PPE in low and middle-income countries during COVID-19

  • Dilini Imbulana
  • Anushree Loyalka
  • Dominic Edwards

Abstract

Background: Infection prevention and control in health care settings involves, among other measures, the use of personal protective equipment (PPE), which encompasses all of the specialised equipment worn by health care workers (HCWs) for protection against health and safety hazards. In low- and middle-income countries (LMICs), there is a higher incidence of infectious disease, often attributed to the poor hospital environmental conditions and reduced availability of PPE, especially during the COVID-19 pandemic. 

Aim: We performed a literature review of proposed methods to prolong the use of PPE and additive measures to protect healthcare workers in resource-limited settings during COVID-19. 

Methods: A search was conducted through several databases, including PubMed, Medline, Scopus, and Google Scholar. Articles were included if they discussed strategies to prolong PPE use for healthcare workers in LMICs. 

Results: Although limited evidence-based strategies exist for PPE in LMICs, extended use of PPE may be attained with effective disinfection or sterilisation, proper doffing, and storage techniques. Alternative PPE includes cloth masks, hand hygiene, and use of face shields. Engineering and administration control of healthcare facilities can further minimise viral transmission. Conclusions: Several measures have been proposed to optimise current protective measures for HCWs.  Extended use and limited reuse of PPE, the use of face shields, proper doffing and hand hygiene, and careful consideration of administrative and engineering controls are all possible strategies to reduce the spread of virus particles to HCWs and patients. However, current studies that show the efficacy of PPE, methods to extend its use, and alternatives to PPE in reducing the transmission of COVID-19 are predominantly conducted in high-income countries. Further research of these strategies in LMICs is required to assess its use in reducing the burden of PPE shortage whilst addressing financial concerns.

Conclusions: Several measures have been proposed to optimise current protective measures for HCWs.  Extended use and limited reuse of PPE, the use of face shields, proper doffing and hand hygiene, and careful consideration of administrative and engineering controls are all possible strategies to reduce the spread of virus particles to HCWs and patients. However, current studies that show the efficacy of PPE, methods to extend its use, and alternatives to PPE in reducing the transmission of COVID-19 are predominantly conducted in high-income countries. Further research of these strategies in LMICs is required to assess its use in reducing the burden of PPE shortage whilst addressing financial concerns.

Published
2020-09-30
How to Cite
Imbulana, D., Loyalka, A., & Edwards, D. (2020). PPE in low and middle-income countries during COVID-19. AMSA Journal of Global Health, 14(2). Retrieved from http://ajgh.amsa.org.au/index.php/ajgh/article/view/111
Section
Review Articles