PPE rationing for surgeons must be devoid of politics, follow guidelines

The need to balance limited supplies of personal protective equipment (PPE) with staff and patient safety during the novel coronavirus disease (COVID-19) pandemic should not leave surgeons treating patients with inadequate PPE, according to a study.

“These are unprecedented times when difficult decisions need to be made,” the investigators said. “However, in the case of rationing PPE, these decisions should be transparent, collaborative, accountable, and adaptable as evidence of the pandemic evolves rather than disguised as guidelines with the minimum level of protection.”

This study sought to inform surgeons of appropriate PPE requirements and to discuss usage, availability, rationing, and future solutions. The investigators performed a systematic review based on the PRISMA guidelines using Medline, Embase, and the World Health Organization (WHO) COVID-19 databases. Nexis was used to identify newspaper and internet article sources.

Bibliographic secondary linkage complemented the initial search. The findings were then analysed together with guidelines from the WHO, Public Health England, the Royal College of Surgeons, and specialty associations.

A total of 1,329 articles were identified, of which 95 met the eligibility criteria. Recommendations made by the WHO on the use of PPE during the COVID-19 pandemic have changed alongside emerging evidence. [Br J Surg 2020;107:1262-1280]

“Medical resources including PPE have been rapidly overwhelmed,” the investigators said. “There has been a global effort to overcome this by combining the most effective use of existing PPE with innovative strategies to produce more.”

Innovative solutions have been provided in most countries owing to the shortage of PPE supplies. One of these was the production of reusable PPE to reduce both the “economic and environmental impact, along with the exploration of simple measures that could aid personal ownership of items and tracking of individual use in hospital settings.” [www.news.sky.com/story/coronavirus‐minister‐confident‐delayed‐shipment‐of‐protective‐equipment‐will‐arrive‐today‐11975742; Polym Degrad Stab 2020;doi:10.1016/j.polymdegradstab.2020.109162; www.mcknights.com/news/products/reusable‐ppe‐makers‐increasing‐production‐to‐counter‐disposables]

In Europe, several business and private groups have brought industry leaders, scientists, and government together to create innovative solutions to meet the PPE demand. Apart from producing new equipment, novel repurposing of existing theatre equipment has been done, including adaptation of orthopaedic helmet systems used for elective arthroplasties, in which manifolds were 3D-printed and hoods sewn onto the helmet. [Arthroplast 2020;doi:10.1016/j.arth.2020.04.035]

In addition, several researchers have attempted to develop electronic PPE using telemedicine tools to perform electronic medical screening examinations, which could help conserve PPE and protect providers while maintaining safe standards for medical screening. [J Am Med Inform Assoc 2020;doi:10.1093/jamia/ocaa048]

“Healthcare resource allocation has political, economic, and moral dimensions, and rationing is inevitable in a system where there are limited resources,” the investigators said. “Rationing of PPE adds a new dimension to modern healthcare practice.”

In addition, the investigators stressed that changes in guidelines must be communicated clearly and honestly to the public and frontline healthcare professionals without any political spin. They also stated that the creation of morally sound policies is as important as following scientific evidence to “maintain trust, solidarity, and a functioning society.”

“Until there is a vaccine or proven treatments available, the requirement for surgeons to limit their workload and take sensible precautions is imperative in reducing transmission, flattening the curve, protecting themselves and patients, and reducing the death toll,” they noted.