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Publication . Article . 2021

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

Arvind Rajamani; Ashwin Subramaniam; Kiran Shekar; Jumana Haji; Jinghang Luo; Shailesh Bihari; Wai Tat Wong; +5 Authors
Open Access
Published: 01 Mar 2021 Journal: Australian Critical Care (issn: 1036-7314, Copyright policy )
Publisher: Elsevier BV
Country: Australia

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.

Subjects by Vocabulary

Microsoft Academic Graph classification: Pandemic Multinational corporation Intensive care Coronavirus disease 2019 (COVID-19) Emergency medicine medicine.medical_specialty medicine Waste disposal business.industry business Personal protective equipment Health care Preparedness


Critical Care, Emergency, Australia, COVID-19, Hong Kong, Humans, India, Infection Control, Intensive Care Units, New Zealand, Pandemics, Personal Protective Equipment, Philippines, SARS-CoV-2, Singapore, Surveys and Questionnaires, Research Paper, Personal-protective equipment, preparedness, training, quality assurance, Asia-Pacific, ICU, COVID-19, Coronavirus, Critical Care Nursing, Emergency Nursing

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