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Response to: Dos Santos WM Use of personal protective equipment reduces the risk of contamination by highly infectious diseases such as COVID-19 Evidence-Based Nursing 2021: 24:41
Nurses need accessible and thorough evidence-based guidance to support safe, effective care due to the risk of SARS-CoV-2/COVID-19 infection, sickness, and death. Selection and use of appropriate Personal Protective Equipment (PPE) is fundamental to respiratory protection programs and access to the latest evidence is vital to underpin practice and policy decisions.
The Evidence-Based Nursing commentary by Dr Dos Santos on a recent Cochrane Review of PPE use in healthcare workers offers some useful insights. However, there are other key details and findings from the original review that are also important for readers. While covering more of the body appeared to result in enhanced protection, more difficult donning, doffing, and poorer user comfort could lead to higher contamination risk. Also, more breathable PPE might result in a similar number of contamination spots on the user’s trunk compared to less permeable materials (MD 1.60, 95% CI −0.15 to 3.35) and potentially increase user satisfaction (MD −0.46, 95% CI −0.84 to −0.08).
Centers for Disease Control and Prevention guidance resulted in less contamination compared with using no guidance (small patches: MD −5.44, 95% CI −7.43 to −3.45). Other key findings include:
- One-step glove plus gown removal versus separa...
- One-step glove plus gown removal versus separate removal resulted in less bacterial contamination (RR 0.20, 95% CI 0.05 to 0.77) but not fluorescent contamination (RR 0.98, 95% CI 0.75 to 1.28).
- Double-gloving resulted in less viral and bacterial contamination (RR 0.34, 95% CI 0.17 to 0.66) but not fluorescent contamination (RR 0.98, 95% CI 0.75 to 1.28).
- Additional spoken instructions resulted in fewer doffing errors (MD −0.9, 95% CI −1.4 to −0.4) and fewer contamination spots (MD −5, 95% CI −8.08 to −1.92).
- Extra sanitation of gloves with quaternary ammonium or bleach decreased contamination, but not alcohol‐based hand rub.
- Additional computer simulation reduced doffing errors (MD −1.2, 95% CI −1.6 to −0.7).
- Improved skill scores following PPE donning video lecture (MD 30.70, 95% CI 20.14 to 41.26).
- Face-to-face instruction reduced non-compliance with doffing guidance more than folders or videos alone (odds ratio 0.45, 95% CI 0.21 to 0.98).
De Castella T. WHO says ‘at least’ 115,000 health workers have now died from Covid-19. Nursing Times. 27 May 2021. Available: https://www.nursingtimes.net/news/coronavirus/who-says-at-least-115000-h... (Accessed 31 May 2021).
Verbeek JH, Rajamaki B, Ijaz S, et al. Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane Database Syst Rev. 2020;4: CD011621. doi:10.1002/14651858.CD011621.pub4.