Variations in Personal Protective Equipment Preparedness in Intensive Care Units during the COVID-19 Pandemic: A Survey of Asia-Pacific Countries
Authors: Rajamani Arvind , Subramaniam Ashwin , Shekar Kiran , Haji Jumana , Luo Jinghang , Bihari Shailesh , Wong Wai Tat , Gullapalli Navya , Renner Markus , Alcancia Claudia Maria , Ramanathan Kollengode 
Published: May 2020

Objectives

To evaluate PPE-preparedness across intensive care units (ICUs) in 6 Asia-Pacific countries. PPE-preparedness was defined as the adherence to guidelines, training HCWs, procuring PPE stocks and responding appropriately to a suspected case (transportation and admission to hospital).

Design

Cross-sectional web-based survey.

Setting

ICUs in Australia, New Zealand (NZ), Singapore, Hong Kong (HK), India and Philippines with a 24/7 Emergency/Casualty Department, and capable of mechanically ventilating patients for >24 hours.

Interventions

Questionnaire sent to intensivists in 633 Level ll/lll ICUs in 6 Asia-Pacific countries by email, WhatsApp™ and text messaging.

Main outcome measures

263 intensivists responded, of whom 231 were eligible for analysis. Response rates were 68%-100% in all countries except India, where it was 24%. 97% either conformed to or exceeded WHO recommendations for PPE-practice. 59% employed airborne precautions irrespective of aerosol-generation-procedures. There were variations in negative-pressure room use (highest in HK/Singapore), training (best in NZ), and PPE stock-awareness (best in HK/Singapore/NZ). High-flow-nasal-oxygenation and non-invasive ventilation were not options in most HK (66.7%, 83.3% respectively) and Singapore ICUs (50%, 80% respectively), but were considered in other countries to a greater extent. 38% reported not having specialized airway teams. Showering and “buddy-systems” were underutilized. Clinical waste disposal training was suboptimal (38%).

Conclusions

Most intensivists from six Asia-Pacific countries appeared to be aware of the WHO PPE-guidelines by either conforming to/exceeding the recommendations. Despite this, there were widespread variabilities across ICUs and countries in several domains, particularly related to PPE-training and preparedness. Standardising PPE guidelines may translate to better training, better compliance and policies that improve HCW safety. Adopting low-cost approaches such as buddy-systems should be encouraged. More importantly, better pandemic preparedness and building systems with deeply embedded culture of safety is essential to ensure the safety and well-being of HCWs during such pandemics.

Author Contributorship

Summary Box

What is already known on this topic

Personal-protective equipment (PPE) is the cornerstone to preventing HCW- infections. A search was done on March 23, 2020 on PubMed, Embase or Google Scholar using the mesh terms “personal protective equipment”, “PPE”, “preparedness OR practice OR training”. It revealed no previous studies on PPE preparedness in intensive care units (ICUs). No filters were used for the search.

Several guidelines/recommendations issued by health organisations on PPE practice exist

What are the new findings

As the first study to evaluate PPE-preparedness in ICUs, it demonstrated major concerns on PPE-preparedness across several ICUs, particularly in Australia, India and Philippines. There was suboptimal PPE-training, under-utilisation of low-cost interventions such as buddy-systems/team-training, and stock-awareness.

The guidelines by health organisations on PPE practice have several conflicting recommendations.

How might it impact on clinical practice in the foreseeable future

Standardising PPE guidelines by health organisations may translate to better training, better compliance and policies that improve HCW safety.

To ensure the safety and well-being of HCWs, urgent measures are needed to improve PPE-preparedness and building systems with deeply embedded culture of safety. By helping ICUs evaluate and improve their current state of PPE preparedness, the study may help prevent healthcare worker infections and save lives.