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BackgroundClinical guidelines on infection prevention strategies in healthcare workers (HCWs) play an important role in protecting them during the SARS-CoV-2 pandemic. Poorly constructed guidelines that are not comprehensive and are ambiguous may compromise HCWs safety. We aimed to develop and validate a tool to appraise guidelines on infection prevention strategies in HCWs. MethodsA 3-stage, web-based, Delphi consensus-building process among a panel of diverse HCWs and healthcare managers was utilised. We validated the tool by appraising 40 international, specialty-specific and procedure-specific guidelines along with national guidelines from countries with a wide range of gross national income. ResultsOverall consensus ([≥]75%) was reached at the end of three rounds for all six domains included in the tool. The chosen domains allowed appraisal of guidelines in relation to general characteristics (domain-1), recommendations on engineering (domain-2) and administrative aspects (domain 4-6) of infection prevention, as well as personal protection equipment (PPE) use (domain-3). The appraisal tool performed well across all domains and inter-rater agreement was excellent. All included guidelines performed relatively better in domains 1-3 compared with domains 4-6 and this was more evident in guidelines originating from lower income countries. ConclusionThe guideline appraisal tool was robust and easy to use. Recommendations on engineering aspects of infection prevention, administrative measures that promote optimal PPE use and HCW wellbeing were generally lacking in assessed guidelines. This tool may enable health systems to adopt high quality HCW infection prevention guidelines during SARS-CoV-2 pandemic and may also provide a framework for future guideline development. FundingNo funding received. Key SummaryWe developed and validated a guideline-appraisal tool by appraising 40 different guidelines from countries with varying GNI. This tool may help healthcare systems to adopt high-quality HCW infection-prevention guidelines during COVID-19 pandemic and may also provide a guideline development framework.
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ObjectivesTo evaluate PPE-preparedness across intensive care units (ICUs) in 6 Asia-Pacific countries. PPE-preparedness was defined as the adherence to guidelines, training HCWs, procuring PPE stocks and responding appropriately to a suspected case (transportation and admission to hospital). DesignCross-sectional web-based survey. SettingICUs in Australia, New Zealand (NZ), Singapore, Hong Kong (HK), India and Philippines with a 24/7 Emergency/Casualty Department, and capable of mechanically ventilating patients for >24 hours. InterventionsQuestionnaire sent to intensivists in 633 Level ll/lll ICUs in 6 Asia-Pacific countries by email, WhatsApp and text messaging. Main outcome measures263 intensivists responded, of whom 231 were eligible for analysis. Response rates were 68%-100% in all countries except India, where it was 24%. 97% either conformed to or exceeded WHO recommendations for PPE-practice. 59% employed 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 non-invasive ventilation were not options in most HK (66.7%, 83.3% respectively) and Singapore ICUs (50%, 80% respectively), but were considered in other countries to a greater extent. 38% reported not having specialized airway teams. Showering and "buddy-systems" were underutilized. Clinical waste disposal training was suboptimal (38%). ConclusionsMost intensivists from six Asia-Pacific countries appeared to be aware of the WHO PPE-guidelines by either conforming to/exceeding the recommendations. Despite this, there were widespread variabilities across ICUs and countries in several domains, particularly related to PPE-training and preparedness. Standardising PPE guidelines may translate to better training, better compliance and policies that improve HCW safety. Adopting low-cost approaches such as buddy-systems should be encouraged. More importantly, better pandemic preparedness and building systems with deeply embedded culture of safety is essential to ensure the safety and well-being of HCWs during such pandemics. Author Contributorship O_TBL View this table: org.highwire.dtl.DTLVardef@1f291aorg.highwire.dtl.DTLVardef@1c388ccorg.highwire.dtl.DTLVardef@4a1a65org.highwire.dtl.DTLVardef@10af39aorg.highwire.dtl.DTLVardef@1ff1eaa_HPS_FORMAT_FIGEXP M_TBL C_TBL Summary BoxO_ST_ABSWhat is already known on this topicC_ST_ABSO_LIPersonal-protective equipment (PPE) is the cornerstone to preventing HCW- infections. A search was done on March 23, 2020 on PubMed, Embase or Google Scholar using the mesh terms "personal protective equipment", "PPE", "preparedness OR practice OR training". It revealed no previous studies on PPE preparedness in intensive care units (ICUs). No filters were used for the search. C_LIO_LISeveral guidelines/recommendations issued by health organisations on PPE practice exist C_LI What are the new findingsO_LIAs the first study to evaluate PPE-preparedness in ICUs, it demonstrated major concerns on PPE-preparedness across several ICUs, particularly in Australia, India and Philippines. There was suboptimal PPE-training, under-utilisation of low-cost interventions such as buddy-systems/team-training, and stock-awareness. C_LIO_LIThe guidelines by health organisations on PPE practice have several conflicting recommendations. C_LI How might it impact on clinical practice in the foreseeable futureO_LIStandardising PPE guidelines by health organisations may translate to better training, better compliance and policies that improve HCW safety. C_LIO_LITo ensure the safety and well-being of HCWs, urgent measures are needed to improve PPE-preparedness and building systems with deeply embedded culture of safety. By helping ICUs evaluate and improve their current state of PPE preparedness, the study may help prevent healthcare worker infections and save lives. C_LI
