Applying the precautionary principle to personal protective equipment (PPE) guidance during the COVID-19 pandemic: did we learn the lessons of SARS?

Crosby, Lauren; Crosby, Edward T.

doi:10.1007/s12630-020-01760-y

Cited by 16 publications

(17 citation statements)

References 43 publications

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“…Judge Campbell emphasized the use of the precautionary principle, which dictates that when there are two conflicting recommendations during an unclear healthcare threat, that the safer approach be followed. 11 This results in frontline healthcare providers trusting that the recommendations made by national or society structures are to protect them. Once more evidence is gleaned, or other protections such as vaccination are widespread, recommendations should change to reflect the current situation.…”

Section: Discussionmentioning

confidence: 99%

Airway recommendations for perioperative patients during the COVID-19 pandemic: a scoping review

Grudzinski

Sun

Zhang

et al. 2021

Preprint

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Purpose: Numerous guideline recommendations for airway and perioperative management during the COVID-19 pandemic have been published. We identified, synthesized, and compared guidelines intended for anesthesiologists. Source: Member society websites of the World Federation of Societies of Anesthesiologists and the European Society of Anesthesiologists were searched. Recommendations focused on perioperative airway management of patients with proven or potential COVID-19 disease were included. Accelerated screening was used; data extraction was performed by one reviewer and verified by a second. Data was organized into themes based on perioperative phase of care. Principal Findings: Thirty unique sets of recommendations were identified. None reported methods for systematically searching or selecting evidence to be included. Four were updated following initial publication. For induction and airway management, most recommended minimizing personnel and having the most experienced anesthesiologist perform tracheal intubation. Significant congruence was observed amongst recommendations that discussed personal protective equipment. Of those that discussed tracheal intubation methods, most (96%) recommended video laryngoscopy, while discordance existed regarding use of flexible bronchoscopy. Intraoperatively, 23% suggested specific anesthesia techniques and most (63%) recommended a specific operating room for patients with COVID-19. Postoperatively, a minority discussed extubation procedures (33%), or care in the recovery room (40%). Non-technical considerations were discussed in 27% and psychological support for healthcare providers in 10%. Conclusion: Recommendations for perioperative airway management of patients with COVID-19 overlap to a large extent. However, we also identified significant differences. This may reflect the absence of a coordinated response towards studying and establishing best-practices in perioperative patients with COVID-19. Registration: Open Science Framework (https://osf.io/a2k4u/)

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Section: Discussionmentioning

confidence: 99%

Airway recommendations for perioperative patients during the COVID-19 pandemic: a scoping review

Grudzinski

Sun

Zhang

et al. 2021

Preprint

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“…In addition, the recommendations seemed to be based on a very limited number of referenced publications, or none at all; regardless, the messages primarily remained clear and were either delivered concisely or extensively, with protocols ranging between 7 and 60 pages in length. Guidelines and policy recommendations, including protocols, should be grounded in evidence-based practice approaches and in precautionary principles, as suggested by Crosby and Crosby [ 63 ]. Without more evidence-based information on SARS-CoV-2 and oral health care, future studies should focus on the hard evidence that does exist and can reasonably be extrapolated to the provision of oral health care services; they should also include providers’ perspectives to elicit their views on the future of delivering oral health care during the COVID-19 pandemic.…”

Section: Discussionmentioning

confidence: 99%

A Pan-Canadian narrative review on the protocols for reopening dental services during the COVID-19 pandemic

et al. 2020

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The current coronavirus disease 2019 (COVID-19) pandemic is impacting the way in which dental services are provided. The aim of this narrative review was twofold: to summarize key areas from the Canadian protocols available for the reopening and restructuring of dental services across the country and to critically review these protocols based on existing evidence. A narrative review of the existing Canadian protocols, written in English and French, was undertaken between April 15 and July 13, 2020. The protocols were obtained by searching through regulatory bodies and websites from professional organizations, and from personal contacts through academic institutions and policy leaders. The data extraction form focused only on protocols related to dentistry, and the information was compiled by a hired assistant. Content was categorized via group discussions with the research team on eight areas: office management and procedures, patient and staff screening, treatment procedures, office layout, risk reduction, personal protective equipment, supporting information, and length and readability. Thirteen protocols were identified and offered substantial variation in the level of details provided. All but two protocols specified proper donning/doffing of personal protective equipment, while all protocols recommended daily monitoring of COVID-19 related signs and symptoms in staff and patients. They varied in terms of recommended mask types, eye and face shield protection, and head coverings. While all protocols aimed at restructuring emergency dental services, their recommendations were often not based on the published evidence. This narrative review summarized key areas from 13 provincial and territorial protocols in Canada to help oral health care providers plan the reopening of their services. The information conveyed across all documents was clear, but variance highlights the need for a coordinated effort to develop an evidence-based document for dental practitioners.

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“…As hospitals in Canada begin to ramp-up surgical procedures, it is our responsibility to be role-models in HCW safety and advocate for ourselves and our other HCW colleagues to maintain appropriate PPE protocols. It will be a paradigm shift to view PPE protocols, including real-time coaching, as an investment in HCW safety and morale, 5 and not simply as a threat to operating room efficiency.…”

Section: To the Editormentioning

confidence: 99%

In reply: Personal protective equipment during the COVID-19 pandemic (Letters #1 and #2)

Duggan

Lockhart

Grocott

2020

Can J Anesth/J Can Anesth

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Applying the precautionary principle to personal protective equipment (PPE) guidance during the COVID-19 pandemic: did we learn the lessons of SARS?

Cited by 16 publications

References 43 publications

Airway recommendations for perioperative patients during the COVID-19 pandemic: a scoping review

Airway recommendations for perioperative patients during the COVID-19 pandemic: a scoping review

A Pan-Canadian narrative review on the protocols for reopening dental services during the COVID-19 pandemic

In reply: Personal protective equipment during the COVID-19 pandemic (Letters #1 and #2)

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