Health Workers With Appropriate PPE Don't Get COVID-19

By Lisa Rappaport

July 06, 2020

(Reuters Health) - Health workers who have appropriate personal protective equipment (PPE) including protective suits, masks, gloves, goggles, face shields, and gowns don't develop COVID-19 symptoms or test positive for SARS-CoV-2, a Chinese study suggests.

Researchers examined data on 116 doctors and 304 nurses who were deployed to Wuhan, China, for six to eight weeks from January 24, 2020 to April 7, 2020. They were all involved in aerosol-generating procedures, and provided with appropriate PPE to care for patients with COVID-19.

Participants worked four- to six-hour shifts over an average of 5.4 days per week, and they spent an average of 16.2 hours weekly working in intensive care units (ICU).

None of them reported COVID-19 symptoms when they were deployed to hospitals in Wuhan. After they returned home, they all tested negative for SARS-CoV-2 specific nucleic acids and IgG or IgM antibodies.

"In Wuhan, most of the affected healthcare professionals became infected in the early phase of the outbreak and the main reason was probably a lack of appropriate PPE," said senior study author Dr. Haipeng Xiao, president of the First Affiliated Hospital of Sun Yat-sen University in Guangzhou.

"The current study found that appropriate PPE and proper application give healthcare professionals a high level of protection against COVID-19," Dr. Xiao said by email.

The participants all worked in one of four hospitals in Wuhan and treated patients with severe or critical cases of COVID-19. More than 80% of patients required critical care and 10%-15% of them received mechanical ventilation.

Study participants received similar PPE to work in the ICU, regular wards, and for cases involving aerosol-generating procedures, researchers report in the The BMJ. This included: N95 respirator masks, medical suits, isolation gowns, aprons, gloves, eye protection, and hair coverings. In areas with no Covid-19 contact, workers wore surgical masks.

In addition, they all got training in proper use of PPE for infection control, including proper procedures for donning and doffing equipment.

The all performed at least one procedure generating aerosol, including tracheal intubation, non-invasive mechanical ventilation, gastric intubation, sputum aspiration, aerosol inhalation, tracheostomy, and throat swab collection.

Outside of work, participants wore masks in public, followed strict social distancing rules, and stayed in designated hotels. It's possible that limited social interactions outside of work helped prevent infection, the study team notes.

The researchers also recruited 77 healthcare professionals with no exposure history to COVID-19 and 80 patients who had recovered from COVID-19 to verify the accuracy of antibody testing, they add.

One limitation of the study is that it doesn't help identify which specific types of PPE might be more effective than others, or what the minimum effective level of PPE might be for resource-limited healthcare settings.

Even so, the study proves the necessity of PPE for healthcare workers during the pandemic, as well as the importance of training on correct use and removal, said Nick Vordos, an associate professor in physics at the International Hellenic University in Kavala, Greece, who conducts PPE research.

"It is one of the few studies that have systematically studied the effectiveness of PPE use, and if we correlate the confirmed deaths of health professionals from COVID-19 due to lack of PPE, then their use in infectious diseases is strongly recommended," Vordos, who wasn't involved in the study, said by email. "In times of a pandemic, people working in the healthcare sector, and especially the experienced ones, are in need of PPE, since their loss can cost even more lives."

SOURCE: The BMJ, online June 10, 2020.


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