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Is it wise not to include hair and shoe covers in personal protective equipment (PPE) recommendations?

Part of: SARS-CoV-2/COVID-19

Published online by Cambridge University Press:  29 October 2020

Chenyu Sun Open the ORCID record for Chenyu Sun [Opens in a new window] ,
Mubashir Ayaz Ahmed  and
Ce Cheng
Chenyu Sun*
Affiliation:
AMITA Health Saint Joseph Hospital Chicago, Chicago, Illinois
Mubashir Ayaz Ahmed
Affiliation:
AMITA Health Saint Joseph Hospital Chicago, Chicago, Illinois
Ce Cheng
Affiliation:
The University of Arizona College of Medicine at South Campus, TucsonArizona
*
Author for correspondence: Chenyu Sun, E-mail: [email protected]
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Abstract

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Type
Letter to the Editor
Information
Infection Control & Hospital Epidemiology , Volume 42 , Issue 11 , November 2021 , pp. 1412
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Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2020. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

To the Editor—Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been spreading globally for more than half year.Reference Guddati1 Healthcare workers (HCWs) on COVID-19 floors and units are aware of the higher risk of contracting SARS-CoV-2.Reference Guddati1 “Routine care can be resumed only with sufficient and adequate personal protective equipment (PPE)” to protect HCWs to ensure continuous patient care during this pandemic.Reference Bresler, Bischoff and Böckler2 In China, 4% of confirmed cases in the first month of COVID-19 outbreak occurred among HCWs, with even higher rates in Europe due to delayed recognition of COVID-19 rather than PPE failures.Reference Rhee, Baker and Klompas3 However, the items included in PPE protocol and policies vary from institution to institution. The US Centers for Disease Control and Prevention (CDC) does not include hair covers and shoe covers in their PPE recommendations for HCWs.4

Despite the CDC not including them, hair covers and shoe covers, along with face masks, gowns, gloves, and other PPE are often used to prevent contamination from patient contact and droplets.Reference Guddati1 A recent study suggested that the shoes of HCWs might serve as a vector of SARS-CoV-2, transferring it from floors in COVID-19 rooms to floors throughout the unit.Reference Redmond, Dousa and Jones5 This is not surprising because SARS-CoV-2 contamination was common on floors in COVID-19 patient rooms.Reference Redmond, Dousa and Jones5,Reference Kim, Lee and Lee6 Although data on how long SARS-CoV-2 can survive on hairs, or whether it is common to have the contamination on hairs of HCWs are very limited, the virus remains viable for hours to days on different materials.Reference van Doremalen, Bushmaker and Morris7 Therefore, the potential contamination on hairs of HCWs may represent risks of nosocomial infection among non–COVID-19 patients.

We believe it is better to be cautious rather than regretful, and HCWs should be provided shoe covers and hair covers as part of PPE when providing care for COVID-19 patients. More studies will also be needed to assess the risk of contamination on human hairs as well as the efficacy of hair and shoe covers in healthcare settings.

References

Guddati, A. Protection of healthcare professionals during an epidemic: medical, ethical, and legal ramifications. Interact J Med Res 2020;9:e19144.10.2196/19144CrossRefGoogle Scholar
Bresler, AM, Bischoff, MS, Böckler, D. SARS-CoV-2—how can and must medical personnel protect themselves? Gefasschirurgie 2020;15:1–10.Google Scholar
Rhee, C, Baker, MA, Klompas, M. The COVID-19 infection control arms race. Infect Control Hosp Epidemiol 2020. doi: 10.1017/ice.2020.211.CrossRefGoogle Scholar
Interim infection prevention and control recommendations for healthcare personnel during the coronavirus disease 2019 (COVID-19) pandemic. Centers for Disease Control and Prevention website. https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html. Updated July 15, 2020. Accessed September 22, 2022.Google Scholar
Redmond, SN, Dousa, KM, Jones, LD, et al. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acid contamination of surfaces on a coronavirus disease 2019 ward and intensive care unit. Infect Control Hosp Epidemiol 2020. doi: 10.1017/ice.2020.416.CrossRefGoogle Scholar
Kim, UJ, Lee, SY, Lee, JY, et al. Air and environmental contamination caused by COVID-19 patients: a multi-center study. J Korean Med Sci 2020;35:e332.CrossRefGoogle ScholarPubMed
van Doremalen, N, Bushmaker, T, Morris, DH, et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med 2020;382:1564–1567.CrossRefGoogle ScholarPubMed