published between 2018 and 2021
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.
As fourth-year King's College London medical students, we have read this article with great enthusiasm and felt we could identify with the concerns raised. We want to offer an additional perspective.
In terms of direct hazards, we have noticed that some of our colleagues have felt unsafe on specific placements. This is undoubtedly the case in psychiatry where patients may, unfortunately, become verbally abusive and at times physically intimidating.
Additional concerns may arise when students are placed peripherally in areas where there is a substantial crime. This can involve anything from petty theft to more serious crimes like muggings.
A clinical risk that we have been well trained to anticipate and handle are needlestick injuries. This is an example of adequate preparation making us feel more comfortable, i.e. working with sharps despite risks involved.
There are times when senior staff expectations are exceedingly high, and due to indirect risks such as stress and burnout, us students may fail to reach these standards. In some instances, lack of support and understanding perpetuate the cycle of stress. We have, however, noticed that this is less likely to occur when students have a longitudinal supervisor.
Overall we understand that certain risks are unavoidable, and we appreciate the vast number of measures in place aimed at safeguarding against risks and hazards during clinical placements. From our experience as medical stu...
Overall we understand that certain risks are unavoidable, and we appreciate the vast number of measures in place aimed at safeguarding against risks and hazards during clinical placements. From our experience as medical students, we find that these interventions are mainly aimed at direct risks and hazards with the indirect types being overlooked.
We propose that students be made more aware of the types of indirect hazards they may encounter and better equip them to escalate concerns. This can take many forms, such as lectures, debriefing sessions, reflective practice and of course, one on one meetings with longitudinal supervisors.