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Experiences of personal protective equipment and reasons for non-compliance

02 October 2022
Volume 14 · Issue 10



The COVID-19 pandemic created challenges in prehospital care. Paramedics have been required to adhere to strict protocols regarding infection control and the use of personal protective equipment (PPE). These protocols have evolved as the pandemic progressed. Understanding the experiences of paramedics in using PPE and their reasons behind not adhering to recommended guidelines should improve the limited evidence base and assist healthcare organisations to form tailored PPE guidance, enabling better protection of paramedics.


This study aimed to analyse evidence on paramedics' experiences of using PPE and explore the reasons behind non-compliance to inform PPE policies.


Searches of five key databases identified papers relating to frontline practitioners' experiences of using PPE; frontline was defined as working in patient-facing roles in prehospital, emergency department or critical care settings. Articles were then subject to thematic analysis as part of this narrative review.


Three themes emerged: physical and emotional wellbeing; impact on patient care and clinical effectiveness; and PPE fatigue. The evidence explores health professionals' experiences of working in this difficult environment but very little data exist regarding the impact of PPE, specifically on UK paramedics or their reasons for not adhering to PPE protocols.


PPE affects wearers in a variety of ways. Factors behind non-adherence are multifactorial. A paucity of literature exists regarding paramedics' experiences of using PPE.

COVID-19, the respiratory disease caused by SARS-CoV-2, led to the World Health Organization (WHO) declaring a pandemic in March 2020 (WHO, 2022). COVID-19 has a variety of symptoms, which have changed as the virus mutated and understanding of the disease deepened. Significant mortality has been seen in particular demographic groups. Many patients are asymptomatic, compounding difficulties in infection control and prevention of disease transmission (Atzrodt et al, 2020; Fink et al, 2020).

Health professionals are still required to adhere to strict protocols regarding the use of personal protective equipment (PPE), particularly when in proximity to medical procedures thought to generate aerosols. This is because SARS-CoV-2 is primarily transmitted through respiratory particles in the form of droplets, aerosols or fomites (Leong et al, 2020).

Infection control guidelines have been variable and contradictory in some instances. It remains recommended that PPE be worn when caring for patients to provide a protective barrier, shielding the wearer from exposure with external contaminants. Level 2 PPE was initially recommended for use with all patients regardless of COVID-19 status, with level 3 PPE reserved for use in patients who were suspected of or had been confirmed as being COVID-19 positive (Figure 1).

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