Personal Protective Equipment for Protecting Healthcare Staff during COVID-19 Outbreak: A Narrative Review
Context: The World Health Organization (WHO) declared a pandemic state as the coronavirus spread across the world. Personal protective equipment (PPE) has become a critical subject during the COVID-19 outbreak. It is necessary to prevent coronavirus transmission to healthcare workers (HCWs) as providing care. They are at high risk of exposure to coronavirus. The aim of this study was to provide a brief review of some routes of transmission of COVID-19, what, when and why PPE is recommended base on the route of transmission. Evidence acquisition: In this review, articles were extracted from the Google Scholar, Scopus, Web of Science, and PubMed search engines. The main keywords for search were coronavirus, COVID-19, personal protective PPE, healthcare, transmission, contact, and protect. Results: Findings showed the COVID-19 transmission rate in the HCWs that wore PPE significantly decreased. All HCWs must use appropriate and adequate PPE in order to minimize the COVID-19 transmission. Conclusion: Although still uncertainty remains around COVID-19 transmission and it is early to have conclusion on its prevention, most of recommendations and guidance have emphasized to apply the PPE during COVID-19 outbreak among HCWs.
2. Del Rio C, Malani PN. COVID-19—new insights on a rapidly changing epidemic. JAMA;Epub ahead of print.
3. World Health Organization. Coronavirus disease (COVID-19) outbreak situation [Accessed 25 Mar 2020; cited 10 Apr 2020]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019.
4. Wu HL, Huang J, Zhang CJ, He Z, Ming WK. Facemask shortage and the novel coronavirus disease (COVID-19) outbreak: Reflections on public health measures. EClinicalMedicine. 2020:100329.
5. Adams JG, Walls RM. Supporting the health care workforce during the COVID-19 global epidemic. JAMA. 2020;Epub ahead of print.
6. Cook TM. Personal protective equipment during the COVID‐19 pandemic–a narrative review. Anaesthesia. 2020;Epub ahead of print.
7. Infection prevention and control for COVID-19 in healthcare settings [Accessed 31 Mar 2020; cited 12 Apr 2020]. Available from: https://www.ecdc.europa.eu/en/publications-data/infection-prevention-and-control-covid-19-healthcare-settings.
8. Istituto Superiore di Sanita' (ISS). Sorveglianza Integrata COVID-19 in Italia 2020 [updated 26 March 2020; cited 26 March 2020]. Available from: http://www.epicentro.iss.it/coronavirus/bollettino/Infografi ca_26marzo%20ITA.pdf.
9. Personal Protective Equipment: Questions and Answers. [updated 14Mar 2020; cited 9 Apr 2020]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirator-use-faq.html.
10. World Health Organization. Rational use of personal protective equipment (PPE) for coronavirus disease (COVID-19): interim guidance, [Accessed 6 Apr 2020; cited 10 Apr 2020 ]. Available from: https://apps.who .int/iris/handle/10665/331498.
11. World Health Organization. Infection prevention and control during healthcare when novel coronavirus (nCoV) infection is suspected. Interim Guidance Geneva2020 [Accessed 19 Mar 2020; cited 10 Apr 2020]. Available from: https://www.who.int/publications-detail/infection-prevention-and-control-during-health-care-when-novel-coronavirus-(ncov)-infection-is-suspected.
12. Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS One. 2012;7(4):e35797.
13. Jahani R, Khaledyan D, Jahani A, Jamshidi E, Kamalinejad M, Khoramjouy M, Faizi M. Evaluation and comparison of the antidepressant-like activity of Artemisia dracunculus and Stachys lavandulifolia ethanolic extracts: an in vivo study. Res Pharm Sci. 2020;14(6):554-65.
14. Public Health England. COVID-19: infection prevention and control guidance 2020 [updated 6 Mar 2020; cited 8 Apr 2020]. Available from: https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control/wuhan-novel-coronavirus-wn-cov-infection-prevention-an d-control-guidance
15. van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN, et al. Aerosol and surface stability of HCoV-19 (SARS-CoV-2) compared to SARS-CoV-1. N Engl J Med. 2020:NEJMc2004973.
16. BS EN 149:2001+A1:2009 Respiratory protective devices. Filtering half masks to protect against particles. Requirements, testing, marking. British Standard Institute 2009. [Accessed 28 Mar 2020; cited 29 Mar 2020]. Available from: https://www.bsigroup.com/en-GB/topics/novel-coronavirus-covid-19/medical-devices-ppe/.
17. Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19). Intensive Care Med. 2020. [publication pending]
18. Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS One. 2012;7(4):e35797.
