At the peak of the
coronavirus disease 2019 (COVID-19) pandemic,
hand hygiene audits indicated decreased compliance in a 12-bed
critical care (CC) area with ventilated
COVID-19 patients, where staff used
personal protective equipment (PPE), including sessional use of long-sleeved gowns in accordance with the recommendations of Public Health England. There was also a cluster of three
central venous catheter (CVC)
infections along with increases in the number of patients from whom enteric Gram-negative bacteria (GNB) were isolated from sterile sites. Environmental sampling of near-patient surfaces and frequently touched sites demonstrated that 11.5% of areas were contaminated with enteric GNB in the
COVID-19 CC area, compared with 2.6% and 2.7% in
COVID-19 and non-COVID-19 general wards, respectively. Following a risk assessment, hospital policy was changed to replace long-sleeved gowns with short-sleeved gowns. The CC unit underwent enhanced cleaning with
hypochlorite-based
disinfectant and was resampled 8 days later. On resampling, no GNB were isolated from the CC unit. Following this change in PPE,
hand hygiene compliance returned to baseline standards and no further CVC
infections were identified. Staff reported a preference for short-sleeved gowns. No evidence currently exists that PPE beyond that recommended for pandemic
influenza (respiratory protection plus standard PPE) adds to the protection of healthcare workers (HCWs) from
severe acute respiratory syndrome coronavirus-2. Long-sleeved gowns prevent HCWs performing
hand hygiene effectively. While it is imperative that HCWs are adequately protected, protection of patients from
infection hazards is equally important. Further studies are necessary to establish risks from PPE to inform a review of current guidance.