Use of Personal Protective Equipment When Providing Vaginal Delivery Care in Times of COVID-19

Keywords: Coronavirus Infections, Natural Childbirth, Personal Protection, Health Personnel, Respiratory Protective Devices, Eye Protective Devices, Gloves; Surgical, Protective Clothing

Abstract

Introduction. In December 2019, in Wuhan, China, there was an outbreak of atypical pneumonia caused by the SARS-CoV-2 virus, which is a type of coronavirus causative of COVID-19, which overtime became a pandemic. In this context, the use of personal protective equipment is of special interest, especially when providing care in vaginal delivery, due to the confusion in obstetric circles regarding the best way to protect healthcare personnel in these cases. The objective of this review article is to identify which are the personal protective elements indicated for providing care in vaginal birth and their correct use during COVID-19. Division of Covered Topics. A narrative review of the literature was carried out, accessing the following databases: PubMed, Medline, Elsevier, Google Scholar, and websites such as the World Health Organization (WHO), Center for the Control and Prevention of Diseases (CDC), and the American College of Obstetricians and Gynecologists, among others. Keywords such as “Coronavirus Infections”, “Normal Birth,” Personal Protective Elements,” “Healthcare Personnel”, “Respiratory Protective Devices”, and “Eye Protection Devices” were used. The literature allowed us to identify introductory aspects on the matter, epidemiology, general characteristics of personal protective elements, and the specific elements for correct use when providing care in vaginal birth. Conclusions. Labor is considered an aerosol-generating procedure. Therefore, the main recommendation is the use of an N95 mask or a respirator which allows for greater protection for healthcare personnel when assisting vaginal birth, in order to avoid infection due to SARS-CoV-2. However, there must be an adequate and complete use of personal protective equipment, such as surgical gowns, hats, eye protection and gloves, regardless of the patient’s symptomatology.

Author Biographies

Margarita Navarro-Rubiano, Universidad Autónoma de Bucaramanga

Physician, Specialist in Gynecology and Obstetrics, Professor. Universidad Autónoma de Bucaramanga. Floridablanca, Santander, Colombia.

Marggy Stephanía Sáenz-Gómez, Universidad Autónoma de Bucaramanga

Medical Student. Universidad Autónoma de Bucaramanga. Floridablanca, Santander, Colombia

Néstor Fabián Sanabria-Duarte, Universidad Autónoma de Bucaramanga

Medical Student. Universidad Autónoma de Bucaramanga. Floridablanca, Santander, Colombia

Hugo Armando Solano-Dizeo, Universidad Autónoma de Bucaramanga

Medical Student. Universidad Autónoma de Bucaramanga. Floridablanca, Santander, Colombia

María Cristina Suárez-Gómez, Universidad Autónoma de Bucaramanga

Medical Student. Universidad Autónoma de Bucaramanga. Floridablanca, Santander, Colombia

References

Organización Mundial de la Salud (OMS). COVID-19: cronología de la actuación de la OMS [Internet]. 2020 [citado 19 de mayo de 2020]. Recuperado a partir de: https://bit.ly/31k2d04

Elshafeey F, Magdi R, Hindi N, Elshebiny M, Farrag N, Mahdy S, et al. A systematic scoping review of COVID-19 during pregnancy and childbirth. Int J Gynaecol Obstet [Internet]. 2020;150(1):47-52. doi: https://doi.org/10.1002/ijgo.13182

Chen L, Li Q, Zheng D, Jiang H, Wei Y, Zou L, et al. Clinical Characteristics of Pregnant Women with Covid-19 in Wuhan, China. N Engl J Med [Internet]. 2020;382:e100. doi: https://doi.org/10.1056/NEJMc2009226

Sutton D, Fuchs K, D'Alton M, Goffman D. Universal Screening for SARS-CoV-2 in Women Admitted for Delivery. N Engl J Med [Internet]. 2020;382:2163-2164. doi: https://doi.org/10.1056/NEJMc2009316

