Emerg Infect Dis — Ann Surg e—e J Bone Joint Surg Am. Updated 18th June Br J Surg 12 :e—e Indian J Surg — Download references. You can also search for this author in PubMed Google Scholar. Correspondence to Vikesh Agrawal.
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Received : 17 August Accepted : 30 December Published : 06 January Issue Date : February Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article.
Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search SpringerLink Search. Download PDF. Introduction As the COVID pandemic rages across the world with no end or clear treatment in sight, its prevention is of paramount importance.
Data Synthesis An all-inclusive list of relevant geographical, methodological, surgical, and evaluation of evidence parameters was made after a preliminary review of included guidelines. Result The initial search yielded a total of studies, out of these 41 guidelines on surgery and laparoscopic surgery during COVID matching with pre-defined criteria were chosen and evaluated in this rapid scoping review Fig.
Full size image. Table 3 The identified gaps in the existing knowledge on the use of PPE and the practice recommendations based on scoping review Full size table. Data Availability Available. References 1. CDC videos for donning and doffing personal protective N masks donning and doffing. The full video can be found at this CDC website. Fit testing is paramount to ensure proper mask fit. There is a distinct possibility that personal protective equipment, including acceptable masks such as the N95 mask may be in short supply.
Healthcare institutions are encouraged to develop protocols for preserving supplies of masks and protective equipment. The CDC has outlined strategies for optimizing the supply of facemasks. The Medical University of South Carolina developed donning and doffing checklists.
The below illustration provides a schematic for use of personal protective equipment from the University of Kansas Intubation Risks Aerosolization and droplet transmission of the COVID virus are important hazards for surgical personnel. Aerosolization and droplet transmission hazard increases with procedures such as endotracheal intubation, tracheostomy, gastrointestinal endoscopy and during the evacuation of pneumoperitoneum and aspiration of body fluids during laparoscopic procedures.
Surgeons and personnel not needed for intubation should remain outside the operating room until anesthesia induction and intubation are completed for patients with or suspected of having COVID infection. A review article that presented data on the use and effectiveness of negative pressure operating rooms is referenced here: Chow TT, Yang XY.
Ventilation performance in operating theatres against airborne infection: review of research activities and practical guidance. In circumstances where beards are worn for religious reasons, or where someone has a skin condition that makes it impractical to shave every day, alternative personal protective equipment in the form of respiratory hoods should be offered for those working in areas where FFP3 is deemed necessary.
FFP3 and FFP2 face masks are types of tight fitting respiratory protective equipment that provide a higher level of respiratory protection than surgical face masks. Quantitative fit testing, which involves ambient particle counting or controlled negative pressure measurements, should be used as an alternative to test the adequacy of the respirator.
Fit tests must also be carried out whenever there is a change to the type or model or whenever there is a change in circumstances of the wearer that could alter the fit of the mask e. The HSE has guidance on this including an instructional video. The user must be trained on how to carry out a fit check.
A fit check is not a substitute for a fit test. Some members are reporting that equipment to undertake fit testing is not available and, with multiple brands of masks supplied, this is placing additional pressures on an already overstretched workforce. Some employers are reportedly relying on fit checks rather than fit tests. There are also issues with the suitability of different models of masks, with many nursing staff failing fit tests.
The RCN believes that employers must ensure that those carrying out fit testing, be it in-house or externally are competent to do such testing. Using an externally accredited fit tester, who can also provide training for additional fit testers within an organisation, provides assurances on competency. Staff who are required to wear FFP3 or FFP2 masks should be trained in how to carry out a fit check in addition to donning and doffing training.
Where risk assessments require staff to wear FFP3 or FFP2 masks and where a subsequent fit test is failed for all models available, staff should either be redeployed to areas where FFP3 and FFP2 masks are not required or be provided with a powered or constant flow airline breathing apparatus respirator protection with loose fitting hoods or helmets which do not require fit testing.
A list of external accredited fit testers can provide training for additional fit testers within your organisation. The previous shortage of long sleeved non-surgical gowns to protect HCWs working in high risk areas or performing aerosol generating procedures AGP has led the Health and Safety Executive to approve the use of disposable coveralls as an alternative to gowns for high risk activities or for staff working in such areas.
The safe donning and doffing putting on and taking off of coveralls is required and HCWs required to use coveralls should receive training from their employer on how to do this safely. Coveralls provided for use in health care to deliver care for COVID related activities must meet the required procurement specifications. Long sleeves and hand hygiene — some members have reported being asked to cut the sleeves short to facilitate hand hygiene.
Likewise, some Trusts support rolling up of sleeves to support hand hygiene and unnecessary glove use. Please see our section below on raising concerns if required. However, it is recognised that wearing PPE for long periods can also create additional health and safety risks for nursing staff.
PPE is extremely uncomfortable and can lead to heat stress, fatigue and heat related illness, which places a risk to both nursing staff and the patients that they are looking after. The health and safety of health and care staff is of paramount importance and the RCN expect employers to meet their legal duties by taking all appropriate steps to both assess and mitigate the risk of nursing staff developing heat stress and related illnesses.
These steps include:. Employers should assess any risks to these individuals and make necessary adjustments under both health and safety and equality law. For information on how to reduce the risk of heat stress and related illness, please see Rest, Rehydrate and Refuel. HSE have also produced a heat stress risk assessment toolkit for employers.
Our guidance on skin health is here along with our publication on maintaining skin health when using PPE. PPE for use in health and care settings must meet specified health and safety standards included within the product specifications for examination gloves, gowns, surgical face masks, respirator masks and eye protection.
