The Urologist, Personal Protective Equipment (PPE) and COVID-19
Authors: Mukherjee Subhabrata , Bonatsos Vasileios , Raza Asif 
Published: October 2020

Background and Objective To review the literature from a urologist’s perspective regarding the use of Personal Protective Equipment (PPE), associated challenges, and other potential measures that can be taken to reduce the risk of nosocomial COVID-19 transmission. Material and Methods A literature review using PubMed, Cochrane Review, and Google Scholar database search was performed using the keyword terms “COVID-19”, “Coronavirus”, “Personal Protective Equipment” (PPE), “healthcare workers” (HCW), “protection”, “masks”, and “urology”. Non-English articles were excluded. We present a summary of key guidance provided by regulatory bodies as well as some of the key articles published to date relating to PPE. Discussion SARS-CoV-2 virus is found mainly in the respiratory system but is also in blood, feces, semen, and urine. Both standard infection control precautions (SICPs) and transmission-based precautions (TBPs) are necessary to reduce nosocomial transmission of COVID-19 infection. PPE includes gowns, gloves, masks or respirators, goggles, and face shields; however, wearing PPE is only part of many precautionary measures that are necessary to prevent viral transmission. When used appropriately PPE not only protects HCWs from patients but also protects patients from HCWs who may be asymptomatic carriers of COVID-19 infection. Attention should also be paid to fit testing and fit checking, donning and doffing, and ever-evolving guidelines on PPE. Wearing PPE for a long time is also technically challenging and may adversely affect surgical outcomes. Shortages of PPE in the supply chain during the peak of the pandemic as well as concerns about substandard PPE should be considered for a possible second wave of COVID-19. Other key measures to minimize nosocomial SARS-CoV-2 virus transmission are a symptom and temperature screening of patients and staff; controlling the flow of patients, staff, and relatives in hospitals; self-isolation by patients before elective surgery; a robust testing protocol for both patients and staff; patient and staff cohorting; physical distancing; good hand hygiene; respiratory etiquette including face coverings for patients, staff and visitors; proper disposal of waste and enhanced cleaning; thorough cleaning and sterilization of surgical equipment performed post-operatively; choosing suitable anesthetic methods to minimize aerosolization of the virus; and if possible ensuring a negative-pressure theatre environment while dealing with COVID-19 positive patients. As scientific and regulatory bodies continue to issue updated guidance as more data is collected and a better knowledge base is developed regarding COVID-19 employers and staff need to keep up to date with guidance also. Conclusion COVID-19 will be around for the foreseeable future and infection rates may fluctuate as restrictions are eased. HCWs including urologists should take appropriate PPE measures not only in theatres, clinics, and endoscopy suits but also when performing simple tasks such as urine dipsticks, catheter, nephrostomy management, digital rectal examination (DRE), prostate biopsies, etc. as SARS-CoV-2 can be detected in feces, urine, and semen. Both employers and HCWs should adhere strictly to current guidelines and work together to minimize nosocomial transmission of COVID-19 infection.