Organización Mundial de la Salud (OMS), Organización Panamericana de la Salud (OPS). Recomendaciones para el cuidado integral de mujeres embarazadas y recién nacidos [Internet]. 2020 [citado 20 de mayo de 2020]. Recuperado a partir de: https://www.everywomaneverychild-lac.org/wp-content/uploads/2020/04/EMBARAZADAS_SPANISH-COVID19-OMS.pdf

Centros para el Control y la Prevención de Enfermedades (CDC). Cómo se propaga el COVID-19 [Internet]. 2021. Recuperado a partir de: https://bit.ly/31lNz8z

Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J. Aerosol Generating Procedures and Risk of Transmission of Acute Respiratory Infections to Healthcare Workers: A Systematic Review. PLoS One [Internet]. 2012;7(4):e35797. doi: https://doi.org/10.1371/journal.pone.0035797

Stephens AJ, Barton JR, Bentum NA, Blackwell SC, Sibai BM. General Guidelines in the Management of an Obstetrical Patient on the Labor and Delivery Unit during the COVID-19 Pandemic. Am J Perinatol [Internet]. 2020;37(8):829-836. doi: https://doi.org/10.1055/s-0040-1710308

Schwartz DA. An Analysis of 38 Pregnant Women With COVID-19, Their Newborn Infants, and Maternal-Fetal Transmission of SARS-CoV-2: Maternal Coronavirus Infections and Pregnancy Outcomes. Arch Pathol Lab Med [Internet]. 2020;144(7):799-805. doi: https://doi.org/10.5858/arpa.2020-0901-SA

Zhang W, Du RH, Li B, Zheng XS, Yang XL, Hu B, et al. Molecular and serological investigation of 2019-nCoV infected patients: implication of multiple shedding routes. Emerg Microbes Infect [Internet]. 2020;9(1):386-389. doi: https://doi.org/10.1080/22221751.2020.1729071

Wang W, Xu Y, Gao R, Lu R, Han K, Wu G, et al. Detection of SARS-CoV-2 in Different Types of Clinical Specimens. JAMA [Internet]. 2020;323(18):1843-1844. doi: https://doi.org/10.1001/jama.2020.3786

Jefferson T, Del Mar CB, Dooley L, Ferroni E, Al-Ansary LA, Bawazeer GA, et al. Physical interventions to interrupt or reduce the spread of respiratory viruses. Cochrane Database Syst Rev [Internet]. 2020;11:CD006207. doi: https://doi.org/10.1002/14651858.CD006207.pub5

Centros para el Control y la Prevención de Enfermedades (CDC). Enfermedad del coronavirus 2019 (COVID-19): Casos en los EE.UU. [Internet]. 2020 [citado 20 de agosto de 2020]. Recuperado a partir de: https://stacks.cdc.gov/view/cdc/86982

World Health Organization (WHO). WHO Coronavirus Disease (COVID-19) Dashboard [Internet]. 2020 [citado 15 de febrero del 2022]. Recuperado a partir de: https://covid19.who.int/

Administración de Seguridad y Salud (OSHA). Riesgo de Exposición de los Trabajadores a COVID-19 [Internet]. 2020 [citado 20 de agosto de 2020]. Recuperado a partir de: https://bit.ly/2QjLxj6

Ministerio de Sanidad, Gobierno de España. Estrategia de detección precoz, vigilancia y control de COVID-19 [Internet]. Actualizado al 22 de diciembre del 2021 [citado 15 de febrero del 2022]. Recuperado a partir de: https://bit.ly/31ktJdN

Centros para el Control y la Prevención de Enfermedades (CDC), Instituto Nacional para la Seguridad y Salud Ocupacional (NIOSH). Conozca su respirador: su salud podría depender de ello. Equipo de protección personal (EPP) para trabajadores de la salud. La verdad sobre los respiradores [Internet]. 2013 [citado 22 de mayo de 2019]. Recuperado a partir de: https://bit.ly/3hCrsQB

Van der Sande M, Teunis P, Sabel R. Professional and home-made face masks reduce exposure to respiratory infections among the general population. PLoS One [Internet]. 2008;3(7):e2618. doi: https://doi.org/10.1371/journal.pone.0002618

