Haji Jumana Yusuf, Subramaniam Ashwin, Kumar Prashant, Ramanathan Kollengode, Rajamani Arvind
Department of Anesthesia and Critical Care, Aster CMI Hospital, Bengaluru, Karnataka, India.
Department of Intensive Care, Frankston Hospital, VIC Monash University VIC, Frankston, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.
Indian J Crit Care Med. 2020 Sep;24(9):809-816. doi: 10.5005/jp-journals-10071-23550.
Optimal personal protective equipment (PPE) preparedness is key to minimize healthcare workers (HCW) infection with COVID-19. This two-phase survey evaluated PPE preparedness (adherence to Ministry of Health India (MoH) PPE-recommendations; HCW-training; PPE-inventory; PPE-breach management) in Indian intensive care units (ICU).
The phase 1 survey was distributed electronically to intensivists from 481 Indian hospitals between March 25, 2020, and April 06, 2020, as part of a multinational survey. Phase 2 was repeated in 320 Indian hospitals between April 20, 2020, and April 30, 2020.
Response rate was 25% from 22 states. PPE practice varied between states and between private, government, and medical colleges. Between phase 1 and phase 2, all aspects of PPE training improved: donning/doffing 43% vs 66%, respectively; value <0.01); safe waste disposal practices (38% vs 52%; value = 0.09); intubation training (18% vs 31%; value = 0.05); and transport (18% vs 31%; value = 0.05). Perception of confidence for adequate PPE-training improved from 39 to 53% ( value = 0.26). In all, 47 to 60% ICUs adhered to MoH recommendations. Wearing N95-masks at all times increased from 47 to 60% ( value = 0.89). Very few ICUs provided quantitative/qualitative N95 masks fit testing (12% vs 29%; value <0.01). Low-cost practices like "buddy-system" for donning-doffing (27% vs 44%; value = 0.02) and showering after PPE breach (10% vs 8%; value = 0.63) were underutilized. There was reluctance to PPE reuse. In all, 71% were unaware/diffident about PPE inventory.
Despite interstate variability, most ICUs conformed to MoH recommendations. This survey conducted during initial pandemic phase demonstrated improved PPE preparedness uniformly across India with scope for further improvement. We suggest implementation of quality improvement measures to improve pandemic preparedness and minimize HCW infection rates, focused on regular PPE training, buddy system, and PPE-breach management.
Haji JY, Subramaniam A, Kumar P, Ramanathan K, Rajamani A. State of Personal Protective Equipment Practice in Indian Intensive Care Units amidst COVID-19 Pandemic: A Nationwide Survey. Indian J Crit Care Med 2020;24(9):809-816.
优化个人防护装备（PPE）准备情况是将医护人员感染2019冠状病毒病（COVID-19）的风险降至最低的关键。这项两阶段调查评估了印度重症监护病房（ICU）的PPE准备情况（遵守印度卫生部（MoH）的PPE建议；医护人员培训；PPE库存；PPE违规管理）。
作为一项跨国调查的一部分，第一阶段调查于2020年3月25日至2020年4月6日以电子方式分发给来自481家印度医院的重症医学专家。第二阶段于2020年4月20日至2020年4月30日在320家印度医院重复进行。
来自22个邦的回复率为25%。PPE的使用情况在各邦之间以及私立、政府和医学院之间存在差异。在第一阶段和第二阶段之间，PPE培训的各个方面都有所改善：穿脱分别为43%对66%（P值<0.01）；安全废物处理做法（38%对52%；P值=0.09）；插管培训（18%对31%；P值=0.05）；以及转运（18%对31%；P值=0.05）。对充分PPE培训的信心感知从39%提高到53%（P值=0.26）。总体而言，47%至60%的ICU遵守了MoH的建议。始终佩戴N95口罩的比例从47%提高到60%（P值=0.89）。很少有ICU提供N95口罩的定量/定性适合性测试（12%对29%；P值<0.01）。像穿脱的“伙伴系统”（27%对44%；P值=0.02）和PPE违规后淋浴（10%对8%；P值=0.63）等低成本做法未得到充分利用。人们不愿意重复使用PPE。总体而言，71%的人对PPE库存不了解/不确定。
尽管各邦之间存在差异，但大多数ICU符合MoH的建议。在疫情初期阶段进行的这项调查表明，印度各地的PPE准备情况普遍有所改善，但仍有进一步改进的空间。我们建议实施质量改进措施，以提高疫情防范能力并将医护人员感染率降至最低，并重点关注定期PPE培训；伙伴系统；以及PPE违规管理。
哈吉JY，苏布拉马尼亚姆A，库马尔P，拉马纳坦K，拉贾马尼A。COVID-19大流行期间印度重症监护病房个人防护装备的使用状况：一项全国性调查。《印度重症医学杂志》2020年；24（9）：809 - 816。