19. Rahmati O, Panahi M, Ghiasi SS, Deo RC, Tiefenbacher JP, Pradhan B, et al. Hybridized neural fuzzy ensembles for dust source modeling and prediction. Atmos Environ. 2020;224:117320.
20. European Centre for Disease Prevention and Control. Personal protective equipment (PPE) needs in healthcare settings for the care of patients with suspected or confirmed novel coronavirus (2019-nCoV) 2020 [Accessed 7 Feb 2020; cited 18 Mar 2020]. Available from: https://www.ecdc.europa.eu/sites/defaul t/files/documents/novel-coronavirus-personal-protective-equipment-needs-healthcare-settings.pdf.
21. Gralton J, Tovey E, McLaws ML, Rawlinson WD. The role of particle size in aerosolised pathogen transmission: a review. J Infect. 2011;62:1-13.
22. Nicas M, Nazaroff WW, Hubbard A. Toward understanding the risk of secondary airborne infection: emission of respirable pathogens. J Occup Environ Hyg. 2005:2:143-54.
23. Government of Canada. Infection prevention and control for novel coronavirus (2019-nCoV): interim guidance for acute healthcare settings. [Accessed 7 Feb 2020; cited 18 Mar 2020]. Available from: https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirusinfection/health-pro fessionals/interim-guidance-acute healthcaresettings.html.
24. European Centre for Disease Prevention and Control. Guidance for wearing and removing personal protective equipment in healthcare settings for the care of patients with suspected or confirmed COVID-19 2020 [Accessed 28 Feb 2020; cited 20 Mar 2020]. Available from: https://www.ecdc.europa.eu/en/pub lications-data/guidance-wearing-and-removing-personal-protectiv e-equipment-healthcare-settings.
25. The National Personal Protective Technology Laboratory (NPPTL). Respirator trusted source information. [Accessed 26 Jan 2018; cited 10 Apr 2020]. Available from: https://www.cdc.gov/niosh/npptl /topics/respirators/disp_part/respsource3healthcare.html.
26. Desaei N, Mehrotra P . Medical masks are a tool that can be used to prevent the spread of respiratory infection. JAMA. 2020;Epub ahead of print.
27. European Centre for Disease Prevention and Control. Novel coronavirus (SARS-CoV-2) - Discharge criteria for confirmed COVID-19 cases – When is it safe to discharge COVID-19 cases from the hospital or end home isolation? [Accessed 10 Mar 2020; cited 30 Mar 2020]. Available from: https://www.ecdc.europa.eu/sites/default/files/documents/COVID-19-Discharge-criteria.pdf
28. European Centre for Disease Prevention and Control. Disinfection of environments in healthcare and non healthcare settings potentially contaminated with SARS-CoV-2 Stockholm: ECDC. [Accessed 1 Mar 2020; cited 30 Mar 2020]. Available from: https://www.ecdc.europa.eu/sites/default/files/documents/En vironmental-persistence-of-SARS_CoV_2-virus-Options-for-cleaning2020-03-26_0.pdf.
29. Ministry of Health Singapore. Press Releases. [Accessed 14 Feb 2020; cited 2 Apr 2020]. Available from: https://www.moh.gov.sg/.
30. Wang J et al., Reasons for healthcare workers becoming infected with novel coronavirus disease 2019 (COVID-19) in China. J Hosp Infect. 2020;Epub ahead of print.
31. Jefferson T, Del Mar C, Dooley L, Ferroni E, Al-Ansary LA, et al. Physical interventions to interrupt or reduce the spread of respiratory viruses: systematic review. BMJ. 2009;339:b3675.
32. World Health Organization. Infection prevention and control during health care for probable or confirmed cases of novel coronavirus (nCoV) infection: interim guidance, [Accessed 30 Jan 2020; cited 2 Apr 2020]. Available from: https://reliefweb.int/report/world/infection-prevention-and-control-during-health-care-when-novel-coronavirus-ncov.
33. Seto WH, Tsang D, Yung RW, Ching TY, Ng TK, Ho M, et al. Advisors of Expert SARS group of Hospital Authority. Effectiveness of precautions against droplets and contact in prevention of nosocomial transmission of severe acute respiratory syndrome (SARS). Lancet. 2003;361(9368):1519-20.
34. Chung JS, Ling ML, Seto WH, Peng Ang BS, Tambyah PA. Debate on MERS-CoV respiratory precautions: surgical mask or N95 respirators? Singapore Med J. 2014;55(6):294-7.
35. Nickell LA, Crighton EJ, Tracy CS, Al-Enazy H, Bolaji Y, Hanjrah S, et al. Psychosocial effects of SARS on hospital staff: survey of a large tertiary care institution. CMAJ. 2004;170(5):793-8.
