An article in the Canadian Medical Association Journal provides an overview on personal protective equipment (PPE) in healthcare settings, including evidence on the effectiveness of N95 masks, as well as the importance of including healthcare workers’ perspectives regarding this equipment.

“Answering questions such as how aerosols are generated, how limited supply of PPE can be managed, how care can be organized to optimize PPE use, and how healthcare worker perspectives can be integrated into organizational decisions are central to protecting healthcare workers from COVID-19 and future pandemic pathogens,” write Jeanna Parsons Leigh, MD, faculty of medicine, Dalhousie University, Halifax, Nova Scotia, and her coauthors.

The authors analyze the use of N95 masks, compared with medical masks, in preventing viral respiratory infections and suggest ways to manage the limited supply of N95 masks and other protective devices. They hope the article will help organizations with decision-making around how to protect healthcare workers and patients while managing often scarce resources.

Real-world effectiveness of PPE may vary, especially during the early stages of an outbreak. Similarly, complex PPE regimens may not be better at protecting against transmission. “More is not necessarily better,” write the authors. “For Ebola, critical errors remained more common in enhanced versus basic PPE regimens despite training.”

Moreover, meticulous attention to training healthcare workers in the correct methods of donning and doffing PPE is crucial. Specifically, involving healthcare workers in developing strategies for PPE use, as well as clear communication, is important for ensuring front-line workers have confidence and use PPE effectively. 

“Critical to choosing PPE regimens, but rarely explored, is how safe healthcare workers feel with the PPE regimen designated by their local hospital,” write Leigh and her colleagues. “Individuals and organizations may interpret the literature differently and may arrive at different conclusions as to which PPE is appropriate for a given context for a novel virus. A breakdown in trust and communication can lead to conflict, anxiety, and worker absences.”