Evaluating the national PPE guidance for NHS healthcare workers during the COVID-19 pandemic

Thomas, John P.; Srinivasan, Anand; Wickramarachchi, Chandu; Dhesi, Parveen K; Hung, Yat Ma; Kamath, Ajay

doi:10.7861/clinmed.2020-0143

Cited by 79 publications

(81 citation statements)

References 48 publications

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“…Thus, the higher risk noted in the UK could reflect a higher infection rate because of differences in the quality and appropriate use of PPE across practice settings 19 or country-specific differences in PPE recommendations for health-care workers or the general public (eg, cloth face coverings). 20 , 21 Ideally, we would assess risk within a population that has undergone uniform screening. However, the current shortage of PCR-based testing kits does not make such an approach feasible but could justify targeted screening of front-line health-care workers.…”

Section: Discussionmentioning

confidence: 99%

Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study

Nguyen¹,

Drew²,

Graham³

et al. 2020

The Lancet Public Health

1,838

1,600

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Summary Background Data for front-line health-care workers and risk of COVID-19 are limited. We sought to assess risk of COVID-19 among front-line health-care workers compared with the general community and the effect of personal protective equipment (PPE) on risk. Methods We did a prospective, observational cohort study in the UK and the USA of the general community, including front-line health-care workers, using self-reported data from the COVID Symptom Study smartphone application (app) from March 24 (UK) and March 29 (USA) to April 23, 2020. Participants were voluntary users of the app and at first use provided information on demographic factors (including age, sex, race or ethnic background, height and weight, and occupation) and medical history, and subsequently reported any COVID-19 symptoms. We used Cox proportional hazards modelling to estimate multivariate-adjusted hazard ratios (HRs) of our primary outcome, which was a positive COVID-19 test. The COVID Symptom Study app is registered with ClinicalTrials.gov , NCT04331509 . Findings Among 2 035 395 community individuals and 99 795 front-line health-care workers, we recorded 5545 incident reports of a positive COVID-19 test over 34 435 272 person-days. Compared with the general community, front-line health-care workers were at increased risk for reporting a positive COVID-19 test (adjusted HR 11·61, 95% CI 10·93–12·33). To account for differences in testing frequency between front-line health-care workers and the general community and possible selection bias, an inverse probability-weighted model was used to adjust for the likelihood of receiving a COVID-19 test (adjusted HR 3·40, 95% CI 3·37–3·43). Secondary and post-hoc analyses suggested adequacy of PPE, clinical setting, and ethnic background were also important factors. Interpretation In the UK and the USA, risk of reporting a positive test for COVID-19 was increased among front-line health-care workers. Health-care systems should ensure adequate availability of PPE and develop additional strategies to protect health-care workers from COVID-19, particularly those from Black, Asian, and minority ethnic backgrounds. Additional follow-up of these observational findings is needed. Funding Zoe Global, Wellcome Trust, Engineering and Physical Sciences Research Council, National Institutes of Health Research, UK Research and Innovation, Alzheimer's Society, National Institutes of Health, National Institute for Occupational Safety and Health, and Massachusetts Consortium on Pathogen Readiness.

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Section: Discussionmentioning

confidence: 99%

Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study

Nguyen¹,

Drew²,

Graham³

et al. 2020

The Lancet Public Health

1,838

1,600

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“…The COVID-19 pandemic has had significant negative effects globally on public health, the economy, and political climates, and it has placed great pressure and stress on HCPs. Negative effects include both the direct effects of catching the virus, leading to illness and even death, and the indirect effects, which can include fear of contracting the virus and passing it to family members; lack of sufficient PPE; longer work hours; deployment to different work Please consider that as a medical professional that your opinion may be highly valued by the public; thus, please be sure to be fair and appropriate in what you say to reporters or post on social media References from the WHO and other scientific organizations specifically recommend ways to care for HCPs 1,2,6,7,[11][12][13][14][15] 8.…”

Section: Discussionmentioning

confidence: 99%

“…Table 1 lists the challenging scenarios encountered and alternative responses. 1,2,[5][6][7][8][9][10][11][12][13][14][15] We recognize that awareness of these challenges is not enough. We value constructive feedback, innovation, and inclusion of ideas from experts in the provision of excellent healthcare.…”

Section: Eleven Challenging Scenarios and Responsesmentioning

confidence: 99%

Ten Eleven Things Not to Say to Healthcare Professionals During the Coronavirus Disease 2019 Pandemic

et al. 2020

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On March 11, 2020, the infection caused by the coronavirus disease 2019 (COVID‐19) virus was declared a pandemic. Throughout this pandemic, healthcare professionals (HCPs) have experienced difficulties stemming from poor communications, resource scarcity, lack of transparency, disbelief, and threats to the safety of their loved ones, their patients, and themselves. As part of these hardships, negative statements have been heard repeatedly. This paper describes 11 scenarios of unhelpful and dysfunctional messages heard by the authors and their colleagues during the COVID‐19 pandemic, reported to us by a combination of peers, administrative leadership, and the public. We explain why not to use such messaging, and we suggest more helpful and compassionate expressions based upon recommendations published by scientific organizations and well‐established psychological principles. The first 10 scenarios discussed include (1) lack of understanding regarding the extent of the pandemic; (2) shaming over not seeing patients in person; (3) lack of clear and consistent communication from leadership on pandemic‐related practice changes; (4) opinions that personal protective equipment (PPE) use by HCPs causes fear or is unnecessary; (5) forcing in‐person care without appropriate PPE; (6) the risk of exposure to asymptomatic individuals as it relates to opening clinics; (7) media gag orders; (8) pay and benefit reductions; (9) spreading of misinformation about the COVID‐19 pandemic; and (10) workload expectations. The 11th scenario addresses HCPs’ psychological and physical reactions to this challenging and prolonged stressful situation. We close by discussing the need for support and compassion at this difficult and unpredictable time and by offering suggestions to foster resilience and feelings of self‐efficacy among HCPs.

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“…Appropriate mitigation strategies are required to ensure that CPET can be conducted safely and without posing a risk of transmission and infection. Screening patients is a possible strategy but the reliability of the testing methods has been questioned 16 ; therefore, additional approaches are needed which include the availability of appropriate personal protective equipment and other infection protection measures (see published guidelines from the Association for Respiratory Technology and Physiology, 13 Royal College of Physicians, 17 and the European Respiratory Society 18 ).…”

Section: Precautions and Risk Mitigation For Cpet Testingmentioning

confidence: 99%

Cardiopulmonary exercise testing in the COVID-19 endemic phase

Faghy

Sylvester

Cooper³

et al. 2020

British Journal of Anaesthesia

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Evaluating the national PPE guidance for NHS healthcare workers during the COVID-19 pandemic

Cited by 79 publications

References 48 publications

Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study

Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study

Ten Eleven Things Not to Say to Healthcare Professionals During the Coronavirus Disease 2019 Pandemic

Cardiopulmonary exercise testing in the COVID-19 endemic phase

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