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American College of Surgeons Statement on Resident Access to Personal Protective Equipment

The following Statement on Resident Access to Personal Protective Equipment (PPE) was developed by the American College of Surgeons (ACS) Resident and Associate Society (RAS) and approved by the (ACS) Board of Regents at its June 11-12, 2021, meeting in Chicago, IL.

The American College of Surgeons has long stood for quality and safety in health care. This principle was demonstrated in the April 2020 “ACS Statement on PPE Shortages during the COVID-19 Pandemic,” which called for adequate PPE for all involved in health care. This statement included our colleagues in training. The Centers for Disease Control and Prevention (CDC), Occupational Safety and Health Agency, and other public health advocates stress the importance of adequate, available, and appropriate PPE to ensure the safety of patients and health care professionals and to mitigate spread of contagious diseases.

A survey of residents from across the U.S. last year identified that a lack of access to personal protective equipment (PPE) amid the coronavirus (COVID-19) pandemic was predictive of depression and burnout.1 The Resident and Associate Society (RAS) conducted a follow-up survey, which revealed that more than one-third of residents have experienced PPE shortages in the last year. The ACS is concerned that as recently as February 2021, and despite a significant improvement in supply chain, residents across the country still are reporting challenges in accessing PPE.

In response to this data, the ACS is issuing the following statement regarding PPE for surgical residents. The recommendations are outlined below, and the ACS leadership affirms that if any resident feels uncomfortable or unsafe wearing their PPE in its current state when taking care of patients, the resident should be entitled to PPE replacement without question or opposition. Residents are encouraged to speak up immediately with concerns regarding their safety during patient care. In line with recommendations from the CDC regarding N95 respirators/masks2-4, the ACS recommends that health care institutions take the following steps:

  • Implement practices that allow extended use and/or limited reuse of N95 respirators when acceptable. If there’s no available manufacturer-specific guidelines about N95 reuse (using the same N95 respirator for multiple encounters with patients but removing it after each encounter) or for extended use (using the same N95 mask for multiple patient encounters without removal), residents should not be asked to wear N95 masks more than five times.
  • Prioritize the use of N95 respirators for personnel at the highest risk of contracting or experiencing complications of infection, such as residents in direct contact with patients with COVID-19 or of unknown COVID-19 status.
  • Residents should discard any respirator that is obviously damaged or becomes hard to breathe through and be given an N95 replacement immediately following this circumstance.
  • To reduce contact transmission after donning an N95, residents should discard N95 respirators following use during aerosol generating procedures; respirators contaminated with blood, respiratory or nasal secretions, or other bodily fluids from patients; or following close contact with, or exit from, the care area of any patient co-infected with an infectious disease requiring contact precautions.  Residents should be given an N95 replacement immediately following any of these circumstances.
  • Residents should be provided with labeled containers or paper bags used for storing respirators to reduce accidental usage of another person’s respirator.

The ACS is aware of reports of residents being asked to provide their own PPE or pay for PPE supplied to them. There also have been reports of PPE being locked in storage by hospital personnel, making it difficult for residents to acquire what they need in a timely fashion. Similarly, the College has received reports of PPE usage for extended periods of time and beyond the recommended duration, which renders the N95 mask ineffective in preventing infection and placing residents at risk of acquiring COVID-19 infection. Our trainees are part of the front line, and the ACS leadership strongly condemns these practices.

Lastly, if trainees encounter macro- or microaggressions when attempting to acquire new PPE according to the recommendations above or are denied PPE when requested, an expeditious institutional mechanism should be in place to report these events and have them corrected by program or hospital leadership. We recommend this statement be made accessible to all hospital personnel so that institutional staff are educated regarding these policies and to avoid these instances from occurring.

Looking forward, the ACS leadership affirms that residents taking care of patients with known COVID-19 or COVID-19 unknown status should be given priority in the future for protective equipment and practices, including vaccinations and booster vaccinations, if found to be merited. 

The ACS leadership recognizes, respects, and supports surgical trainees. Any surgical resident who is confronted with issues acquiring PPE despite the above statement should contact their institutional Accreditation Council for Graduate Medical Education representation.

References

  1. Coleman JR, Abdelsattar JM, Glocker R. The COVID-19 pandemic and the lived experiences of surgical residents, fellows, and early-career surgeons in the American College of Surgeons. J Am Coll Surg. 2020;S1072-7515(20):32402-32409.
  2. Centers for Disease Control and Prevention. Recommended guidance for extended use and limited reuse of N95 filtering facepiece respirators in healthcare settings. Available at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/decontamination-reuse-respirators.html. Accessed July 8, 2021.
  3. Centers for Disease Control and Prevention. Guidance for the selection and use of personal protective equipment (PPE) in healthcare settings. Available at: https://www.cdc.gov/hai/pdfs/ppe/ppeslides6-29-04.pdf. Accessed July 8, 2021.
  4. Centers for Disease Control and Prevention. Using PPE. Available at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/using-ppe.html. Accessed July 8, 2021.

To be published in the Bulletin of the American College of Surgeons, September 2021.