Personal protective equipment preparedness in Asia-Pacific intensive care units during the coronavirus disease 2019 pandemic: A multinational survey

Abstract

Background: There has been a surge in coronavirus disease 2019 admissions to intensive care units (ICUs) in Asia-Pacific countries. Because ICU healthcare workers are exposed to aerosol-generating procedures, ensuring optimal personal protective equipment (PPE) preparedness is important.

Objective: The aim of the study was to evaluate PPE preparedness across ICUs in six Asia-Pacific countries during the initial phase of the coronavirus disease 2019 pandemic, which is defined by the World Health Organization as guideline adherence, training healthcare workers, procuring stocks, and responding appropriately to suspected cases.

Methods: A cross-sectional Web-based survey was circulated to 633 level II/III ICUs of Australia, New Zealand (NZ), Singapore, Hong Kong (HK), India, and the Philippines.

Findings: Two hundred sixty-three intensivists responded, representing 231 individual ICUs eligible for analysis. Response rates were 68-100% in all countries except India, where it was 24%. Ninety-seven percent of ICUs either conformed to or exceeded World Health Organization recommendations for PPE practice. Fifty-nine percent ICUs used airborne precautions irrespective of aerosol generation procedures. There were variations in negative-pressure room use (highest in HK/Singapore), training (best in NZ), and PPE stock awareness (best in HK/Singapore/NZ). High-flow nasal oxygenation and noninvasive ventilation were not options in most HK (66.7% and 83.3%, respectively) and Singapore ICUs (50% and 80%, respectively), but were considered in other countries to a greater extent. Thirty-eight percent ICUs reported not having specialised airway teams. Showering and "buddy systems" were underused. Clinical waste disposal training was suboptimal (38%).

Conclusions: Many ICUs in the Asia-Pacific reported suboptimal PPE preparedness in several domains, particularly related to PPE training, practice, and stock awareness, which requires remediation. Adoption of low-cost approaches such as buddy systems should be encouraged. The complete avoidance of high-flow nasal oxygenation reported by several intensivists needs reconsideration. Consideration must be given to standardise PPE guidelines to minimise practice variations. Urgent research to evaluate PPE preparedness and severe acute respiratory syndrome coronavirus 2 transmission is required.

Keywords: Coronavirus; ICU; Personal protective equipment; Preparedness; Quality assurance; Training.

Fig. 1

CONSORT diagram demonstrating a 42% response rate. After exclusion, 231 ICUs were included for final analysis. The overall response rate was very good, except in India, which reduced the overall response rate. ICU, intensive care unit.

Fig. 2

PPE practices in each country to manage patients with COVID-19 admitted to the ICU. This figure summarises the PPE practices in each country. For each category, the colour-coded bars represent the proportion of intensivists from that country that reported using that PPE. AGP, aerosol-generating procedure; N95 for AGP, wearing N95 masks routinely only for aerosol-generating procedures (i.e., droplet precautions); N95 at all times, wearing N95 masks routinely irrespective of aerosol-generating procedures (i.e., airborne precautions); PAPR, personal air-purifying respirator; ICU, intensive care unit; PPE, personal protective equipment; COVID-19, coronavirus disease 2019. (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)

Fig. 3

Oxygen therapy options in the nonintubated patient with suspected/confirmed COVID-19. COVID-19, coronavirus disease 2019.