Personal protective equipment use by healthcare workers in intensive care unit during the early phase of COVID-19 pandemic in Italy: a secondary analysis of the PPE-SAFE survey

Abstract

Background: Italy was the first Western country to be heavily affected by COVID-19. Healthcare workers (HCWs) were exposed to a high risk of occupational infection, partially due to insufficient personal protective equipment (PPE) supplies. This study aimed to describe the practices, availability, training, confidence in PPE use and the adverse effects due to extended PPE use, as reported by HCWs in Italy. We also aimed to provide a comparison between Italian data and those from other countries. Methods: This study was a secondary analysis of a previously published international study, the PPE-SAFE Survey, conducted in April 2020. Data were analysed from the original study database. Results: We analysed the responses from 380 healthcare workers based in Italy, out of the 2711 respondents to the international survey. Among the Italian respondents, FFP2 and FFP3 respirators or equivalent were the most used masks for routine tasks (respectively 188/380, 50%; and 163/380, 43%). The median time of wearing PPE without taking a break was 5 h [interquartile range (IQR) 4–6], with statistically significant difference from other countries [median 4 h (IQR 2–5) p < 0.0001]. In Italy, 249 out of 380 (65%) HCWs had never performed a formal fit test for a N95 mask or equivalent and 91/380 (24%) never had a partner for donning and doffing procedures. Most of the respondents (299/380, 79%) had received formal training in PPE use at any time. Conclusion: Most of the surveyed Italian HCWs reported working at above usual capacity, long shifts with PPE without breaks and routine use in intensive care unit of aerosol protection (e.g. FFP2/FFP3), hazmat suits and face shields/visors. The correct adherence to safety procedures (e.g. donning/doffing in pairs, performing fit test) has substantial scope for improvement in the future.

Ventilator-Associated Pneumonia in Patients with COVID-19: A Systematic Review and Meta-Analysis

“…On the other hand, the ICUs may have been overcrowded in the period of peak of COVID-19 pandemic, with a possibly inadequate staffing (e.g., nurse to patient ratio) and more episodes of cross-contaminations. Healthcare workers may have also encountered difficulties related to the wearing of personal protective equipment in the setting of COVID-19-dedicated ICUs [38]. When considered together, these issues may have reduced the adherence to infection control standard and VAP prevention bundles [16].…”

Adverse Effects of Personal Protective Equipment Among Intensive Care Unit Healthcare Professionals During the COVID-19 Pandemic: A Scoping Review

“…Japanese respondents who reported significant thirst were 32.2%, while 47.4% of worldwide respondents reported this issue. Additionally, a recently published secondary analysis of the PPE-SAFE study in Italy (Ippolito et al, 2021) reported that the median time of wearing PPE continuously was 5 h (Interquartile range: 4-6 h). This finding was statistically significantly higher than other countries.…”

Characterization of epidemiological distribution and outcome of COVID-19 in patients with hereditary hemorrhagic telangiectasia: a nationwide retrospective multi-centre study during first wave in Italy

“…This scenario may even more be exacerbated in Italy during the first wave, in light of the restrictive measures which were applied to avoid the collapse of the national health system in front of the devastating and unexpected spreading of COVID-19 [ 26 ]. Uncontrollable epidemic spreading induced Italian Government to declare a nationwide lockdown and to release indication for mandatory utilize of personal protective equipment/individual protection devices (PPE/DPI) [ 27 ]. On the other hand, prolonged wearing of face and hand covering tools might have affected bleeding frequency of nasal, oral, and skin telangiectases in HHT patients.…”