Personal protective equipment for reducing the risk of COVID-19 infection among healthcare workers involved in emergency trauma surgery during the pandemic: an umbrella review
Authors: Griswold Dylan P , Gempeler Andres , Kolias Angelos , Hutchinson Peter J. , Rubiano Andres 
Published: September 2020

ABSTRACTObjectiveThe objective of this review was to summarise the effects of different personal protective equipment (PPE) for reducing the risk of COVID-19 infection in health personnel caring for patients undergoing trauma surgery. The purpose of the review was to inform recommendations for rational use of PPE for emergency surgery staff, particularly in low resources environments where PPE shortages and high costs are expected to hamper the safety of healthcare workers (HCWs) and affect the care of trauma patients.IntroductionMany healthcare facilities in low-and middle-income countries are inadequately resourced. COVID-19 has the potential to decimate these already strained surgical healthcare services unless health systems take stringent measures to protect healthcare workers from viral exposure.Inclusion criteriaThis review included systematic reviews, experimental and observational studies evaluating the effect of different PPE on the risk of COVID-19 infection in HCWs involved in emergency trauma surgery. Indirect evidence from other healthcare settings was considered, as well as evidence from other viral outbreaks summarised and discussed for the COVID-19 pandemic.MethodsWe conducted searches in the L·OVE (Living OVerview of Evidence) platform for COVID-19, a system that performs automated regular searches in PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and over thirty other sources. The risk of bias assessment of the included studies was planned with the AMSTAR II tool for systematic reviews, the RoBII tool for randomised controlled trials, and the ROBINS-I tool for non-randomised studies. Data were extracted using a standardised data extraction tool and summarised narratively. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach for grading the certainty of the evidence was followed.ResultsWe identified 17 systematic reviews that fulfilled our selection criteria and were included for synthesis. We did not identify randomised controlled trials during COVID-19 or studies additional to those included in the reviews that discussed other similar viral respiratory illnesses.ConclusionsThe use of PPE drastically reduces the risk of COVID-19 compared with no mask use in HCWs in the hospital setting. N95 and N95 equivalent respirators provided more protection and were found to halve the risk of COVID-19 contagion in HCWs from moderate and high-risk environments. Eye protection also offers additional security and is associated with reduced incidence of contagion. These effects apply to emergency trauma care. Decontamination and reuse appear as feasible, cost-effective measures that would likely help overcome PPE shortages and enhance the allocation of limited resources.SUMMARY OF FINDINGSThere is high certainty that the use of N95 respirators and surgical masks are associated with a reduced risk of coronaviruses respiratory illness when compared with no mask use. In moderate to high-risk environments, especially in aerosol-generating procedures, N95 respirators are associated with a more significant reduction in risk of COVID-19 infection compared with surgical masks. Eye protection also reduces the risk of contagion.Decontamination of masks and respirators with ultraviolet germicidal irradiation, vaporous hydrogen peroxide, or dry heat is effective and does not affect PPE performance or fit.(Figure 1: GRADE summary of findings)