PPE is no silver bullet for keeping frontline staff safe

August 05, 2020
by Valerie Dimond, Contributing Reporter
Frontline healthcare workers are at increased risk of being infected with COVID-19 despite following established safety measures, including the proper use of personal protective equipment (PPE), compared to the general community, especially among ethnic populations.

The discovery was revealed by researchers at Massachusetts General Hospital and King's College London and published in The Lancet Public Health.

U.S. and U.K. guidelines recommend that healthcare workers who are caring for people with COVID-19 wear a mask. The current global shortage of masks, face shields and other PPE has caused many frontline workers to conserve PPE by wearing what they have for longer durations and/or reusing it, although disinfection protocols for PPE still lack scientific consensus on best practice. The study also revealed that non-white healthcare workers were disproportionately affected by little PPE adequacy and were more likely to work in clinical settings with greater exposure to patients with COVID-19.

Yet, the research found that even healthcare workers with adequate access and use of PPE were still at high risk when caring for COVID-19 patients. Again, they found that Black, Asian, and minority ethnic healthcare workers were disproportionately affected, highlighting the possibility for healthcare workers to spread infection within the workplace and community, especially if workers are asymptomatic or mildly symptomatic.

“This study demonstrates how the two major crises that the U.S. faces — the COVID-19 pandemic and systemic racism — are inextricably linked and need immediate attention,” said senior study author Andrew T. Chan in a news release.

Also, the research results should warrant increased testing to reduce hospital-based transmission, as well as measures to ensure proper use of PPE and adherence to other infection control procedures.

"Although it is clear that healthcare workers on the front line of the fight against COVID-19 have an increased risk of infection, our country continues to face vexing shortages of PPE," said Chan. "Our results underscore the importance of providing adequate access to PPE and also suggest that systemic racism associated with inequalities in access to PPE likely contribute to the disproportionate risk of infection among minority frontline healthcare workers."

In the effort to bring improved PPE to market, a Boston-based hospital and the Massachusetts Institute of Technology (MIT) last month announced development of a new mask prototype called the iMASC that allows for a better fit to the face while preventing marks and bruises after prolonged use.

"Furthermore, it has been tested on different sterilization methods—such as autoclaving, soaking in bleach or isopropanol—which can be easily performed both at hospitals and in the home,” said Kamilla Kan, medical device analyst at GlobalData “However, even with a huge demand for PPE, it is hard to predict if the iMasc will be successful in the competitive market since the new system is still in the process of development. The mask's cost of production may be too expensive, and the quality control might be too hard to maintain for large-scale production."

In sum, the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota reported that a commentary in The Lancet Public Health calls for universal face masking, data transparency, and cooperation among international governments to ensure equitable distribution of PPE, including use of the World Health Organization's international portal for PPE orders.

"If we are ever to outpace COVID-19, there must be accountability at every level, from the community to top government officials," wrote the op-ed authors. "By combining a centralized mechanism for supply chain oversight with universal masking and data transparency at local levels, it is possible to afford healthcare workers the protection they deserve."