Practical ideas that solve the PPE crisis
Staff across our NHS have voiced concerns over a shortage of personal protective equipment (PPE). Here, consultant surgeon at the University Hospital of Wales, Meena Agarwal, offers some practical alternatives to keep workers safe during the outbreak...
NHS staff across the UK are already catching – and in some cases dying – of Covid-19 infection.
The vital question we need to ask ourselves is how can these healthcare workers be protected from this lethal virus?
I would like to put forward some very practical suggestions for overcoming the shortage of personal protective equipment (PPE) for healthcare workers, at least in the short term.
These suggestions are not for the people working in designated Covid19 wards and intensive care units (ICU); no doubt they would require the full World Health Organizationprescribed PPE.
However, if it proves that there is shortage in these areas as well, my suggestions would work for them too.
Staff working in other areas of the hospital, such as ambulance staff, clinical staff, caterers, domestic staff and other care workers who come into contact with patients (who are not yet tested for the virus), also need to wear protective clothing to prevent transmitting infection and cross contaminating patients.
Anybody who is in the hospital due to some unrelated illness has an immune system compromised to a certain extent and so needs extra protection to prevent catching the virus.
Most PPE currently in use worldwide is disposable and can only be used once. With limited supply, however hard we try, we cannot fulfil the exponentially increasing demand to supply every healthcare worker on a daily basis.
So to look for an alternative method for personal protection, we have to understand the properties of this virus:
■ This virus stays in aerosols around patients and can be inhaled by people present in the area. It can also land on any exposed surfaces, skin or hair;
■ The virus contaminates various surfaces and remains alive there for a variable period;
■ The positive thing about this virus is that the contaminated surfaces can be effectively decontaminated by either washing with soap and water or by treatment with disinfectant. It does not require autoclaving (a special method used to sterilise surgical equipment, gowns etc).
Most of the hospital staff – apart from people in theatres and intensive care units – currently wear disposable gloves which are ill-fitting and barely go above the wrist, a flimsy plastic apron and surgical scrubs leaving their hands, neck and hairs exposed. These hospital scrubs are not waterproof either.
So my suggestions are as follows:
■ 1. Scrubs
A waterproof jacket with hood and waterproof trousers to wear on top of scrubs.
These need to be worn with the zip fastened and hood up as if going for a walk in the rain.
These should be removed by a notouch technique and washed after every use in the washing machine with bleach-based detergent.
If difficult to keep the hood up, a disposable or washable shower-cap can be used to keep it in place.
A disposable plastic apron could be worn over this arrangement, to be changed in between patients.
■ 2. Gloves
Instead of flimsy disposable gloves, something more substantial could be used like well-fitting washing-up gloves with extra long cuffs.
The disposable gloves could be worn on the top of these and changed between patients. These washing up gloves can be washed and reused.
■ 3. Shoes
These should be either covered by disposable shoe covers or plastic wellies could be used, which are easily washed daily or decontaminated by disinfectant.
■ 4. Face
After wearing the above, the only remaining area to protect is the face.
No doubt N95/ FFP2/ FFP3/N99 masks are absolutely necessary for people in ICU and Covid-19 wards, but these masks are in short supply and are disposable for one-time use only.
So for the rest of the staff, an ordinary surgical mask, goggles and a visor will give some degree of protection and will limit cross infection.
■ 5. Supply
There is no shortage of waterproof jackets/trousers anywhere in our country. The big stores could open up their stocks, and if the public launderettes also open up for washing these daily in large numbers, we will have a constant supply of all that is needed as PPE.
There is also no shortage of rubber washing up gloves or plastic wellies or goggles.
I understand the visors are currently being made on a large scale locally. This will leave us to focus on manufacturing FFP3 masks on a large scale.
These suggestions are not an ideal situation, but are desperate measures in the middle of a pandemic when one has to choose between no protective equipment or reuse of PPE due to shortages.
Disposable PPE needs to be changed after every four to six-hour shift, and the current levels of supply will not be able to fulfil this demand for quite some time.
However, by adopting these suggestions, we will have a very large supply of clean protective clothing for every healthcare worker in the country.
Better to have healthcare workers looking like cartoon figures than to continue risking lives.