Reuse of Personal Protective Equipment: Results of a Human Factors Study Using Fluorescence to Identify Self-Contamination During Donning and Doffing.

BACKGROUND: At least 115,000 health and care workers (HCWs) are estimated to have lost their lives to COVID-19, according to the the chief of the World Health Organization (WHO). Personal protective equipment (PPE) is the first line of defense for HCWs against infectious diseases. At the height of the pandemic, PPE supplies became scarce, necessitating reuse, which increased the occupational COVID-19 risks to HCWs. Currently, there are few robust studies addressing PPE reuse and practice variability, leaving HCWs vulnerable to accidental contamination and harm. OBJECTIVE: The objective of this study was to assess potential HCW contamination during PPE donning, doffing, and reuse. METHODS: The study included 28 active acute care physicians, nurses, and nurse practitioners that evaluated 5 simulated patients with COVID-like symptoms while donning and doffing PPE between each patient encounter. An N95 mask was contaminated with a transparent fluorescent gel applied to the outside of the N95 mask to simulate contamination that might occur during reuse. Participants were evaluated after PPE doffing for each encounter using a black light to assess for face and body contamination. RESULTS: All participants had multiple sites of contamination, predominantly on their head and neck. None of the participants were able to don and doff PPE without contaminating themselves during five consecutive simulation cycles. CONCLUSIONS: The current Centers for Disease Control and Prevention PPE guidelines for donning and doffing fall short in protecting HCWs. They do not adequately protect HCWs from contamination. There is an urgent need for PPE and workflow redesign.

Challenges and future opportunities to unlock the critical supply chain of personal and protective equipment (PPE) encompassing decontamination and reuse under emergency use authorization (EUA) conditions during the COVID-19 pandemic: Through a reflective circularity and sustainability lens.

Severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2), and the resulting coronavirus disease (COVID-19), was declared a public health emergency of global concern by the World Health Organization (WHO) in the early months of 2020. There was a marked lack of knowledge to inform national pandemic response plans encompassing appropriate disease mitigation and preparation strategies to constrain and manage COVID-19. For example, the top 16 "most cited" papers published at the start of the pandemic on core knowledge gaps collectively constitute a staggering 29,393 citations. Albeit complex, appropriate decontamination modalities have been reported and developed for safe reuse of personal and protective equipment (PPE) under emergency use authorization (EUA) where critical supply chain shortages occur for healthcare workers (HCWs) caused by the COVID-19 pandemic. Commensurately, these similar methods may provide solutions for the safe decontamination of enormous volumes of PPE waste promoting opportunities in the circular bioeconomy that will also protect our environment, habitats and natural capital. The co-circulation of the highly transmissive mix of COVID-19 variants of concern (VoC) will continue to challenge our embattled healthcare systems globally for many years to come with an emphasis placed on maintaining effective disease mitigation strategies. This viewpoint article addresses the rationale and key developments in this important area since the onset of the COVID-19 pandemic and provides an insight into a variety of potential opportunities to unlock the long-term sustainability of single-use medical devices, including waste management.