Lessons learned from the ‘first wave’

As we enter a second phase of the pandemic, the lessons learned from managing the challenges of the ‘first wave’ will be crucial. Experts speaking at the Central Sterilising Club’s virtual study day shared their insights into strategies to manage shortages of PPE and important lessons learned on the building of field hospitals, to meet demand in a crisis.

Shortages of personal protective equipment (PPE) hit the headlines during the height of the first wave of the COVID-19 pandemic. As the crisis escalated, Trusts were forced to consider strategies around the potential reuse of single-use PPE. A recent virtual study day, by the Central Sterilising Club, looked at the evidence to support reuse of PPE, strategies for decontamination and reflected on some of the efforts Trusts have made to address staff fears around the transmission of the virus. Colin Brown, a consultant in infectious diseases and medical microbiology, from Public Health England and the Royal Free Hospital NHS Trust, gave an overview of ‘PPE guidance’, ‘what went well’ and ‘what lessons were learnt’, during the first wave. Brown explained that he had been actively involved in developing clinical guidance, since January 2020. During the early stages of the pandemic, the infection prevention and control (IP&C) guidance around PPE was based on the assertion that it was a high consequence infectious disease. However, as experience and knowledge of the disease developed, the guidance changed in April 2020. Brown commented that most of the pandemic plans had initially been for influenza, but it became clear there was a need for more dedicated and specific COVID plans, taking into consideration the risk of asymptomatic carriage and transmission within closed environments. The guidance was changed in line with awareness of generalised transmission in the community and highlighted the need to wear PPE in health and social care, for each patient encounter, regardless of whether the individual presented with symptoms. This rapidly increased the amount of PPE that was used and led to a stressor on the stockpile – prompting the publication of


a rationale document, by the Government, on ‘considerations for acute PPE shortages’, which looked at the reuse of PPE, other types of PPE that might be used, and whether other single-use equipment could also be reused.

Brown explained that the evidence base, at this time was very limited, so the guidance relied heavily on expert opinion and was developed in close collaboration with the Health and Safety Executive (HSE), in order to formulate decisions on what would be practical and safe. The resulting PHE guidance document on IP&C had over 1.5 million views online, while a guidance document on considerations for acute PPE shortages had nearly 100,000. “It was clear that there was a lot of interest in the guidance and what it had to say. There was a paradigm shift in IP&C practice. Although the notion of reuse of PPE

goes against what we have been taught and usual practice, that is not say that it isn’t safe or cannot be looked into,” he commented. In June 2020, Elaine Toomey and Yvonne Conway et al, published a rapid evidence review for ‘extended use or reuse of single-use surgical masks and filtering facepiece respirators’ (Centre for Evidence- Based Medicine).1

The main findings of the review were:

1 While extended use or re-use of single- use surgical masks or respirators (with or without reprocessing) is generally not recommended, guidance from various organisations supports such measures (preferably extended use rather than re-use) as a last-resort measure during critical shortage.

2 Comparisons across guidance documents and systematic reviews highlight limited evidence, varying levels of detail, and


2020 Evelien Doosje

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