Use of personal protective equipment against coronavirus disease 2019 by healthcare professionals in Wuhan, China: cross sectional studyBMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m2195 (Published 10 June 2020) Cite this as: BMJ 2020;369:m2195
- Min Liu, professor1,
- Shou-Zhen Cheng, professor1,
- Ke-Wei Xu, professor2,
- Yang Yang, professor3,
- Qing-Tang Zhu, professor1,
- Hui Zhang, associate professor1,
- Da-Ya Yang, associate professor1,
- Shu-Yuan Cheng, doctoral candidate1,
- Han Xiao, research assistant1,
- Ji-Wen Wang, associate professor2,
- He-Rui Yao, professor2,
- Yu-Tian Cong, professor3,
- Yu-Qi Zhou, professor3,
- Sui Peng, professor1,
- Ming Kuang, professor1,
- Fan-Fan Hou, professor4,
- KK Cheng, professor5,
- Hai-Peng Xiao, professor of medicine in endocrinology1
- 1The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
- 2Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- 3The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- 4Nan Fang Hospital, Southern Medical University, Guangzhou, China
- 5Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Correspondence to: H-P Xiao
- Accepted 2 June 2020
Objective To examine the protective effects of appropriate personal protective equipment for frontline healthcare professionals who provided care for patients with coronavirus disease 2019 (covid-19).
Design Cross sectional study.
Setting Four hospitals in Wuhan, China.
Participants 420 healthcare professionals (116 doctors and 304 nurses) who were deployed to Wuhan by two affiliated hospitals of Sun Yat-sen University and Nanfang Hospital of Southern Medical University for 6-8 weeks from 24 January to 7 April 2020. These study participants were provided with appropriate personal protective equipment to deliver healthcare to patients admitted to hospital with covid-19 and were involved in aerosol generating procedures. 77 healthcare professionals with no exposure history to covid-19 and 80 patients who had recovered from covid-19 were recruited to verify the accuracy of antibody testing.
Main outcome measures Covid-19 related symptoms (fever, cough, and dyspnoea) and evidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, defined as a positive test for virus specific nucleic acids in nasopharyngeal swabs, or a positive test for IgM or IgG antibodies in the serum samples.
Results The average age of study participants was 35.8 years and 68.1% (286/420) were women. These study participants worked 4-6 hour shifts for an average of 5.4 days a week; they worked an average of 16.2 hours each week in intensive care units. All 420 study participants had direct contact with patients with covid-19 and performed at least one aerosol generating procedure. During the deployment period in Wuhan, none of the study participants reported covid-19 related symptoms. When the participants returned home, they all tested negative for SARS-CoV-2 specific nucleic acids and IgM or IgG antibodies (95% confidence interval 0.0 to 0.7%).
Conclusion Before a safe and effective vaccine becomes available, healthcare professionals remain susceptible to covid-19. Despite being at high risk of exposure, study participants were appropriately protected and did not contract infection or develop protective immunity against SARS-CoV-2. Healthcare systems must give priority to the procurement and distribution of personal protective equipment, and provide adequate training to healthcare professionals in its use.
Contributors: ML, SZC, KWX, YY, QTZ, HZ, DYY, and SYC contributed equally to this paper. HPX and KKC conceived and designed the study. ML, SZC, KWX, YY, QTZ, JWW, HRY, YTC, YQZ, SP, and MK contributed to recruitment of patients and healthcare professionals, data collection, data analysis, and data interpretation. HZ, DYY, SYC, and HX contributed to literature search and data collection. HZ, DYY, SYC, HX, and KKC drafted the manuscript. MK, FFH, KKC, and HPX are the guarantors. All authors approved the final version of the manuscript. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.
Funding: This work was funded by grants from the First Affiliated Hospital of Sun Yat-sen University. The funder was not involved in the design and conduct of the study; collection, analysis, interpretation of data, writing of the report, or decision to submit the article for publication.
Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: grant funding from the First Affiliated Hospital of Sun Yat-sen University; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.
Ethical approval: This study was approved by the First Affiliated Hospital of Sun Yat-sen University (2020-130). Written informed consent was obtained from all participants before enrolment.
Data sharing: No additional data available.
Dissemination to participants and related patient and public communities: The findings of this study will be disseminated to all clinical departments caring for patients with covid-19 at author affiliated institutions. In addition, our media relation departments will plan to further disseminate through press releases, as well as our institutional websites.
The manuscript’s guarantors (MK, FFH, KKC, and HPX) affirm that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.
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