Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff

Abstract

We found very low quality evidence that more breathable types of PPE may not lead to more contamination, but may have greater user satisfaction. We also found very low quality evidence that double gloving and CDC doffing guidance appear to decrease the risk of contamination and that more active training in PPE use may reduce PPE and doffing errors more than passive training. However, the data all come from single studies with high risk of bias and we are uncertain about the estimates of effects.We need simulation studies conducted with several dozens of participants, preferably using a non-pathogenic virus, to find out which type and combination of PPE protects best, and what is the best way to remove PPE. We also need randomised controlled studies of the effects of one type of training versus another to find out which training works best in the long term. HCWs exposed to highly infectious diseases should have their use of PPE registered and should be prospectively followed for their risk of infection.

Experience of Chicagoland acute care hospitals in preparing for Ebola virus disease, 2014–2015

“…This is disappointing as occupational health experts can contribute substantially to the prevention of infection among patients and HCP, and since the 2014-2015 EVD outbreak there has been movement to increase the availability of information about PPE from these and other federal occupational health agencies. [19][20][21][22] There remains, however, a need to provide further guidance on how to evaluate ensembles, not just individual pieces of PPE, for their level of protection against infectious diseases and for their comfort and usability.…”

‘VIOLET’: a fluorescence-based simulation exercise for training healthcare workers in the use of personal protective equipment

“…Furthermore, training in a safe environment can identify staff with particular issues such as claustrophobia or overheating, as well as potential systematic errors and environmental problems such as optimal placement of disposal bins and zone demarcation [34,35]. Despite the clear need for optimized training programmes, methods have been unclear to date [23].…”

“…However, these studies have low numbers of participants. The lack of clear evidence for PPE components and training methods required for their correct use and doffing was concluded in a Cochrane review, which called for higher-powered studies to address both issues [23].…”

Barriers and factors affecting personal protective equipment usage in St. Mary’s Hospital Lacor in Northern Uganda

“…It (PPE) provides health care workers with a barrier to prevent human contact with viruses like Ebola and potential transmission of the disease. In a metaanalysis,Verbee, Ijaz, Mischke, Ruotsalainen, Mäkelä et al, (2016) 9 found that gowns protected better than aprons, while double gloving led to less contamination compared to single gloving (Relative Risk (RR) 0.36; 95% CI 0.16 to 0.78) and training at least reduced non-compliance with doffing procedures (OR 0.45; 95% CI 0.21 to 0.98). Much as training is important in ensuring compliance to PPE use, 30.5% of our staffs report having no training in PPE.…”