Just the Facts: Protecting frontline clinicians during the COVID-19 pandemic

Atkinson, Paul; French, James; Lang, Eddy; McColl, Tamara; Mazurik, Laurie

Recommendations for the appropriate levels of PPE required by health care workers tend to vary by administrative regions, by risk of exposure and procedure, and with time as evidence is reviewed and incorporated into guidelines. Droplet and contact precautions are now recommended for the routine care of all ED patients with suspected or confirmed COVID-19; however, due to the poor reliability of clinical features in predicting cases, some jurisdictions, including Canada, have now implemented universal precautions for all ED patients. 5 Airborne precautions should be used when AGMPs are planned or anticipated to be performed on all patients during the pandemic. 8 WHO and PHAC provide guidance on the minimum levels of protection required for various situations, including triage of undifferentiated patients, standard treatment of suspected cases and also for high risk procedures where aerosolization of the virus is most probable. 4 Their advice covers respirators (e.g., N95, FFP2, or equivalent standard), surgical masks, eye and face protection, water resistant and waterproof gowns, and gloves ( Figure 1 ). Other regional occupational health and safety (OSH) agencies provide locally applicable standards. 8 It is clear that, when in close contact with a patient suspected or diagnosed with COVID-19, in addition to minimizing the time with the patient, health care workers should be provided with appropriate levels of protection, such as respirators and eye and face protection, if the severity of the case is undetermined (e.g., at triage), or there is any risk of airborne (aerosol) spread, such as during resuscitation, noninvasive ventilation, high flow nasal cannulae, airway procedures, or if the patient is actively coughing into the air.