# 2493
The problem of assuring adequate PPE's (Personal Protective Equipment) for HCW's (Health Care Workers) during a pandemic has been a subject of discussion in this blog on more than one occasion, including:
What The Well-Dressed HCW Will Be Wearing During The Next Pandemic
Australia: Will Doctors Work In A Pandemic?
Pandemic Issues For Home Health Providers - Pt 3
Catching Up With The Nurses Poll
Canadian Study: Nurses Left Short In A Crisis
It is one of the great logistical challenges facing the health delivery system during a pandemic, and the availability of PPE's will likely factor heavily in the decision of HCW's as to whether they will work during a pandemic crisis.
CIDRAP News has an overview of a new study, just published in the Journal of Infection Control, that reports on a pandemic drill at a UK hospital where the staff followed pandemic infection control guidelines for 24 hours.
This study raises some serious issues, which I'll address in a future blog. For now, the report by CIDRAP editor Robert Roos is well worth reading in its entirety.
Hospital pandemic drill reveals major supply challenges
Robert Roos
News Editor
Nov 25, 2008 (CIDRAP News) – Hospital workers who followed official infection control guidelines for pandemic influenza for 1 day used 10 times as many gloves as usual, generated three times as much clinical waste, and found that many tasks took longer than normal, according to a new report.
The 24-hour exercise in a British hospital also revealed various other challenges, including that hospital workers lacked confidence in their ability to follow infection control guidelines, felt uncomfortable wearing surgical masks, and felt that wearing personal protective equipment (PPE) hindered communication, according to the report, published online by the Journal of Infection Control.
"Healthcare in a pandemic situation is not simply a case of applying pandemic influenza infection control guidance to current practice; hospitals need to consider changing the way care and services are delivered," states the report by N. F. Phin of Cheshire and Merseyside Health Protection Unit, Chester, UK, and colleagues.
British health authorities issued infection control guidance for pandemic flu in October 2005, the report says. The guidelines call for healthcare workers (HCWs) to wear gloves, a plastic apron or gown, and a surgical mask when coming within 3 feet of pandemic flu patients. They recommend the use of an FFP3 respirator (equivalent to a US N-99 respirator, designed to stop 99% of small airborne particles) and eye protection during aerosol-generating procedures.
Here is the Abstract (slightly reparagraphed for readability):
Personal protective equipment in an influenza pandemic: a UK simulation exercise
N.F. Phina, A.J. Rylandsb, J. Allanb, C. Edwardsb, J.E. Enstonec and J.S. Nguyen-Van-Tamd
aCheshire and Merseyside Health Protection Unit, Chester UK
bWirral University Teaching Hospital NHS Foundation Trust, Upton UK
cHospital Infection Society, London, UK
dUniversity of Nottingham, Nottingham, UK
Received 14 February 2008;
accepted 4 September 2008.
Available online 17 November 2008.
Summary
There is limited experience of both operational and financial impacts that adoption of UK pandemic influenza infection control guidance will have on the use of personal protective equipment (PPE), patients and staff. We attempted to assess these issues from a live exercise in a hospital in north-west England. During this 24 h exercise, all staff on an acute general medical ward wore PPE and adopted the procedures described in the UK pandemic influenza infection control guidance.
Teams of infection control nurses observed and recorded staff behaviour and practice throughout the exercise, including staff attitudes towards the use of PPE. Although World Health Organization recommendations on the likely use of high-level PPE (FFP3 respirators) proved to be excessive, more gloves and surgical masks were used than expected.
Despite pre-exercise training, many staff lacked confidence in using PPE and following infection control measures. They found PPE uncomfortable, with even basic tasks taking longer than usual.
Large quantities of clinical waste were generated: an additional 12 bags (570 L) per day. The estimates of PPE usage within this exercise challenge assumptions that large amounts of high-level PPE are required, with significant implications for healthcare budgets.
A programme of ongoing infection control education is needed. Healthcare in a pandemic situation is not simply a case of applying pandemic influenza infection control guidance to current practice; hospitals need to consider changing the way care and services are delivered.
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