the limited supply of N95 masks and other PPE. They hope the article will help organizations with decision-making around how to protect health care workers and patients while managing often scarce resources.

Real-world effectiveness of PPE may vary, especially during the early stages of an outbreak. As well, complex PPE regimens may not be better at protecting against transmission.

"More is not necessarily better: for Ebola, critical errors remained more common in enhanced versus basic PPE regimens despite training," write the authors. Meticulous attention to training health care workers in the correct methods of donning and doffing PPE is crucial.

Involving health care workers in developing strategies for PPE use as well as clear communication is important for ensuring front-line workers have confidence and use PPE effectively.

"Critical to choosing PPE regimens, but rarely explored, is how safe health care workers feel with the PPE regimen designated by their local hospital," write the authors. "Individuals and organizations may interpret the literature differently, and may arrive at different conclusions as to which PPE is appropriate for a given context for a novel virus. A breakdown in trust and communication can lead to conflict, anxiety and worker absences."

"Perspectives on personal protective equipment in acute-care facilities during the COVID-19 pandemic" is published June 25, 2020.