PPE for all healthcare staff

GO to any hospital in Malaysia and it is still common to see healthcare workers walking around without appropriate face masks inside the facilities, including in the outpatient clinics and wards.

Some hospitals have enforced compulsory face mask policies within their clinical areas. However, hospitals have differing policies on the use of personal protective equipment (PPE). Appropriate PPE use is typically not mandated in non-Covid-19-designated hospitals.

We have heard about how healthcare professionals have unknowingly managed and even performed invasive procedures (e.g. intubation, surgery) on Covid19 positive patients without donning adequate PPE. These patients either had no symptoms or failed to disclose their contact history with positive cases or their recent travels.

The question then is: “Why are we not making it mandatory for all healthcare workers in the country to wear appropriate PPE during this pandemic?” Unfortunately, the answer is not so straightforward.

There are many policymakers in healthcare who strictly abide by guidelines set by international authoritative bodies such as the World Health Organisation (WHO) that strongly discourage individuals, including healthcare workers, from using face masks when not directly exposed to Covid-19 symptomatic individuals.

This recommendation is based on the premise that masks are ineffective against the spread of Covid19 in asymptomatic individuals. This argument may no longer hold true in the case of Covid-19, where pre-symptomatic transmission has been increasingly reported.

There is also currently a global shortage of PPE. As a result, many hospitals may also be rationing the use of N95 masks and surgical masks.

This situation is not unique to our country. The US Center for Disease Control (CDC), for example, recently loosened its guidelines and allowed the reuse of single-use face masks and N95 respirators.

We should “look East” to countries such as Singapore, Hong Kong, Japan and China that have done well in the current pandemic. They have exhibited judicious yet proper use of PPE such as face masks.

As emerging evidence is beginning to show a significant role for pre-symptomatic transmission of Covid-19, the use of PPE in all clinical encounters is going to be instrumental to protect Malaysian healthcare workers, including in our non-Covid-19 designated hospitals and wards.

It makes little sense to limit access of healthcare workers to face masks and other PPE in healthcare settings based on their disciplines or specialities that are arbitrarily delineated as “non-front line”.

It is also nonsensical to rely on a patient’s travel history or selected symptoms to determine whether protection via a face mask is warranted for the attending healthcare worker.

With the establishment of community transmission, we need liberalisation of PPE use in healthcare facilities.

In Malaysia, a substantial number of healthcare workers, and even entire clinical departments, have been placed under quarantine. They are taken off their duties for up to 14 days due to breaches in self-protection as a result of managing asymptomatic Covid-19 patients who are being treated for other ailments.

It is a travesty if any healthcare worker is infected in the course of carrying out his or her duty because of lack of PPE. To quote Dr Peter Slavin, president of the Massachusetts General Hospital: “We wouldn’t want to send soldiers into war without helmets and armour, we don’t want to do the same with our healthcare workers.” DR NIRMALA BHOO PATHY and DR SANJAY RAMPAL Department of Social and Preventive Medicine Faculty of Medicine Universiti Malaya