Bałazy A, Toivola M, Adhikari A, Sivasubramani SK, Reponen T, Grinshpun SA. Do N95 respirators provide 95% protection level against airborne viruses, and how adequate are surgical masks? Am J Infect Control [Internet]. 2006;34(2):51-7. doi: https://doi.org/10.1016/j.ajic.2005.08.018

The American College of Obstetricians and Gynecologists (ACOG). COVID-19 FAQs for Obstetrician-Gynecologists, Obstetrics: Should pregnant patients wear a mask? REVISED [Internet]; 2020 [citado marzo de 2022]. Recuperado a partir de: https://www.acog.org/clinical-information/physician-faqs/covid-19-faqs-for-ob-gyns-obstetrics

Herrera M, Arenas J, Rebolledo M, Baron J, de León J, Yomayusa N, et al. Guía Provisional de la FIMMF para la Embarazada con Infección por Coronavirus (COVID-19), control prenatal, precauciones para unidades de diagnóstico prenatal, parto, puerperio y lactancia; Información para Profesionales para la Salud. Fundación Internacional de Medicina Materno Fetal (FIMMF) [Internet]. 2020. Recuperado a partir de: http://www.ibfan-alc.org/COVID-19/documentos/FIMMF-EMBARAZO_COVID-19.pdf

Society for Maternal-Fetal Medicine, Society for Obstetric and Anesthesia and Perinatology. Labor and Delivery COVID-19 Considerations [Internet]. 2020 [citado 15 de febrero del 2022]. Recuperado a partir de: https://bit.ly/2QhHPX5

Suy-Franch A. Recomendaciones para la prevención de la infección y el control de la enfermedad por coronavirus 2019 (COVID-19) en la paciente obstétrica. Sociedad Española Ginecología y Obstetricia (SEGO) [Internet]. 2020 [citado 15 de febrero del 2022]. Recuperado a partir de: https://bit.ly/34rIKMP

Boelig RC, Manuck T, Oliver EA, Di Mascio D, Saccone G, Bellussi F, et al. Labor and delivery guidance for COVID-19. Am J Obstet Gynecol MFM [Internet]. 2020;2(2):100110. doi: https://doi.org/10.1016/j.ajogmf.2020.100110

Chu DK, Akl EA, Duda S, Solo K, Yaacoub S, Schünemann HJ. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. Lancet [Internet]. 2020;395(10242):1973-1987. doi: https://doi.org/10.1016/S0140-6736(20)31142-9

Ministerio de Salud y Protección Social. Lineamientos generales para el uso de tapabocas convencional y máscaras de alta eficiencia [Internet]. 2020. Recuperado a partir de: https://www.minsalud.gov.co/Ministerio/Institucional/Procesos%20y%20procedimientos/GIPS18.pdf

Fisher EM, Shaffer RE. Considerations for Recommending Extended Use and Limited Reuse of Filtering Facepiece Respirators in Health Care Settings. J Occup Environ Hyg [Internet]. 2014;11(8):D115-28. doi: https://doi.org/10.1080/15459624.2014.902954

Centers for Disease Control and Prevention (CDC). Implementing Filtering Facepiece Respirator (FFR) Reuse, Including Reuse after Decontamination, When There Are Known Shortages of N95 Respirators [Internet]. 2020. Recuperado a partir de: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/decontamination-reuse-respirators.html

World Health Organization (WHO). Rational use of personal protective equipment for coronavirus disease (COVID-19) and considerations during severe shortages [Internet]. 2020. Recuperado a partir de: https://bit.ly/3jGN00o

Organización Panamericana de la Salud (OPS). Aspectos técnicos y regulatorios sobre uso prolongado, reutilización y reprocesamiento de respiradores en períodos de escasez [Internet]. 2020 [citado 18 de agosto de 2020]. Recuperado a partir de: https://bit.ly/3lbd1pj

Fischer RJ, Morris DH, van Doremalen N, Sarchette S, Matson MJ, Bushmaker T, et al. Effectiveness of N95 Respirator Decontamination and Reuse against SARS-CoV-2 Virus. Emerg Infect Dis [Internet]. 2020:26(9):2253-2255. doi: https://doi.org/10.3201/eid2609.201524

