Introduction
A pandemic is a dangerous and critical situation for all areas of healthcare. It forces doctors to pay much more attention to safety measures than before, so as not to infect patients and not to become ill themselves. However, the personal protective equipment (PPE) they use does not always provide an adequate level of safety. Healthcare workers should take many other measures to protect themselves from infection. Ali, Alradhawi, Shubber, and Abbas (2020) argue that “in response to growing concerns regarding the shortage of PPE, innovations in protective equipment are increasingly important” (p. 71). The purpose of this paper is to study and discuss literature on the use of PPE during pandemics, and to draw conclusions useful for medical practice.
Literature Search Methods
The search was carried out in the Cochrane system, which contains numerous articles on medical topics. Based on the results of the “PPE” query, the search engine returned three articles, two of which were written recently and are directly related to the COVID-19. Then, the research was also conducted with the use of the system Pubmed. The search query was the same and was limited to the last five years. As a result, 1296 articles were found, many of which, however, do not correspond exactly to the given subject of the work. In addition to the use of protective clothing during the pandemic, they are dedicated to surgery, innovations in the development of PPE, and other topics. However, many of them look at the studied problem from different angles, allowing a comprehensive analysis.
Problem Statement
One of the crucial issues that are now being raised in the field of healthcare is related to the use of PPE when working with people infected with COVID-19. First of all, the biggest problem is the lack of this equipment. The load on its production and use at the moment is so high that manufacturers often do not have time to deliver new batches. This leads to the need to use improvised tools and invent new methods of protection. In particular, one of them is protective masks printed on 3D printers, which, however, can only be a temporary solution because of the price and inconvenience.
There is a great risk of infection for each of the doctors working with people infected by COVID-19. According to Verbeek et al. (2020), everyone with COVID-19 disease infects from two to three people, whereas the SARS epidemic in 2003 had an R0 = 3 without control measures and was reduced to 0.4. Unfortunately, COVID-19 is spreading at a high speed, so it is not the fault of medical workers. Most likely, the main problem is the simplicity of its transmission among people, even despite the use of protective equipment. To prevent the transmission of infection, doctors need to have detailed instructions and always responsibly follow safety and hygiene rules.
However, there is a problem with the proper use of PPE. There are instructions according to which it must be worn and removed to avoid infection, but not all doctors follow them. Unfortunately, this attitude towards PPE can cause irreparable harm to patients, not only COVID-19 infected, but also others. In particular, this issue is essential to consider, for example, in the field of surgery and traumatology. Hirschmann et al. (2020) state that “the major aim of our efforts should be to avoid an occupational transmission of COVID-19 by aerosolization of blood or other body fluids and hence adequate personal protective equipment should be available and used during surgery” (p. 9). It means that doctors should use much more methods of protection at the moment. Thus, each epidemic (such as SARS or MERS) leads to a change in treatment approach and attitude to self-defense. The main factors to consider are the sufficient amount of PPE and its proper use.
Methods of Researches
One of the standard methods of studied researches is a literature review. It allows scientists to collect the most relevant data on specific problems and draw conclusions about them. In literature reviews, researchers compare various pandemics and also collect information about different ways of protecting doctors during these periods and the benefits of certain types of PPE. This data set is the basis for new approaches to the development and use of PPEs suitable for the current situation.
Another method of research is the creation and testing of new PPEs. Using different materials and methods of creation, researchers have made several different protective devices. For example, Wesemann et al. (2020) used the capabilities of a 3D printer to create new types of masks. This measure, undoubtedly, is urgent and forced, since ordinary face masks are not enough for doctors at the moment. Thus, this work is practical, offering real methods of protection against infection. However, unfortunately, the results of this development cannot be used everywhere in the future, since they may be expensive and not always convenient.
Other studies are partly psychological, as they use direct communication with practicing doctors as a method. In the course of these studies, researchers have learned about their working conditions, attitudes towards infection, and the use of PPEs. With the help of this survey, researchers were able to see a general picture of modern hospitals and find their weaknesses. In particular, this allows people to determine how the state and the management of hospitals contribute to supporting doctors. This, in turn, makes it possible to correct weaknesses and pay attention to strengths.
Main Outcomes of the Researches
First of all, most studies claim that currently, there is a critical lack of protection against viral infections. This forces people to develop new PPEs and modify old ones. The use of 3D printing for these purposes is interesting because it allows for creating masks that protect the entire face. This method is advantageous, but it does not protect the rest of the body and can be expensive and inconvenient to use.
The study by Lockhart, Duggan, Wax, Saad, and Grocott (2020) is devoted to the various combinations of PPE that protect the whole body. With their use, doctors can protect the eyes, neck, hands, and other potentially vulnerable parts of their bodies. Verbeek et al. (2020) also suggest using various types of equipment such as gowns with gloves attached at the cuff. This allows doctors to remove gloves and gowns together and cover the wrist. Indeed, it is necessary, especially if these doctors perform complex surgeries. In these situations, patients are much more susceptible to contracting various infections, and all measures must be taken to protect them.
