Personal protective equipment preparedness in Asia-Pacific intensive care units during the coronavirus disease 2019 pandemic: A multinational survey
Open accessPublished version of a preprint
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.
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Countries such as Singapore and Hong Kong, which experienced the 2002-2004 SARS outbreak, reported higher pandemic preparedness and response resources, and this could have better mitigated healthcare workers' fears regarding COVID-19.
“Several countries, such as Singapore and Hong Kong, which experienced the 2002–2004 severe acute respiratory syndrome (SARS) outbreak, reported higher pandemic preparedness and response resources, e.g., PPE and negative pressure rooms in intensive care units (ICU), and this could have better mitigated HCWs’ fears regarding COVID-19 [72].”
From A global overview of healthcare workers’ turnover intention amid COVID-19 pandemic: a systematic review with future directions (2022) · cites this paper as [72]
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- Authors
- Rajamani, A., Subramaniam, A., Shekar, K., Haji, J., Luo, J., Bihari, S., Wong, W. T., Gullapalli, N., Renner, M., Alcancia, C. M., & Ramanathan, K.
- Affiliations
- The University of Sydney (AU)
- Frankston Hospital (AU)
- Bond University (AU)
- Western Health (AU)
- Flinders University (AU)
- Chinese University of Hong Kong (HK)
- Dunedin Public Hospital (NZ)
- Makati Medical Center (PH)
- National University Hospital (SG)
- Corresponding author
- Rajamani, Arvind
- Subramaniam, Ashwin
- Shekar, Kiran
- Haji, Jumana
- Luo, Jinghang
- Bihari, Shailesh
- Wong, Wai Tat
- Gullapalli, Navya
- Renner, Markus
- Alcancia, Claudia Maria
- Ramanathan, Kollengode
- ORCID
- Venue
- Australian Critical Care
- Publisher
- Elsevier BV
- Published
- 2021-03
- Volume
- 34
- Issue
- 2
- Pages
- 135-141
- ISSN
- 1033-3355 (ISSN-L)
- 1036-7314
- PMC
- PMC7522707
- OpenAlex
- W3088435325
- Cited by
- 27
- References
- 42
- Citations by year
- 2025: 4 · 2024: 1 · 2022: 8 · 2021: 10 · 2020: 4
- FWCI
- 3.10
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Australian Critical Care (publishedVersion)
- medRxiv (acceptedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- The Sydney eScholarship Repository (The University of Sydney) (submittedVersion)
- Funders
- Metro North Hospital and Health Service
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Infection Control and Ventilation
- Health Sciences › Medicine › Infectious Diseases › Infection Control in Healthcare
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
- Keywords
- personal protective equipment, intensive care unit, COVID-19 pandemic, aerosol-generating procedures, airborne precautions, negative pressure rooms, PPE training, high-flow oxygen therapy, non-invasive ventilation, buddy system, Asia-Pacific region
- MeSH terms
- Personal Protective Equipment, COVID-19, SARS-CoV-2, Australia, Hong Kong, Humans, India, Intensive Care Units, New Zealand, Philippines, Surveys and Questionnaires, Singapore, Infection Control, Pandemics
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