Personal Protection Equipment for COVID-19 – Can less be more?”

Resumo

Justification: Several institutions opted for prolonged use of full body personal protective equipment (PPE) for healthcare workers (HCW) in intensive care COVID-19 units. Nevertheless, to the extent of our knowledge, no prior study has evaluated the efficacy of long-term use of whole-body PPE in reducing SARS-COV-2 transmission and its impact on quality of patient care

Purpose:  This study aims to compare the incidence of HCW infected with SARS-Cov-2 and indicators of patient quality of care in two personal protection equipment (PPE) care models used in the same intensive care units (ICU) in different periods of the COVID-19 pandemic.

Patient and Methods: This is a before and after study. The incidence of HCW infected with SARS-Cov-2, the incidence of central venous catheter (CVC) infections per 1000 CVC-day, Gram-negative carbapenem resistant (CARB-R) bacteremia per 1000 patients-day 48h after ICU admission and confirmed/suspected COVID-19 patients´ ICU mortality rate were compared in two different PPE models.  To evaluate HCW perceptions regarding the two PPE models, a structured questionnaire was applied to ICU HCWs.

Results: The main characteristics of patients admitted to the ICUs during the two periods were similar in both periods. The mean number of infected HCW (t=2.6, p=0.029) and patient mortality was significantly higher in the first period, (t=2.9, p=0.017). Although central venous catheter infections and Gram-negative carbapenem resistant infection rates were higher in whole-body PPE, the differences were not statistically significant.

Conclusion: A less aggressive PPE approach did not lead to higher risks to HCW and yet may have aided in improving patients’ outcomes and the quality of work provided by HCW.