Variation of National and International Guidelines on Respiratory Protection for Health Care Professionals During the COVID-19 Pandemic

Abstract

Conflicting evidence surrounding SARS-CoV-2 transmission, particularly airborne transmission, may have contributed to heterogeneous recommendations for respiratory protection across countries and organizations. 1 Variability among guidelines may generate confusion, anxiety, and mistrust among health care professionals (HCPs) regarding the ability of respiratory protection to prevent SARS-CoV-2 transmission. We assessed variation in international and national guidelines on respiratory protection for HCPs in hospital settings during the first year of the COVID-19 pandemic. MethodsThe Nantes University Hospital determined that this systematic review was exempt from formal review by the institutional review board and from written informed consent because this study used publicly accessible documents. We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Infection prevention and control guidelines on respiratory protection for HCPs published from January 1 to December 31, 2020, by leading organizations in 4 countries and 2 international organizations were collected through a monthly consultation of their official websites (eMethods in the Supplement). We defined HCPs as all workers employed by a hospital. For each included guideline, we extracted data regarding the organization, date of publication, type of respiratory protection recommended (ie, medical face mask [MF] or respirator, including N95 or N99 or filtering facepiece [FFP2 or FFP3]), indication for use, and lists of aerosol-generating procedures (AGPs). We classified the indications for respirators as recommended during AGPs, recommended for targeted continuous use in high-risk areas, and recommended during contact with individuals with suspected or confirmed infections in any circumstance. The indications for MFs were categorized as universal face masking recommended, targeted continuous face masking recommended, or recommended during contact with individuals with suspected or confirmed infections only. Targeted continuous use was defined as the wearing of a respirator or MF by all HCPs during their entire shifts in clinical areas with patients with or without COVID-19.Universal face masking was defined as a requirement for all HCPs entering the facility to wear an MF.

An unprecedented and large-scale support mission to assist residential care facilities during the COVID-19 pandemic

“…Very few facilities did not have eye protection (8.7%) and respirators (FFP2) (7.7%). At that time that medical masks were recommended for healthcare professionals in contact with patients with suspected or confirmed COVID-19 infection, limiting the use of respirators to during aerosol-generating procedures [ 15 ]. During patient care, PPE was reused for different residents with same / different infectious status in 68.2% / 22.7% of NH and in 60.0% / 4.0% of FPD (including gloves).…”

P2/N95 respirators & surgical masks to prevent SARS-CoV-2 infection: Effectiveness & adverse effects

“…Without randomised trials with large participant numbers that control for relevant confounding factors (e.g. use of additional infection control measures), the conclusions regarding the comparison between respirators and surgical masks remain tentative, and guidelines specific to PPE use might remain inconsistent ( 13 ). The ethics of deliberately exposing HCWs to SARS-CoV-2 in settings where safety may be compromised (e.g.…”

“…Inconsistencies related to the understanding of the effectiveness of surgical masks and respirators for preventing SARS-CoV-2 infection among HCWs in different clinical contexts (e.g. when performing perceived high risk procedures compared to not) have contributed to the production of respiratory protection guidelines over the course of the COVID-19 pandemic that have different recommendations ( 13 ).…”

SARS-CoV-2-Infection (COVID-19): Clinical Course, Viral Acute Respiratory Distress Syndrome (ARDS) and Cause(s) of Death

“…The increased use of diuretics, which are routinely given on the assumption that respiratory distress accompanied by ground glass opacities (chest CT scan) up to the development of acute respiratory distress syndrome (ARDS) is a kind of non-cardiac “edema” of the lung, may aggravate the general clinical status of the patient [ 98 ].…”

“…According to the Berlin definition of ARDS [ 103 ], hypoxia without a cardiac cause represents the conditio sine qua non for the diagnosis of acute respiratory distress syndrome (ARDS). This is the case when hypoxemia occurs in COVID-19 patients showing diffuse ground glass opacities in the CT scan of the chest [ 98 ].…”