Sickbert-Bennett EE, Samet JM, Clapp PW, Chen H, Berntsen J, Zeman KL, et al. Filtration Efficiency of Hospital Face Mask Alternatives Available for Use During the COVID-19 Pandemic. JAMA Intern Med [Internet]. 2020;180(12):1607-1612. doi: https://doi.org/10.1001/jamainternmed.2020.4221

Centers for Disease Control and Prevention (CDC). Strategies for Optimizing the Supply of Facemasks [Internet]. 2020 [citado 15 de agosto de 2020]. Recuperado a partir de: https://bit.ly/3eXnkZH

MacIntyre CR, Seale H, Dung TC, Hien NT, Nga PT, Chughtai AA, et al. A cluster randomized trial of cloth masks compared with medical masks in healthcare workers. BMJ Open [Internet]. 2015;5:e006577. doi: https://doi.org/10.1136/bmjopen-2014-006577

Davies A, Thompson KA, Giri K, Kafatos G, Walker J, Bennett A. Testing the efficacy of homemade masks: would they protect in an influenza pandemic? Disaster Med Public Health Prep [Internet]. 2013;7(4):413-8. doi: https://doi.org/10.1017/dmp.2013.43

Howard BE. High-Risk Aerosol-Generating Procedures in COVID-19: Respiratory Protective Equipment Considerations. Otolaryngol Head Neck Surg [Internet]. 2020;163(1):98-103. doi: https://doi.org/10.1177/0194599820927335

Centers for Disease Control and Prevention (CDC). Considerations for Optimizing the Supply of Powered Air-Purifying Respirators (PAPRs) [Internet]. 2020. Recuperado a partir de: https://bit.ly/2D5BhaU

Tompkins BM, Kerchberger JP. Personal Protective Equipment for Care of Pandemic Influenza Patients: A Training Workshop for the Powered Air Purifying Respirator. Anesth Analg [Internet]. 2010;111(4):933-45. doi: https://doi.org/10.1213/ANE.0b013e3181e780f8

Roberge MR, Vojtko MR, Roberge RJ, Vojtko RJ, Landsittel DP. Wearing an N95 respirator concurrently with a powered air-purifying respirator: effect on protection factor. Respir Care [Internet]. 2008;53(12):1685-90. Recuperado a partir de: https://pubmed.ncbi.nlm.nih.gov/19025703/

Centers for Disease Control and Prevention (CDC). Considerations for Selecting Protective Clothing used in Healthcare for Protection against Microorganisms in Blood and Body Fluids [Internet]. 2020. Recuperado a partir de: https://bit.ly/3fZWxxn

Centers for Disease Control and Prevention (CDC). NIOSH Personal Protective Equipment Information (PPE-Info). “Liquid barrier performance and classification of protective apparel and drapes intended for use in health care facilities” [Internet]. 2015 [citado 15 de julio de 2020]. Recuperado a partir de: https://bit.ly/2WUy05l

Centers for Disease Control and Prevention (CDC). Strategies for Optimizing the Supply of Isolation Gowns [Internet]. 2021. Recuperado a partir de: https://bit.ly/39qfp68

Li JPO, Chiu-Lam DS, Chen Y, Wei-Ting DS. Novel Coronavirus disease 2019 (COVID-19): The importance of recognising possible early ocular manifestation and using protective eyewear. Br J Ophthalmol [Internet]. 2020;104(3):297-298. doi: https://doi.org/10.1136/bjophthalmol-2020-315994

Hu K, Patel J, Swiston C, Patel BC. Ophthalmic Manifestations of Coronavirus (COVID-19). En: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022. Recuperado a partir de: https://www.ncbi.nlm.nih.gov/books/NBK556093/

Raboud J, Shigayeva A, McGeer A, Bontovics E, Chapman M, Gravel D, et al. Risk Factors for SARS Transmission from Patients Requiring Intubation: A Multicentre Investigation in Toronto, Canada. PLoS one [Internet]. 2010;5(5):e10717. doi: https://doi.org/10.1371/journal.pone.0010717

Centers for Disease Control and Prevention (CDC). Strategies for Optimizing the Supply of Eye Protection [Internet]. 2020 [citado 14 de agosto de 2020]. Recuperado a partir de: https://bit.ly/2Eatycx

