J Hosp Infect. 2020 Jul 31:S0195-6701(20)30367-4. doi: 10.1016/j.jhin.2020.07.036. Online ahead of print.
At the peak of the COVID-19 pandemic, hand hygiene audits indicated decreased compliance in a 12-bed Critical Care (CC) area with ventilated COVID-19 patients, where staff used PPE including sessional use of full sleeved gowns as per Public Health England (PHE) recommendations. There was also a cluster of 3 central venous catheter (CVC) infections along with increases in the number of patients from whom enteric Gram-negative bacteria (GNB) were isolated from sterile sites. Environmental sampling of near patient surfaces and frequently touched sites demonstrated 11.5% areas contaminated with enteric GNB in the COVID-19 CC area, compared to 2.6% and 2.7% in COVID-19 and non-COVID-19 general wards, respectively. Following a risk assessment, hospital policy was changed to replace long- with short-sleeved gowns. The CC unit had an enhanced clean with hypochlorite based disinfectant and was resampled 8 days later. On resampling we isolated no GNB on the unit. Post PPE change hand hygiene compliance returned to baseline standards and no further CVC infections were identified. Staff reported a preference for short sleeved gowns. No evidence currently exists that PPE beyond that recommended for pandemic influenza (respiratory protection plus standard PPE) adds to protection of health care workers (HCW) from SARS-CoV-2. Long-sleeved gowns prevent HCWs performing hand hygiene effectively. While it is imperative that HCWs are adequately protected, protection of patients from infection hazards is equally important. Further studies are necessary to establish risks from PPE to inform a review of current guidance.