Access to personal protective equipment in healthcare workers during the COVID-19 pandemic in the United Kingdom: results from a nationwide cohort study (UK-REACH)
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Abstract
Background
Healthcare workers (HCWs) are at high risk of SARS-CoV-2 infection. Effective use of personal protective equipment (PPE) reduces this risk. We sought to determine the prevalence and predictors of self-reported access to appropriate PPE (aPPE) for HCWs in the UK during the COVID-19 pandemic.
Methods
We conducted cross sectional analyses using data from a nationwide questionnaire-based cohort study administered between December 2020-February 2021. The outcome was a binary measure of self-reported aPPE (access all of the time vs access most of the time or less frequently) at two timepoints: the first national lockdown in the UK in March 2020 (primary analysis) and at the time of questionnaire response (secondary analysis).
Results
Ten thousand five hundred eight HCWs were included in the primary analysis, and 12,252 in the secondary analysis. 35.2% of HCWs reported aPPE at all times in the primary analysis; 83.9% reported aPPE at all times in the secondary analysis. In the primary analysis, after adjustment (for age, sex, ethnicity, migration status, occupation, aerosol generating procedure exposure, work sector and region, working hours, night shift frequency and trust in employing organisation), older HCWs and those working in Intensive Care Units were more likely to report aPPE at all times. Asian HCWs (aOR:0.77, 95%CI 0.67–0.89 [vs White]), those in allied health professional and dental roles (vs those in medical roles), and those who saw a higher number of COVID-19 patients compared to those who saw none (≥ 21 patients/week 0.74, 0.61–0.90) were less likely to report aPPE at all times. Those who trusted their employing organisation to deal with concerns about unsafe clinical practice, compared to those who did not, were twice as likely to report aPPE at all times. Significant predictors were largely unchanged in the secondary analysis.
Conclusions
Only a third of HCWs in the UK reported aPPE at all times during the first lockdown and that aPPE had improved later in the pandemic. We also identified key determinants of aPPE during the first UK lockdown, which have mostly persisted since lockdown was eased. These findings have important implications for the safe delivery of healthcare during the pandemic.
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SciScore for 10.1101/2021.09.16.21263629: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics Consent: To take part, eligible HCWs had to visit the website, create a user profile and provide informed consent.
IRB: Ethical approval: The study was approved by the Health Research Authority (Brighton and Sussex Research Ethics Committee; ethics reference: 20/HRA/4718).Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources We asked participants about PPE access at two timepoints: Covariates: We selected predictor variables that might be associated with the outcome a priori, based on existing literature and expert opinion. Covariatessuggested: NoneResults from OddPub: We …
SciScore for 10.1101/2021.09.16.21263629: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics Consent: To take part, eligible HCWs had to visit the website, create a user profile and provide informed consent.
IRB: Ethical approval: The study was approved by the Health Research Authority (Brighton and Sussex Research Ethics Committee; ethics reference: 20/HRA/4718).Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources We asked participants about PPE access at two timepoints: Covariates: We selected predictor variables that might be associated with the outcome a priori, based on existing literature and expert opinion. Covariatessuggested: NoneResults from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Furthermore, in light of these findings, it is even more vital that detailed occupational risk assessments that take account of ethnicity are undertaken for UK HCWs.[26] Our study has limitations. As with any consented observational study, there is potential for self-selection bias. We may be reporting only HCWs’ perspectives regarding what is ‘adequate’ PPE rather than lack of access, since significant variation across a range of different clinical procedures exists for PPE between the UK, other countries and the World Health Organisation.[27] However, the large difference in the proportion of HCWs reporting access to PPE in the primary and secondary analyses provides evidence against this, given that UK PPE guidelines did not change in the intervening time. Our findings relating to trust in employer might indicate reporting bias (i.e. those that did not trust their employer to deal with a concern about unsafe clinical practice might be more likely to report a lack of PPE access in their workplace than those that did). Additionally, given the cross sectional nature of the analyses we cannot determine the direction of causality in this association. Finally, we are asking HCWs to recall their experiences of the last year and thus responses may be prone to recall bias. However, UK-REACH is one of the largest and most comprehensive HCW databases in the world to date, and if only a third of 12,000 HCWs report adequate PPE access, this is difficult for policymakers to ignore. Furt...
Results from TrialIdentifier: We found the following clinical trial numbers in your paper:
Identifier Status Title ISRCTN11811602 NA NA Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
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