Organización Mundial de la Salud (OMS). Antes del Parto. Lista OMS de verificación de la seguridad del parto [Internet]. 2015 [citado 15 de agosto de 2020]. Recuperado a partir de: http://apps.who.int/iris/bitstream/handle/10665/207479/WHO_HIS_SDS_2015.26_spa.pdf;jsessionid=729B12A744DC0FD37F21EBE270FCE9A9?sequence=1

Verbeek JH, Rajamaki B, Ijaz S, Sauni R, Toomey E, Blackwood B, et al. Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane Database Syst Rev [Internet] 2020;4:CD011621. doi: https://doi.org/10.1002/14651858.CD011621.pub4.

Panlilio AL, Welch BA, Bell DM, Foy DR, Parrish CM, Perlino CA, et al. Blood and amniotic fluid contact sustained by obstetric personnel during deliveries. Am J Obstet Gynecol [Internet]. 1992;167(3):703-8. doi: https://doi.org/10.1016/s0002-9378(11)91575-0

Markel TA, Gormley T, Greeley D, Ostojic J, Wise A, Rajala J, et al. Hats Off: A Study of Different Operating Room Headgear Assessed by Environmental Quality Indicators. J Am Coll Surg [Internet]. 2017;225(5):573-581. doi: https://doi.org/10.1016/j.jamcollsurg.2017.08.014

Yan Y, Chen H, Chen L, Cheng B, Diao P, Dong L, et al. Consensus of Chinese experts on protection of skin and mucous membrane barrier for health-care workers fighting against coronavirus disease 2019. Dermatol Ther [Internet]. 2020;33:e13310. doi: https://doi.org/10.1111/dth.13310

Sahin D, Ahmet-Erol S, Tanacan A, Ozcan N, Keskin HL, Moraloglu-Tekin O. Protective equipment to use in the vaginal delivery of the pregnant woman with suspected or diagnosed coronavirus disease 2019: delivery table shield. Am J Obstet Gynecol [Internet]. 2020;223(4):599-601. doi: https://doi.org/10.1016/j.ajog.2020.06.021

Centros para el Control y la Prevención de Enfermedades (CDC). Use equipo de protección personal (EPP) cuando atienda a pacientes con COVID-19 confirmado o presunto [Internet]. 2020 [citado 15 de agosto de 2020]. Recuperado a partir de: https://bit.ly/3j8ueh7

Organización Mundial de la Salud (OMS), Organización Panamericana de la Salud (OPS). Pasos para ponerse el equipo de protección personal (EPP), incluida la bata [Internet]. 2015 [citado 15 de agosto de 2020]. Recuperado a partir de: https://bit.ly/3ht2008

Organización Mundial de la Salud (OMS), Organización Panamericana de la Salud (OPS) [Internet]. Pasos para quitarse el equipo de protección personal (EPP), incluida la bata; 2015 [citado 15 de agosto de 2020]. Recuperado a partir de: https://bit.ly/3gq4paT

Centers for Disease Control and Prevention (CDC). Using Personal Protective Equipment (PPE) [Internet]. 2020 [citado 15 de agosto de 2020]. Recuperado a partir de: https://bit.ly/31mqpiw

United Nations Population Fund (UNFPA). COVID-19 Technical Brief for Maternity Services. COVID-19 Guidance Document for Maternity Services [Internet]. 2020 [citado 10 de agosto de 2020]. Recuperado a partir de: https://bit.ly/3hr1EHk

How to Cite
1.
Navarro-Rubiano M, Sáenz-Gómez MS, Sanabria-Duarte NF, Solano-Dizeo HA, Suárez-Gómez MC. Use of Personal Protective Equipment When Providing Vaginal Delivery Care in Times of COVID-19. MedUNAB [Internet]. 2022 May 10 [cited 2026 Mar. 9];25(1):66-78. Available from: https://revistasunabeduco.biteca.online/index.php/medunab/article/view/3938

Downloads

Download data is not yet available.
Published
2022-05-10

Altmetric

Article metrics
Abstract views
Galley vies
PDF Views
HTML views
Other views
Escanea para compartir
QR Code

Some similar items: