Personal protective equipment and evidence-based advice for surgical departments during COVID-19

ANZ J Surg. 2020 Sep;90(9):1566-1572. doi: 10.1111/ans.16194. Epub 2020 Aug 18.


Background: Inconsistencies regarding the use of appropriate personal protective equipment (PPE) have raised concerns for the safety of surgical staff during the coronavirus disease 2019 (COVID-19) pandemic. This rapid review synthesizes the literature and includes input from clinical experts to provide evidence-based guidance for surgical services.

Methods: The rapid review comprised of targeted searches in PubMed and grey literature. Pertinent findings were discussed by a working group of clinical experts, and consensus recommendations, consistent with Australian and New Zealand Government guidelines, were formulated.

Results: There was a paucity of high-quality primary studies specifically investigating appropriate surgical PPE for healthcare workers treating patients possibly infected with COVID-19. SARS-CoV-2 is capable of aerosol, droplet and fomite transmission, making it essential to augment standard infection control measures with appropriate PPE, especially during surgical emergencies and aerosol-generating procedures. All biological material should be treated a potential source of SARS-COV-2. Staff must have formal training in the use of PPE and should be supervised by a colleague during donning and doffing. Patients with suspected or confirmed COVID-19 should wear a surgical mask during transfer to and from theatre. Potential solutions exist in the literature to extend the use of surgical P2/N95 respirators in situations of limited supply.

Conclusion: PPE is advised for all high-risk procedures and when a patient's COVID-19 status is unknown. Surgical departments should facilitate staggered rostering, remote meeting attendance, and self-isolation of symptomatic staff. Vulnerable surgical staff should be identified and excluded from operations with a high risk of COVID-19 infection.

Keywords: COVID-19; SARS-CoV-2; healthcare worker; personal protective equipment; surgery.

Publication types

  • Review

MeSH terms

  • Australia / epidemiology
  • Betacoronavirus*
  • COVID-19
  • Coronavirus Infections / epidemiology
  • Coronavirus Infections / transmission*
  • Disease Transmission, Infectious / prevention & control*
  • Health Personnel / standards*
  • Humans
  • Infection Control / organization & administration*
  • New Zealand / epidemiology
  • Pandemics*
  • Personal Protective Equipment / standards*
  • Personal Protective Equipment / supply & distribution
  • Pneumonia, Viral / epidemiology
  • Pneumonia, Viral / transmission*
  • SARS-CoV-2