To the Editor—With the progression of the coronavirus disease 2019 (COVID-19) pandemic, the personal protective equipment (PPE) shortage has been highlighted.1 The sudden increase in demand for PPE due to the number of COVID-19 cases, misinformation, panic buying, and stockpiling resulted in global shortages. The World Health Organization (WHO) published a guideline for the rational use of PPE for coronavirus disease in healthcare and home-care settings during severe shortages.2 Despite the importance of this topic, observational studies that evaluate the use of PPE during the pandemic by healthcare workers (HCWs) are scarce. A Chinese cross-sectional survey using a self-administered questionnaire included 1,357 HCWs and showed that 89% had sufficient knowledge and 89.7% followed correct practices concerning severe acute respiratory coronavirus virus 2 (SARS-CoV-2).3
Researchers in the division of infection control and hospital epidemiology of a teaching hospital in Brazil observed compliance regarding additional transmission-based precautions in exclusive care units for patients suspect or confirmed to COVID-19 from April 1 to May 15, 2020. The institutional protocol to control the coronavirus disease was developed based on guidelines of the World Health Organization (WHO) and the National Health Surveillance Agency (ANVISA), a regulatory body of the Brazilian government.4,5 Prior to the onset of observations, healthcare professionals (HCPs) received face-to-face or video training on SARS-CoV-2 precautions. In assistance activities, HCPs and support teams should follow contact and droplet precautions or contact and airborne precautions for aerosol-generating procedures.
Compliance was considered as satisfactory when the HCPs wore all 5 proper PPE (ie, gown, eye protection, head cap, mask, and gloves) recommended for each specific procedure. During the study, 260 observations were performed and the compliance rate was 31.5% (n = 82). The compliance rate was 22% (2 of 9) among physiotherapists, 29% (15 of 52) among physicians, 31% (56 of 182) in the nursing team, and 53% (9 of 17) among all others (ie, nutrition team, occupational therapists, X-ray technicians, and cleaning staff). More than 1 improper PPE use was identified in each observation, totaling 322 failures, of which 40% (n=129) were practices that could have resulted in self- and/or environmental contamination. Furthermore, 60% of these failures (n=193) were practices that resulted in waste of PPE (Table 1).
Table 1.
Distribution of Noncompliance to PPE Use in Exclusive Care Units for Patients Suspect or Confirmed to COVID-19 in a Teaching Hospital in Brazil, 2020
| Variable | No. | % |
|---|---|---|
| Practices that could have resulted in self and/or environmental contamination | 129/322 | 40 |
| Use of potentially contaminated PPE outside the assistance area | 44 | 34.1 |
| Professional did not use available PPE | 63 | 48.9 |
| Overuse of PPE with risks of exposure to microorganismsa | 7 | 5.4 |
| Inappropriate PPE with risks of exposure to microorganismsb | 12 | 9.3 |
| Inadequate handling of PPEc | 3 | 2.3 |
| Practices that resulted in waste of PPE | 193/322 | 60 |
| Overuse of PPE | 84 | 43.5 |
| Inappropriate and more expensive PPE than indicatedd | 109 | 56.5 |
| Total | 322 |
Note. PPE, personal protective equipment.
Surgical mask under FFP2/N95.
Gowns had less protection than recommended.
Adjusted the mask in the assistance area.
An N95/FFP2 mask instead of a surgical mask; gowns had higher protection than recommended.
These preliminary results suggest unnecessary consumption of PPE by HCPs, contributing the shortage of these products, which may put the safety of professionals and patients at risk. Therefore, determining the cause of this behavior is crucial to developing targeted interventions to increase precaution compliance to control the spread of SARS-CoV-2.
Acknowledgments
None.
Conflicts of interest
All authors report no conflicts of interest relevant to this article.
Financial support
No financial support was provided relevant to this article.
References
- 1. Ranney ML, Griffeth V, Jha AK. Critical supply shortages—the need for ventilators and personal protective equipment during the COVID-19 pandemic. N Engl J Med 2020;382:e41. [DOI] [PubMed] [Google Scholar]
- 2.Rational use of personal protective equipment for coronavirus disease (COVID-19) and considerations during severe shortages: interim guidance, 6 April 2020. World Health Organization website. https://apps.who.int/iris/handle/10665/331695. Published April 6, 2020. Accessed May 25, 2020.
- 3. Zhang M, Zhou M, Tang F, et al. Knowledge, attitude, and practice regarding COVID-19 among healthcare workers in Henan, China. J Hosp Infect 2020;105:183–187. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Infection prevention and control during health care when COVID-19 is suspected: interim guidance, 19 March 2020. World Health Organization website. https://apps.who.int/iris/handle/10665/331495. Published March 19, 2020. Accessed May 25, 2020.
- 5.Nota técnica GVIMS/GGTES/ANVISA No 04/2020. Orientações para serviços de saúde: medidas de prevenção e controle que devem ser adotadas durante a assistência aos casos suspeitos ou confirmados de infecção pelo novo Coronavírus (SARS-CoV-2). Atualização 4: 08 de maio de 2020. Agencia nacional de vigilância sanitária (ANVISA) website. https://www20.anvisa.gov.br/segurancadopaciente/index.php/alertas/item/nota-tecnica. Published May 8, 2020. Accessed May 25, 2020.