36. Love RG. Acceptable breathing resistance for respirator use. J Int Soc Respir Protection. 1983;1:45-66.
37. Kao TW. The physiological impact of N95 masks on medical staff. (online).2006.
38. Lim EC, Seet RC, Lee KH, Wilder-Smith EP, Chuah BY, Ong BK. Headaches and the N95 face-mask amongst healthcare providers. Acta Neurol Scand. 2006;113(3):199-202.
39. Rebmann T, Carrico R, Wang J. Physiologic and other effects and compliance with long-term respirator use among medical intensive care unit nurses. Am J Infect Control. 2013; 41:1218-23.
40. Jonathan JY Ong, Chandra Bharatendu, Yihui Goh, Jonathan ZY Tang, Kenneth WX Sooi,Yi Lin Tan, et al. Headaches Associated With Personal Protective Equipment - A Cross-Sectional Study Among Frontline Healthcare Workers During COVID-19. Headache. 2020;Epub ahead of print.
41. Health Protection Agency, United Kingdom. Infection Control Advice: Possible or Confirmed MERS-CoV Cases: Version 2.0 [Accessed 13 Jan 2014; cited 2 Apr 2020]. Available from: http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1317136232722.
42. Centers for Disease Control and Prevention. Interim Infection Prevention and Control Recommendations for Hospitalised Patients with Middle East Respiratory Syndrome Coronavirus (MERS-CoV) [Accessed 13 Feb 2014; cited 5Apr 2020]. Available from: http://www.cdc.gov/coronavirus/mers/inf ection-prevention-control.html.
43. Centers for Disease Control and Prevention. Interim guidance on infection control measures for 2009 H1N1 influenza in healthcare settings, including protection of healthcare personnel. [Accessed 13 Feb 2014;cited 10 Apr 2020]. Available from: http://www.cdc.gov/h1n1flu/guidelines_infection_control.html.
44. The National Academies. IOM recommends N95 respirators to protect health care workers from H1N1 flu. [Accessed 13 Feb 2014; cited 11Apr 2020]. Available from: http://www.nationalacademies.org/onpine wsitem.aspx?RecordID=12748.
45. Loeb M, Dafoe N, Mahony J, John M, Sarabia A, Glavin V, et al. Surgical masks vs. N95 respiratory for preventing influenza among health care workers: a randomised trial. JAMA. 2009;302(17):1865-71.
46. World Health Organization. Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected. [Accessed 26 Mar 2014; cited 7 Apr 2020]. Available from: https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov) infection-is-suspected.
47. Jessica J Bartoszko, Mohammed Abdul Malik Farooqi, Waleed Alhazzani, Mark Loeb., Medical Masks vs N95 Respirators for Preventing COVID-19 in Health Care workers A Systematic Review and Meta-Analysis of Randomized Trials. Influenza Other Respir Viruses. 2020;Epub ahead of print.
48. Centers for Disease Control and Prevention (CDC). Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings [Updated 13 Apr 202; cited 12 Apr 2020]. Available from: http://www.cdc.gov.corona virus/2019-ncov/infection-control/control-recommendations.html.
49. Kangqi Ng, Beng Hoong Poon, Troy Hai Kiat Puar, Jessica Li Shan Quah, Wann Jia Loh, Yu Jun Wong, et al. COVID-19 and the Risk to Health Care Workers: A Case Report. Ann Intern Med. 2020;Epub ahead of print.
50. Wang X, Pan Z, Cheng Z. Association between 2019-nCoV transmission and N95 respirator use. medRxiv. 2020;Epub ahead of print.
51. Verbeek JH, Rajamaki B, Ijaz S, Sauni R, Toomey E, Blackwood B, et al. Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane Database Syst Rev. 2016;4:CD011621
52. Greenhalgh T, Chan XH, Khunti K, Durand-Moreau Q, Straube S, Devane D, et al. What is the efficacy of standard face masks compared to respirator masks in preventing covid-type respiratory illnesses in primary care staff? Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford.2020.
53. Belingheri M, Paladino ME, Riva MA. Beyond the assistance: additional exposure situations to COVID-19 for healthcare workers. J Hosp Infect. 2020;Epub ahead of print.
54. Hoe GAN W, Wah LIM J, KOH D. Preventing intra-hospital infection and transmission of COVID-19 in healthcare workers, Safety and Health at Work. 2020;Epub ahead of print.
55. Science Daily (from: McMaster University)., Surgical masks likely good for most COVID-19 treatment.2020. Available from: https://www.sciencedaily.com/releases/2020/04/200406125511.html.
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