A study by Khan and Parab (2020) proposed a method to reduce the usage of PPE because now its amount is critically small. Scientists offer a way to create makeshift masks available to most modern hospitals. They claim that “such masks can be prepared by the hospital staff within the hospital itself and can be sterilized too as mentioned in quantity as required by the staff. So it would not increase the burden on the economy of the country and makes the health care workers self-sufficient” (Khan & Parab 2020, p. 5). Indeed, this can now greatly facilitate the work of doctors and reduce the expenses of hospitals. Each hospital can also invent its methods of protection based on the availability of sufficient materials.
It is worth noting the importance of the atmosphere in hospitals, as it affects the psychological state of doctors. In particular, the mood and mindset of medical workers can make them approach the use of PPE more or less responsibly. First of all, it depends on intrinsic motivation, as “healthcare workers felt motivated to follow the guidance because of fear of infecting themselves and their families, or because they felt responsible for their patients” (Houghton et al., 2020, p. 1). However, often “healthcare workers found it difficult to use masks and other equipment when it made patients feel isolated, frightened or stigmatized. Healthcare workers also found masks and other equipment uncomfortable to use” (Houghton et al., 2020, p. 1). Indeed, this may be important for doctors, but this approach can be considered irresponsible during the pandemic. The critical decision is the maintenance of organizational culture and the education of doctors. Often, because of their profession, they are not much afraid of getting sick, but they need to remember to preserve the health of each patient.
Ways of Solving Current Problems
The results of the studies show that, in general, current problems can be solved, which will simplify the work with COVID-19 patients and help in the fight against the pandemic. It is important to remember that the use of PPE must be responsible and consistent. Only in this way it will bring benefits and prevent the spread of the virus. This means that doctors should not neglect PPE, but wear and change it regularly. The more body parts are protected, the better the effect it will give.
Doctors and hospital managers should also consider alternative methods of protection. Some of them were proposed in the studied papers: they are 3D printing and the use of improvised tools. However, each medical institution can invent special PPE that will help to cope with the pandemic with fewer costs. It will also protect patients and doctors from potential infection much more successfully. Another basic idea is to reduce the use of PPE if it is possible (Ip, Özelsel, Sondekoppam, & Tsui, 2020). It will also be helpful regarding expenses and the availability of necessary protection.
An essential step is the education of doctors because, first of all, it concerns their work inside hospitals. Corporate culture should cultivate responsibility among healthcare providers, especially now. Despite their views on communicating with patients and their comfort, protective equipment should now come first. In addition, this approach should be used at the stage of the training of future doctors. One of its key points should be the idea that they are responsible for the health status of people. For this reason, they should approach their job as responsibly as possible and anticipate and prevent any potential illness.
Conclusion
A large number of studies dedicated to the use of PPE during a pandemic show that scientists around the world are interested in streamlining this process. They agree that right now, there are not enough remedies and medical institutions need new ones. Some researchers propose modifying existing PPEs; some offer new, sometimes, innovative, means of protection. However, most agree that their benefits are manifested only if they are used responsibly. Therefore, it is necessary to use them consistently, no matter what physical and psychological discomfort they may cause. These steps will slow the spread of the pandemic and reduce the burden on the health system process.
References
- Ali, Y., Alradhawi, M., Shubber, N., & Abbas, A. R. (2020). Personal protective equipment in the response to the SARS-CoV-2 outbreak [Letter to the editor]. International Journal of Surgery, 78, 66-67.
- Hirschmann, M. T., Hart, A., Henckel, J., Sadoghi, P., Seil, R., & Mouton, C. (2020). COVID-19 coronavirus: recommended personal protective equipment for the orthopaedic and trauma surgeon. Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA, 1-9. Web.
- Houghton, C., Meskell, P., Delaney, H., Smalle, M., Glenton, C., Booth, A., Chan, X. S., Devane, D., & Biesty, L. M. (2020). Barriers and facilitators to healthcare workers’ adherence with infection prevention and control (IPC) guidelines for respiratory infectious diseases: A rapid qualitative evidence synthesis. Cochrane Database of Systematic Reviews 2020, 4, CD013582.
- Ip, V., Özelsel, T., Sondekoppam, R. V., & Tsui, B. (2020). COVID-19 pandemic: The 3R’s (reduce, refine, and replace) of personal protective equipment (PPE) sustainability. Canadian Journal of Anaesthesia, 1-2. Web.
- Khan, M. M., & Parab, S. R. (2020). Simple economical solution for personal protection equipment (face mask/shield) for health care staff during COVID 19. Indian Journal of Otolaryngology and Head and Neck Surgery: Official Publication of the Association of Otolaryngologists of India, 1-5. Web.
- Lockhart, S. L., Duggan, L. V., Wax, R. S., Saad, S., & Grocott, H. P. (2020). Personal protective equipment (PPE) for both anesthesiologists and other airway managers: Principles and practice during the COVID-19 pandemic.Canadian Journal of Anaesthesia, 1-11. Web.
- Verbeek, J. H., Rajamaki, B., Ijaz, S., Sauni, R., Toomey, E., Blackwood, B., … Kilinc Balci, F.S. (2020). Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane Database of Systematic Reviews 2020, 4, CD011621.
- Wesemann, C., Pieralli, S., Fretwurst, T., Nold, J., Nelson, K., Schmelzeisen, R., … Spies, B.C. (2020). 3-D printed protective equipment during COVID-19 pandemic. Materials, 13(8), 1997.