The Infectious Diseases Society of America (IDSA) released guidelines on the use of personal protective equipment (PPE) for health care professionals (HCP) providing care for patients with confirmed or suspected COVID-19. These guidelines were published in Clinical Infectious Diseases.
The first cases of COVID-19 were reported in Wuhan, China in December 2019, spreading worldwide within months. Transmission of COVID-19 primarily occurs from asymptomatic individuals prior to the onset of symptoms. After symptom onset, viral shedding tends to decrease, however, much remains unknown about the risk for COVID-19 transmission throughout the disease course. In addition, the varying transmissibility between different SARS-CoV-2 variants is another complexity to consider.
According to environmental aerosol researchers, short-range small respiratory particles, such as aerosols or droplets, are likely the main drivers for COVID-19 transmission.
To protect HCPs caring for patients with COVID-19, most healthcare systems have instituted droplet and contact precautions, such as avoiding aerosol-generating procedures (AGP).
For HCPs treating patients with confirmed or suspected COVID-19, a panel of experts from the IDSA emphasized the importance of appropriate PPE use. According to the panel, PPE should comprise gowns, gloves, and eye protection and be worn during routine care or AGPs. The IDSA panel recommended that HCPs use medical/surgical masks or N95, N99, or powered air purifying respirators (PAPR) when caring for patients with confirmed or suspected COVID-19. Compared with HCPs who did not wear a mask, those who any type of mask had a decreased risk for COVID-19 (odds ratio [OR], 0.54; 95% CI, 0.47-0.63). In addition, the use of N95 or PAPRs decreased the risk for COVID-19 compared with surgical masks (OR, 0.76; 95% CI, 0.64-0.91).
In conventional, contingency, or crisis capacity settings (ie, N95 respirator shortages), the panel did not find sufficient evidence that the use of double gloves effectively decreases the risk for COVID-19 transmission compared with single gloves. In addition they also found no evidence to support the use of shoe covers as part of appropriate PPE.
In the event of an N95 respirator shortage, the panel recommended the use of a reprocessed N95 respirator instead of a medical or surgical mask in the setting of AGPs. The IDSA panel noted that the risk for COVID-19 was decreased among HCPs who used reprocessed PPE (adjusted hazard ratio [aHR], 1.46; 95% CI, 1.21-1.76).
In addition to recommending for N95 reuse over surgical masks, in shortage situations, HCPs involved with AGPs should add a face shield or medical/surgical mask to cover their N95 for either extended use or reuse. The United States Centers for Disease Control and Prevention (CDC) defines extended use as a period between 8 and 12 hours and reuse as encounters with up to 5 patients. The IDSA panel noted that the use of an additional face shield or surgical mask may decrease the risk for self-inoculation among HCPs, though additional studies are needed to support this recommendation.
Owing to the inconsistent quality of respirators and other types of PPE, the IDA panel recommended that HCPs perform a fit test to ensure a tight seal of their PPE in clinical settings. They also noted that visual and manual inspection of PPE is often inaccurate.
According to the IDSA panel, the use of PAPR should be considered in only facilities which have established PAPR programs. The proper cleaning and disinfecting of PAPRs may be an issue in facilities which do not have established protocols for the use of these devices.
In addition to PPE, the IDSA advocated for universal masking. Evidence of a universal masking policy from the 2009 influenza season indicated that rates of viral respiratory transmission decreased significantly from 10.3% to 4.4% after the policy was implemented.
The panel was unable to make any recommendation about the role of negative pressure rooms on COVID-19 transmissibility due to insufficient evidence.
According to the IDSA panel, “these recommendations should serve as a minimum for PPE use in healthcare facilities and do not preclude decisions based on local risk assessments or requirements of local health jurisdictions or other regulatory bodies.”
Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.
Lynch JB, Davitkov P, Anderson DJ, et al. Infectious diseases society of america guidelines on infection prevention for healthcare personnel caring for patients with suspected or known COVID-19. Clin Infect Dis. 2021;ciab953. doi:10.1093/cid/ciab953