IDSA publishes PPE guidelines for health care workers treating COVID-19

The Infectious Diseases Society of America has published a set of eight recommendations that provide guidance on the use of personal protective equipment, or PPE, for health care workers treating patients who are suspected, or known, to have COVID-19.

The guidelines, which were developed by a panel of clinicians in the United States, China and Canada, focus on infection prevention among health care workers. The recommendations are based on the latest available evidence and will be updated frequently, according to the IDSA.

“The goal is to provide the best possible evidence-based recommendations for infection prevention and control in health care settings. This is how we prevent the transmission of all infectious diseases both to patients and to health care workers, but, in this case, it’s specific to COVID-19, the disease caused by SARS-CoV-2,” John B. Lynch, MD, MPH, member of the IDSA Board of Directors, chair of the IDSA COVID-19 Infection Prevention Guidelines Expert Panel and medical director of infection prevention and control at Harborview Medical Center in Washington, said during an IDSA briefing. “The guidelines are based on all the evidence we could find so far and are really aimed at maximizing safety in the health care environment for patients and health care workers.”

Allison McGeer, MD, FRCPC, member of the IDSA COVID-19 Infection Prevention Guidelines Expert Panel and professor in the department of microbiology at the University of Toronto, added that the guidelines will enable ID physicians to see what evidence is currently available in regard to PPE and infection prevention for COVID-19.

“It’s interesting to watch the guidelines process,” McGreer said. “The best part of these guidelines is that physicians can see the background information that is currently available, how we currently understand the risks to patients and health care workers and what we can then do, given all the chaos and uncertainty during this pandemic, to make sure people know how to protect themselves and their patients,” McGeer said.

Most of the guidelines emphasize the importance of “appropriate PPE,” including adherence to standards for proper donning and doffing of gloves, gowns, eye protection and masks to limit transmission. For all recommendations, appropriate PPE is defined as eye protection, gown and gloves, in addition to a mask or respirator.

Recommendations 1 through 4 focus on routine patient care. Recommendations 5 through 8 focus on aerosol-generating procedures.

Recommendation 1. In conventional settings, health care personnel treating patients with suspected or known COVID-19 should use either a surgical mask or N95 respirator [or N99 or powered air-purifying respirators (PAPR)] as part of appropriate PPE. (Strong recommendation, moderate certainty of evidence)

Recommendation 2. In contingency or crisis capacity settings, including respirator shortages, health care personnel caring for patients with suspected or known COVID-19 should use a surgical mask or reprocessed respirator instead of no mask as part of appropriate PPE. (Strong recommendation, moderate certainty of evidence)

Recommendation 3. In conventional, contingency or crisis capacity settings, there is no recommendation for the use of double gloves vs. single gloves for health care personnel caring for patients with suspected or known COVID-19 as part of appropriate PPE. (Knowledge gap)

Recommendation 4. In conventional, contingency or crisis capacity settings, the IDSA guideline makes no recommendation for the use of shoe covers vs. no shoe covers for health care personnel caring for patients with suspected or known COVID-19 as part of appropriate PPE. (Knowledge gap)

Recommendation 5. In conventional settings, the IDSA guideline recommends that health care personnel involved in aerosol-generating procedures on patients with suspected or known COVID-19 use an N95 respirator (or N99 or PAPR respirator) instead of a surgical mask as part of appropriate PPE. (Strong recommendation, very low certainty of evidence)

The IDSA notes that the panel “placed a high value on avoiding serious harms to exposed health care personnel” in spite of the very low quality and indirect evidence for this recommendation.

Recommendation 6. In contingency or crisis capacity settings (N95 respirator shortages), health care personnel involved in aerosol-generating procedures on patients with suspected or known COVID-19 should use a reprocessed N95 respirator for reuse as part of appropriate PPE. (Conditional recommendation, very low certainty evidence)

Recommendation 7. In contingency or crisis settings (respirator shortages), health care personnel involved in aerosol-generating procedures on patients with suspected or known COVID-19 should add a face shield or surgical mask as a cover for the N95 respirator to allow for extended use as part of appropriate PPE. (Strong recommendation, very low certainty evidence)

The panel notes that this recommendation assumes that the proper doffing sequence and hand hygiene is performed before and after taking off the face shield or surgical mask covering the respirator.

Recommendation 8. In contingency or crisis settings (during respirator shortages), the panel recommends that health care personnel involved with aerosol-generating procedures on patients with suspected or known COVID-19 should add a face shield or surgical mask as a cover for the N95 respirator to allow for reuse as part of appropriate PPE. (Conditional recommendation, very low certainty evidence)

According to the panel, this recommendation also assumes that the proper doffing sequence and hand hygiene is performed before and after taking off the face shield or surgical mask covering the respirator.

“Our goal is to update these guidelines as a living document — to look whatever research is published and readdress the recommendations if the evidence coming out is strong enough to make a change,” Lynch said. “Of the eight recommendations made, a large number of them are focused on masks, but there are a large number of other desperate questions that need to be answered that have no good evidence base. If we see new evidence around that, we can at least provide commentary.”

These guidelines were published as the second of three parts expected from the panel. The first set focused on treatment of COVID-19 patients and the third is expected to focus on diagnostics. The final document is expected soon. – by Caitlyn Stulpin

Disclosures: Please see the guidelines for an explanation on the disclosure and management of potential conflicts.

