key: cord-0890451-mrk4azvi
authors: Liu, Zhen; Wu, Zhouyang; Zhao, Hongyu; Zuo, Mingzhang
title: Personal protective equipment during tracheal intubation in patients with Coronavirus disease 2019 in China: a cross-sectional survey
date: 2020-08-07
journal: Br J Anaesth
DOI: 10.1016/j.bja.2020.07.047
sha: f99ec41bb2bb56b427f06fc07859f3f2603f5112
doc_id: 890451
cord_uid: mrk4azvi

nan

). 5 An N95 mask respirator is recommended in aerosol-generating procedures and is included in PPE2 and above. 6 Our results revealed that 5 doctors using PPE2 were infected. In addition to what is included in PPE2, eye protection goggles, face shield and protective clothing are required in PPE3. The lack of a face shield leaves the facial skin unprotected and subject to be infected by aerosols. On the other hand, protective devices without eye goggles leave eye mucous membranes exposed to the air, even with a face shield on. SARS-CoV-2 can be detected in air 4 m from the patient 7 and is transmitted through droplets, contact and aerosols. 8 Uncovered skin and mucous membranes could be contaminated by SARS-CoV-2. 9 Our results suggest that besides the N95 mask respirator, both eye goggles and face shield are needed when performing tracheal intubation. Unlike protective clothing, an isolation gown cannot cover the whole body, which may be a reason for infection of doctors using PPE2. It should be noted that an N95 mask respirator, hand hygiene, gloves, scrubs, disposable cap and disposable shoe covers were included in PPE2 and above. Our results suggest that an isolation gown without protective clothing might not be enough to protect HCWs from cross infection by SARS-CoV-2 when performing tracheal intubation. Based on our results, we recommended PPE3 when performing tracheal intubation, although this may be excessive.

This study has some limitations. First, HCWs infected through other sources other than patients such as colleagues in the hospital could not be excluded. Second, PPE availability was different at different times and most doctors included performed more than one intubation case, which made it difficult to have all the protection information for every intubation. Different protective devices were used in different levels of PPE.

Whether one or more of these devices could be deleted cannot be determined in this study and more studies are needed.

In conclusion, PPE3 appears to reduce the risk of HCW infection when performing tracheal intubation in COVID-19 patients. Our study suggests N95 mask respirator, eye goggles, face shield and protective clothing are indispensable during tracheal intubation. 

The authors declare no conflicts of interest. Table 1 . Level of personal protective equipment worn by anaesthesiologists who became infected with SARS-CoV-2. PPE1: surgical face mask, hand hygiene, gloves, scrubs, isolation gown and disposable cap; PPE2: N95 mask respirator, choice between eye protection goggles or face shield, hand hygiene, gloves, scrubs, choice between isolation gown or protective clothing, disposable cap and disposable shoe covers; PPE3: N95 mask respirator, eye protection goggles, face shield, hand hygiene, gloves, scrubs, protective clothing, disposable cap and disposable shoe covers; PPE3 + : all equipment needed in PPE3 and powered air-purifying respirator (PAPR). 

Center) following for valuable discussion and suggestions. The authors thank the following for data collection: Xiangdong Chen (Union Hospital, Tongji Medical College

Jiaqiang Zhang (Henan Provincial People's Hospital

The Central Hospital of Wuhan, Tongji Medical College

Yahong Gong, Yumiao He and Yuchen Yuan (Peking Union Medical College Hospital)

Nowcasting and forecasting the potential domestic and international spread of the 2019-nCoV outbreak originating in Wuhan, China: a modelling study

Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study

Risk factors for SARS transmission from patients requiring intubation: a multicentre investigation in Toronto

Emergency tracheal intubation in 202 patients with COVID-19 in Wuhan, China: lessons learnt and international expert recommendations

Intubation and ventilation amid the COVID-19 outbreak: Wuhan's experience

Protecting healthcare workers from SARS-CoV-2 infection: practical indications

Aerosol and surface distribution of severe acute respiratory syndrome coronavirus 2 in hospital wards

Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia

Outbreak of a new coronavirus: what anaesthetists should know