COVID-19: 5 Considerations on PPE Equitable Access and Fit

As a petite and athletic female physician, Nicole Yedlinsky struggled to find properly fitting personal protective equipment (PPE), a problem exacerbated by the COVID-19 pandemic. Dr. Yedlinsky, a sports and family medicine physician and Associate Professor of Family Medicine and Community Health at Kansas University Medical Center, recently spoke with Dr. David Kuhar, an infectious disease physician with the Centers for Disease Control and Prevention (CDC). They discussed the importance of access to properly fitting PPE, both as a matter of safety for practitioners and patients and as a critical aspect of creating diverse, inclusive health care environments where everyone is supported and treated equitably.

1. When it comes to PPE, one size does not fit all.

   Obtaining PPE was extremely challenging at the start of the COVID-19 pandemic and during surges. This problem was compounded by difficulties in finding well-fitting equipment, especially for individuals who do not fit "the standard size of physicians". Many health care personnel found that PPE sold as "one size fits all" did not fit them appropriately.

2. Inadequate PPE fit adds an emotional toll to an already demanding situation.

   Lack of properly fitting PPE created doubt amongst health care personnel: they did not feel adequately protected at work. Many felt that they were sacrificing their own safety while continuing to provide exceptional care.

   The lack of access to properly fitting PPE added stress, which may have led to burnout and attrition among physicians and nurses.

3. Well-fitting PPE for all health care personnel is critical to building a diverse, equitable and safe health care environment.

4. Because of demand and limited access to PPE, facilities conserved and re-used PPE that was intended for one-time use.

   Some providers had PPE cleaned and/or re-used, which created uncertainty about its ability to protect the wearer.

   Health care settings such as nursing homes and outpatient centers suddenly needed PPE for workers that may not have needed this type of equipment before COVID-19. This created additional demand and the need for numerous rounds of fit testing for each person.

5. Health care personnel should feel protected and must have access to well-fitting PPE.

   The AMA encourages the diversification of PPE design to better fit all body types, cultural expressions, and practices among health care personnel (AMA Policy H-44.810, "Availability of Personal Protective Equipment (PPE)."

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This article provides highlights from episode three of the Stories of Care podcast, PPE Fit and Equity. For the full interview, listen here.

Project Firstline is a national collaborative led by the U.S. Centers for Disease Control and Pre‐ vention (CDC) to provide infection control training and education to frontline healthcare work‐ ers and public health personnel. The American Medical Association is proud to partner with Project Firstline, as supported through CDC-RFA-CK20-2003. CDC is an agency within the De‐ partment of Health and Human Services (HHS). The contents of this article do not necessarily represent the policies of CDC or HHS and should not be considered an endorsement by the Fed‐ eral Government.