The Infectious Diseases Society of America has published a set of eight recommendations that provide guidance on the use of personal protective equipment, or PPE, for health care workers treating patients who are suspected, or known, to have COVID-19.

The guidelines, which were developed by a panel of clinicians in the United States, China and Canada, focus on infection prevention among health care workers. The recommendations are based on the latest available evidence and will be updated frequently, according to the IDSA.

“The goal is to provide the best possible evidence-based recommendations for infection prevention and control in health care settings. This is how we prevent the transmission of all infectious diseases both to patients and to health care workers, but, in this case, it’s specific to COVID-19, the disease caused by SARS-CoV-2,” John B. Lynch, MD, MPH, member of the IDSA Board of Directors, chair of the IDSA COVID-19 Infection Prevention Guidelines Expert Panel and medical director of infection prevention and control at Harborview Medical Center in Washington, said during an IDSA briefing. “The guidelines are based on all the evidence we could find so far and are really aimed at maximizing safety in the health care environment for patients and health care workers.”

Allison McGeer, MD, FRCPC, member of the IDSA COVID-19 Infection Prevention Guidelines Expert Panel and professor in the department of microbiology at the University of Toronto, added that the guidelines will enable ID physicians to see what evidence is currently available in regard to PPE and infection prevention for COVID-19.

“It’s interesting to watch the guidelines process,” McGreer said. “The best part of these guidelines is that physicians can see the background information that is currently available, how we currently understand the risks to patients and health care workers and what we can then do, given all the chaos and uncertainty during this pandemic, to make sure people know how to protect themselves and their patients,” McGeer said.

Most of the guidelines emphasize the importance of “appropriate PPE,” including adherence to standards for proper donning and doffing of gloves, gowns, eye protection and masks to limit transmission. For all recommendations, appropriate PPE is defined as eye protection, gown and gloves, in addition to a mask or respirator.

Recommendations 1 through 4 focus on routine patient care. Recommendations 5 through 8 focus on aerosol-generating procedures.

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Recommendation 1. In conventional settings, health care personnel treating patients with suspected or known COVID-19 should use either a surgical mask or N95 respirator [or N99 or powered air-purifying respirators (PAPR)] as part of appropriate PPE. (Strong recommendation, moderate certainty of evidence)

Recommendation 2. In contingency or crisis capacity settings, including respirator shortages, health care personnel caring for patients with suspected or known COVID-19 should use a surgical mask or reprocessed respirator instead of no mask as part of appropriate PPE. (Strong recommendation, moderate certainty of evidence)

Recommendation 3. In conventional, contingency or crisis capacity settings, there is no recommendation for the use of double gloves vs. single gloves for health care personnel caring for patients with suspected or known COVID-19 as part of appropriate PPE. (Knowledge gap)

Recommendation 4. In conventional, contingency or crisis capacity settings, the IDSA guideline makes no recommendation for the use of shoe covers vs. no shoe covers for health care personnel caring for patients with suspected or known COVID-19 as part of appropriate PPE. (Knowledge gap)

Recommendation 5. In conventional settings, the IDSA guideline recommends that health care personnel involved in aerosol-generating procedures on patients with suspected or known COVID-19 use an N95 respirator (or N99 or PAPR respirator) instead of a surgical mask as part of appropriate PPE. (Strong recommendation, very low certainty of evidence)

The IDSA notes that the panel “placed a high value on avoiding serious harms to exposed health care personnel” in spite of the very low quality and indirect evidence for this recommendation.

Recommendation 6. In contingency or crisis capacity settings (N95 respirator shortages), health care personnel involved in aerosol-generating procedures on patients with suspected or known COVID-19 should use a reprocessed N95 respirator for reuse as part of appropriate PPE. (Conditional recommendation, very low certainty evidence)

Recommendation 7. In contingency or crisis settings (respirator shortages), health care personnel involved in aerosol-generating procedures on patients with suspected or known COVID-19 should add a face shield or surgical mask as a cover for the N95 respirator to allow for extended use as part of appropriate PPE. (Strong recommendation, very low certainty evidence)

The panel notes that this recommendation assumes that the proper doffing sequence and hand hygiene is performed before and after taking off the face shield or surgical mask covering the respirator.

Recommendation 8. In contingency or crisis settings (during respirator shortages), the panel recommends that health care personnel involved with aerosol-generating procedures on patients with suspected or known COVID-19 should add a face shield or surgical mask as a cover for the N95 respirator to allow for reuse as part of appropriate PPE. (Conditional recommendation, very low certainty evidence)

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According to the panel, this recommendation also assumes that the proper doffing sequence and hand hygiene is performed before and after taking off the face shield or surgical mask covering the respirator.

“Our goal is to update these guidelines as a living document — to look whatever research is published and readdress the recommendations if the evidence coming out is strong enough to make a change,” Lynch said. “Of the eight recommendations made, a large number of them are focused on masks, but there are a large number of other desperate questions that need to be answered that have no good evidence base. If we see new evidence around that, we can at least provide commentary.”

These guidelines were published as the second of three parts expected from the panel. The first set focused on treatment of COVID-19 patients and the third is expected to focus on diagnostics. The final document is expected soon. – by Caitlyn Stulpin

Disclosures: Please see the guidelines for an explanation on the disclosure and management of potential conflicts.

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