American Frontline Healthcare Personnel's Access to and Use of Personal Protective Equipment Early in the COVID-19 Pandemic

Abstract

Objectives: To quantify adequacy of personal protective equipment (PPE) for U.S. healthcare personnel (HCP) at the outset of the COVID-19 pandemic and its association with infection risk. Methods: March–May 2020 survey of the national Nurses’ Health Studies and the Growing Up Today study regarding self-reported PPE access, use, and reuse. COVID-19 endpoints included SARS-CoV-2 tests and COVID-19 status predicted from symptoms. Results: Nearly 22% of 22,232 frontline HCP interacting with COVID-19 patients reported sometimes or always lacking PPE. Fifty percent of HCP reported not needing respirators, including 13% of those working in COVID-19 units. Lack of PPE was cross-sectionally associated with two-fold or greater odds of COVID-19 among those who interacted with infected patients. Conclusion: These data show the need to improve the U.S. infection prevention culture of safety when confronting a novel pathogen.

Reported exposure trends among healthcare personnel COVID-19 cases, USA, March 2020–March 2021

“…25 , 26 Nevertheless, higher COVID-19 incidence and seroprevalence have been reported among HCP in nursing homes compared to other health care settings. 2 , 31 HCP cases in nursing homes were also more likely to report health care-associated exposures 32 and less likely to report using adequate PPE 2 , 5 , 32 than those in hospitals in other recent reports.…”

“…23 Inconsistent quarantine of exposed HCP due to staffing shortages, incomplete mask use policies regarding nonpatient areas (eg , break rooms), and limited availability of COVID-19 testing may have allowed for greater transmission between coworkers compared to later months. Insufficient PPE availability 5 may have also contributed to health care-associated exposure trends.…”

“… 1 Many reports have identified significant associations of HCP work-related characteristics with infection or seropositivity. 2 , 3 , 4 , 5 , 6 , 7 Work-related characteristics associated with increased risk of SARS-CoV-2 include contact with COVID-19 patients, 2 , 5 , 6 clinical role, 6 , 7 and insufficient personal protective equipment (PPE). 2 , 5 , 7 These workplace exposure hazards are reflected in comparatively high COVID-19 diagnosis rates and SARS-CoV-2 seroprevalence among HCP.…”

“… 2 , 3 , 4 , 5 , 6 , 7 Work-related characteristics associated with increased risk of SARS-CoV-2 include contact with COVID-19 patients, 2 , 5 , 6 clinical role, 6 , 7 and insufficient personal protective equipment (PPE). 2 , 5 , 7 These workplace exposure hazards are reflected in comparatively high COVID-19 diagnosis rates and SARS-CoV-2 seroprevalence among HCP. 2 Other reports in select HCP populations did not identify many work-related associations but identified significant associations of cumulative community incidence 8 and household and/or community exposures 6 , 8 with seropositivity.…”

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“…In higher income countries, the lack of personal protective equipment (PPE) was a major cause for surgical cancellations or delays. Early in the pandemic, nearly 22% of frontline healthcare personnel reported sometimes or always lacking PPE (Rich-Edwards et al 25 2021). Access to testing and vaccines have exposed the inequities in access to resources to ease the impact of the pandemic.…”