A systematic risk-based strategy to select personal protective equipment for infectious diseases

Abstract

Background: Personal protective equipment (PPE) is a primary strategy to protect health care personnel (HCP) from infectious diseases. When transmission-based PPE ensembles are not appropriate, HCP must recognize the transmission pathway of the disease and anticipate the exposures to select PPE. Because guidance for this process is extremely limited, we proposed a systematic, risk-based approach to the selection and evaluation of PPE ensembles to protect HCP against infectious diseases. Methods: The approach used in this study included the following 4 steps: (1) job hazard analysis, (2) infectious disease hazard analysis, (3) selection of PPE, and (4) evaluation of selected PPE. Selected PPE should protect HCP from exposure, be usable by HCP, and fit for purpose. Results: The approach was demonstrated for the activity of intubation of a patient with methicillin-resistant Staphylococcus aureus or Severe Acute Respiratory Syndrome coronavirus. As expected, the approach led to the selection of different ensembles of PPE for these 2 pathogens. Discussion: A systematic risk-based approach to the selection of PPE will help health care facilities and HCP select PPE when transmission-based precautions are not appropriate. Owing to the complexity of PPE ensemble selection and evaluation, a team with expertise in infectious diseases, occupational health, the health care activity, and related disciplines, such as human factors, should be engaged. Conclusions: Participation, documentation, and transparency are necessary to ensure the decisions can be communicated, critiqued, and understood by HCP.

Recommended Personal Protective Equipment for Cochlear Implant and Other Mastoid Surgery During the COVID‐19 Era

“…18 We therefore based our PPE assessment strategy on this evidence-based framework, which states that the categories of PPE performance that must be considered include 1) donning, doffing, and changing; 2) usability, and 3) fit for purpose. 18 We also ensured that we involved HCWs, specifically otolaryngologists, in the simulation of the activity for which the PPE was being assessed. 18 In terms of donning and doffing, all the PPE options that were subjected to a full ergonomic assessment were performed with ease.…”

3-D Printed Protective Equipment during COVID-19 Pandemic

“…The present article is based on the belief that documentation and transparency [17] using open-source data will help identify ways to combat the spread of SARS-CoV-2 infection. The rationale of the present investigation was to remove the necessity of time-consuming testing procedures with respect to printing time, ease of assembly, printability, and the comfort of using open-access data to print face shields in situations of scarcity.…”

A Personal Respirator Specification for Health-care Workers Treating COVID-19 (PeRSo)

“…airborne, droplet or contact). 8 infection is primarily transmitted by droplets and fomites transmitted by face touching, although it is also envisaged that there may be an airborne infection route for HCW performing aerosol-generating procedures in health-care settings. 9 Respiratory Protective Equipment (RPE) or respirators that can be continuously worn by front-line health staff provide protection against air-borne pathogens, as well as a physical or psychological barrier to avoid transmission from surfaces and fomites.…”

“…14 Full-face respirators and respirators with hoods are reported to offer greater respiratory protection and more facial coverage against splash than FFRs. 8 Where an elastomeric full-face respirator may cause skin discomfort, rashes and oedema if worn for long periods, hood-type PAPR devices are reported to be more comfortable by delivering a continuous airflow. 15 Furthermore a hood limits inadvertent facial touching by the healthcare worker, avoids issues of compromised fit between masks and goggles, and by removing the need to change the RPE between patients the clinician's work can be much more efficient.…”