Personal Protective Equipment (PPE)

The effectiveness of face masks in reducing the transmission of COVID-19 from an infected wearer to an uninfected person continues to be a key area of research in addressing spread of the disease. Nature Medicine recently released a study that examined the respiratory droplet and aerosol transmission of coronaviruses and examined the degree to which surgical masks prevented transmission.

The study looked at more than 100 coronavirus-infected patients and measured the presence of the virus in both droplet and aerosol form. The findings were significant. When the patients were not wearing a face mask, 30 percent had coronavirus present in their exhaled droplets, and 40 percent had droplets present in their exhaled aerosols. When patients were wearing face masks, no virus was detected in their exhalations, adding to the body of evidence that surgical face masks are an important means of preventing the spread of COVID-19. The implications of these results support recently updated recommendations that both COVID-19-infected patients and hospital personnel should wear face masks in hospital settings.

Surgeons should be aware that the Occupational Safety and Health Administration (OSHA) has published guidance on preparation for the workplace in response to the COVID-19 pandemic. That document can be found here. This guidance document states (page 15) that “those who work within 6 feet of patients known to be, or suspected of being, infected with SARS-CoV-2 and those performing aerosol-generating procedures, need to use respirators” and that the respirators to which it refers are “National Institute for Occupational Safety and Health (NIOSH)-approved, N95 filtering facepiece respirators or better” and that they “must be used in the context of a comprehensive, written respiratory protection program that includes fit-testing, training, and medical exams.”

The OSHA regulation enforcing this standard can be found here and reads in part, “A respirator shall be provided to each employee when such equipment is necessary to protect the health of such employee.”Reference to these regulations could be considered in circumstances whereby surgeons are precluded from using appropriate and necessary personal protective equipment, particularly in circumstances in which they have their own N95 mask.

The Journal of the American College of Surgeons has published a best practice guideline—“Precautions for Operating Room Team Members during the COVID-19 Pandemic”—that highlights the development of an institutional algorithm to protect operating room team (OR) members during the COVID-19 pandemic and how to conserve personal protective equipment (PPE). Researchers from the department of surgery at Stanford University, CA, created a PPE taskforce that was tasked with developing a common algorithm for PPE use to be used throughout the interventional platform (OR, interventional suites, and endoscopy).

The American College of Hyperbaric Medicine (ACHM) has produced a four-minute video tutorial outlining how to construct a do-it-yourself (DIY) intubation shield. The cost-effective shield, made of readily available materials, provides an extra barrier of protection for health care personnel during the COVID-19 pandemic and may be used for both intubation and extubation. Printable diagram and construction information may be accessed here.

Many hospitals are experiencing shortages of personal protective equipment (PPE) and drugs necessary to provide safe, high-quality care to COVID-19 patients. To help U.S. health care centers prepare for the potential onslaught of these patients, the U.S. Department of Health and Human Services (HHS) Assistant Secretary for Preparedness and Response (ASPR) has issued a Hospital Personal Protective Equipment Planning Tool to assist hospitals in determining approximate minimum PPE needs based on special pathogen categories and facility-specific variables. Calculators are available for Ebola/viral hemorrhagic fever, as well as special respiratory pathogens such as Middle East respiratory syndrome/severe acute respiratory syndrome (MERS/SARS), and pandemic influenza. The ASPR cautions that the tool is intended for preplanning purposes—not for use during an outbreak.