Personal Protective Equipment (PPE) for Surgeons during COVID-19 Pandemic: A Systematic Review of Availability, Usage, and Rationing.

BACKGROUND: Surgeons need guidance regarding appropriate personal protective equipment (PPE) during the COVID-19 pandemic based on scientific evidence rather than availability. The aim of this paper is to inform surgeons of appropriate PPE requirements, and to discuss usage, availability, rationing and future solutions. METHODS: A systematic review was undertaken in accordance with the PRISMA guidelines using the MEDLINE, EMBASE, & WHO COVID-19 Databases. Newspaper and internet article sources were identified using NEXIS. The search was complemented by bibliographic secondary linkage. The findings were analysed alongside guidelines from the World Health Organisation (WHO), Public Health England (PHE), the Royal College of Surgeons & Specialty Associations. RESULTS: Of a total 1329 articles identified, 305 were removed (duplicates etc), and finally, 95 studies met the inclusion criteria. Recommendations made by the WHO regarding the use of PPE in the COVID-19 pandemic have evolved alongside emerging evidence. Medical resources including PPE have been rapidly overwhelmed. There is a global effort to overcome this by combining the most effective use of existing PPE in combination with innovative strategies to produce more. Practical advice on all aspects of PPE are detailed in this systematic review. CONCLUSION: Although there is a need to balance limited supplies with staff and patient safety, this should not leave surgeons treating patients with inadequate PPE. This article is protected by copyright. All rights reserved.