This is to ensure reliable and effective protection against infection, and ensure PPE is fit for purpose. Any personal protective equipment made by hand, for example cotton face masks, will not provide the level of protection required against COVID Your employer is responsible for providing you with PPE that meets health and safety standards.
Anyone wishing to donate equipment to the health service as part of the COVID response should visit the government website. Type IV reactions can cause contact urticaria. In sensitised individuals with a type I allergy to NRL, exposure can be life threatening.
Powdered NRL gloves are particular risk to those with latex allergies as proteins attach themselves to the powder and become airborne increasing the risk of exposure.
Many health care organisations have taken steps to eliminate or severely restrict the use of products containing NRL from their sites. The RCN expects all health and social care organisations to have and to follow their policies on the management of latex allergy in staff and patients. Safer alternatives or latex free products should be used and staff and patients with known latex allergy should never be exposed to NRL containing products. Powdered NRL gloves should never be used.
Any allergic type reactions to PPE, including skin rashes, should be reported using the organisations incident reporting form and through the yellow card reporting system to the MHRA. Wearing PPE is extremely uncomfortable and can lead to heat stress, fatigue and heat related illness. It is recognised that wearing PPE for long periods can also create additional health and safety risks for staff. For those experiencing symptoms due to menopause, this can sometimes add to the burden of working in intensive areas of practice.
It is always important to recognise that for many reasons the impact of the menopause may differ greatly for individuals. For some, symptoms may include poor concentration, tiredness, poor memory, feeling low or depressed and lowered confidence. Hot flushes at work are a major source of distress for many women.
Things that make hot flushes more difficult to cope with are working in hot and poorly ventilated environments, formal meetings and high visibility work such as formal presentations.
These symptoms can be compounded when having to wear PPE, especially for long periods of time, and it is important that staff are supported to enable them to cope in these challenging times. It is important in these circumstances, to remain hydrated and to use a good hydrating moisturiser which can be applied under masks and to keep some cool wet wipes handy. You can find further guidance in The menopause and work: guidance for RCN representatives which outlines some of these symptoms and possible adjustments to be considered in the workplace.
RCN guidance for nurses, midwives and health visitors Menopause and mental health pocket cards For information on how to reduce the risk of heat stress and related illness, please see Rest, Rehydrate and Refuel.
Menopause at work: managing hot flushes and PPE - Nursing Standard article which may require signing in to access in full. The provision of reusable face respirators is one option for respiratory protective equipment RPE.
Reusable face respirators can support the reduction in use of single use respirators where supply is problematic and reduce the need for repeat fit testing where multiple brands are supplied, or individuals have difficulty in finding a mask that fits correctly.
Where reusable respirators are provided some RCN members report these are pooled following cleaning for reuse by different staff rather than being allocated to individual members for their personal use.
This is unacceptable and we expect employers to introduce:. Reusable RPE must also be subject to thorough maintenance, examination and tests. They are identified through this symbol present on packaging or equipment instructions.
As a result, the RCN does not support the re-use of single use PPE at this time and is currently considering the implications of this guidance.
If you have been asked to reuse PPE, you should raise the following questions with your employer in writing:. Ask for the answers to these questions in writing and use your local reporting procedures to record each time you are placed in this position.
Finally, an aspect of utmost importance for successful performance in emergency surgery is to exercise both psychomotor and cognitive skills, which involve a complex decision analysis [ 19 ]. Adequate judgment in surgical practice has been established as the capacity to make accurate decisions with the available information [ 20 ].
PPE use and the adverse working conditions generated during the pandemic seem to have caused increased fatigue during surgical procedures, influencing surgical judgment. The answers received point to the assumption that the sum of these factors had a toll on overall comfort and surgical fatigue. Engelmann et al. Unfortunately, the working conditions during pandemic outbreaks make this strategy hard to follow.
Research on PPE during infectious disease outbreaks had focused mainly on safety issues, but our study highlights areas for future research. We feel there is an increasing need to develop upgraded PPE designs, making them more comfortable, reusable, and sustainable. Improved comfort would enhance surgical performance, OR staff well-being, and a sense of confidence using PPE in times of pandemics. It is important to note that our study had several limitations.
First, the assessment method relied on perceptions prone to bias, because remembrance is subjective. Second, the study was international, and we are aware of the differences in working conditions and equipment available in each country. Third, the sampling method recruited a higher number of European responders, so that results may rule out global generalizations.
Even with these limitations, we believe that our study highlights the problematic working conditions for surgeons using PPE during the COVID pandemic and that they may be useful for orienting efforts to be made toward the improvement of PPE comfort level availability for future pandemics. In summary, we found that the use of personal protective equipment alters both visual and communication abilities during emergency surgery.
Emergency surgery using this equipment was found to convey toward surgical discomfort and increased fatigue, affecting the decision-making process and surgical performance. J Med Virol 92 4 — World Health Organization. Statement on the second meeting of the International Health Regulations Emergency Committee regarding the outbreak of novel coronavirus nCoV.
Emerg Microbes Infect 9 1 — J Am Coll Surg. Surg Clin North Am 92 1 — Article Google Scholar. Hull L, Sevdalis N Advances in teaching and assessing nontechnical skills. Surg Clin North Am 95 4 — Verbeek JH, Ijaz S, Mischke C et al Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane Database Syst Rev. Antimicrob Resist Infect Control
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