Coronavirus: Healthcare workers adapting to ‘unfamiliar’ PPE

Irish healthcare workers will need to adapt to using unfamiliar personal protection equipment (PPE) for the duration of the coronavirus emergency, the Health Service Executive clinical lead on infection control has said.

Martin Cormican, professor of bacteriology at NUI Galway, has said that three of the four main categories of PPE in the massive €200 million consignment being imported from China would not be the standard clothing or equipment used by Irish clinicians and health workers.

The item that is substantially different is the hazard suit. The standard in Irish healthcare is a long-sleeve gown, which is easily removed once it has been used.

Prof Cormican, who is HSE clinical lead on healthcare-associated infection and antimicrobial resistance, said gowns were not available at present because of the unprecedented global demand for PPE. He said the items that were supplied instead were hazard suits, which he emphasised were equally good in terms of protection.

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He said, however, that all those who used them would need to undergo training on how to safely remove them once they have been used as they were more complicated to take off than gowns. He said the HSE has produced a training video to assist people in putting on, and removing, the suits.

“We have favoured long gowns because people are used to them and they are easier to get on and off without contamination,” he said.

“Being familiar with PPE is important. We would have preferred to stay with long-sleeve gowns. But [in the consignment] we have got these cover-all suits or boiler suits.”

Several million suits, which are standard n many EU countries, are in the consignment from China, which will be arriving into Ireland this month.

Aer Lingus is expected to complete at least 300 flights to import the entirety of the order.

‘Good’ protection

Prof Cormican said the HSE had been working “flat-out” procuring PPE in an extraordinarily difficult situation. He said some items of equipment that came in the first batch a fortnight age were “unfamiliar to healthcare workers”.

“The focus of the HSE is getting the best possible protection we can provide to people. In other times we would have preferred other equipment but this is what we can get and it provides a good measure of protection.”

The other two categories that would not be readily familiar to Irish healthcare workers and clinicians are surgical masks and respirators, and goggles or visors.

“In Ireland, we have preferred a mask where you tie a knot on the crown of your head and lift off easily,” he said. “We would preferred to stay with that but they are not available. What we can get is a mask with [the same] face part but which is attached with ear loops.

“We have produced training videos showing people how to take off masks with ear loops.”

He said the mask at the top was easier to use without putting the hand near the front of the face.

While Prof Cormican said the standard of face shields and goggles were acceptable, the HSE would have preferred if they were wholly made of plastic.

“Some have elastic and again there is an issue with taking them off,” he said. Generally he said that a shortage of eye and face protection in the Irish healthcare system had led to a situation where people were reusing equipment which was not ideal. He said that, at least with plastic, they could be fully sterilised before reuse.

‘Sessional use’

He said that the gloves included in the first batch were satisfactory and no action needed to be taken.

He said that managing the supply of PPE had become a major issue throughout the world and had led to some changes in approach to maximise use of equipment. He said that, in many countries, sets of PPE were not being changed after every patient but were changed after “sessional use”, for example a ward round, although gloves were changed and hands washed after every patient.

Meanwhile, Prof Cormican said nursing homes presented a huge challenge in terms of infection control. He praised colleagues who were looking after very vulnerable people in extremely difficult circumstances.

He said that there had been difficulties accessing PPE but said the challenges extended beyond that.

“What strikes me is control of an infection once it gets into a nursing home is very difficult. It’s a congregated setting in most incidents and by their nature they are places with people who need a lot of care and are very dependent.”

He said the imperatives were reminding nursing home staff not to come to work if they had any symptoms, regular checking for symptoms, regular taking of temperatures of staff and patients, and shutting down visiting.

He said that had to be balanced against the humanity of people in the last stages of their lives.

“There does need to be accommodation for essential visiting for relatives approaching the end of life. There has to be some degree of exception.”

He said general policy is to cocoon each section of the nursing home, minimise traffic between wards and “if there is an infection in one ward, try to contain it there and segregate the units from each other”.