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Somri M, Hochman O, Somri-Gannam L, Gaitini L, Paz A, Bumard T, Gómez-Ríos MÁ. Removal of Contaminated Personal Protective Equipment With and Without Supervision. A Randomized Crossover Simulation-Based Study. Simul Healthc 2024; 19:137-143. [PMID: 37185879 DOI: 10.1097/sih.0000000000000726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Personal protective equipment (PPE) reduces the risk of pathogens reaching the skin and clothing of health care personnel. We hypothesize that doffing PPE following verbal instructions by a supervisor is more effective in reducing contamination compared with doffing without verbal instructions. Our primary aim was to determine contamination rates with and without supervised doffing. The secondary aim was to determine the number and localization of contaminated body sites and PPE removal times in both groups. METHODS Staff members of Bnai Zion Medical Center participated in this single-center, randomized simulation study (NCT05008627). Using a crossover design, all participants donned and doffed the PPE twice, once under guidance from a trained supervisor and then independently without supervision (group A), or vice versa (group B). Participants were randomized to either group A or B using a computer-generated random allocation sequence. The PPE was "contaminated" with Glo Germ on the thorax, shoulders, arms, hands, legs, and face shield. After doffing the PPE, the participant was examined under ultraviolet light to detect traces of contamination. The following variables were collected: contamination rates, the number and localization of contaminated body sites, and PPE doffing time. RESULTS Forty-nine staff members were included. In group A, the contamination rate was significantly lower (8% vs. 47%; χ 2 = 17.19; p < 0.001). The sites most frequently contaminated were the neck and hands. Mean PPE doffing time under verbal instructions was significantly longer [mean (SD): 183.98 (3.63) vs. 68.43 (12.75) seconds, P < 0.001] compared with unsupervised doffing. CONCLUSIONS In a simulated setting, PPE doffing following step-by-step verbal instructions from a trained supervisor reduces the rate of contamination but prolongs doffing time. These findings could have important implications for clinical practice and could further protect health care workers against contamination from emerging and high-consequence pathogens.
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Affiliation(s)
- Mostafa Somri
- From the Department of Anesthesia (M.S., L.S.-G., L.G.), Bnai Zion Medical Center, Haifa, Israel; Faculty of Medicine (M.S., L.G.), Technion, Israel Institute of Technology, Haifa, Israel; Bnai Zion Medical Center (O.H.), Haifa, Israel; Infectious Disease and Infection Control Unit (A.P., T.B.), Bnai Zion Medical Center, Haifa, Israel; Department of Anesthesia and Perioperative Medicine (M.A.G.-R.), Complejo Hospitalario Universitario de A Coruña, A Coruña, Galicia, Spain; and Spanish Difficult Airway Group (GEVAD) (M.A.G.-R.), A Coruña Spain
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Berryhill BA, Burke KB, Smith AP, Morgan JS, Tarabay J, Mamora J, Varkey JB, Mumma JM, Kraft CS. A bacteriophage-based validation of a personal protective equipment doffing procedure to be used with high-consequence pathogens. Infect Control Hosp Epidemiol 2024:1-7. [PMID: 38706211 DOI: 10.1017/ice.2024.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
OBJECTIVE To determine if the high-level personal protective equipment used in the treatment of high-consequence infectious diseases is effective at stopping the spread of pathogens to healthcare personnel (HCP) while doffing. BACKGROUND Personal protective equipment (PPE) is fundamental to the safety of HCPs. HCPs treating patients with high-consequence infectious diseases use several layers of PPE, forming complex protective ensembles. With high-containment PPE, step-by-step procedures are often used for donning and doffing to minimize contamination risk to the HCP, but these procedures are rarely empirically validated and instead rely on following infection prevention best practices. METHODS A doffing protocol video for a high-containment PPE ensemble was evaluated to determine potential contamination pathways. These potential pathways were tested using fluorescence and genetically marked bacteriophages. RESULTS The experiments revealed existing protocols permit contamination pathways allowing for transmission of bacteriophages to HCPs. Updates to the doffing protocols were generated based on the discovered contamination pathways. This updated doffing protocol eliminated the movement of viable bacteriophages from the outside of the PPE to the skin of the HCP. CONCLUSIONS Our results illustrate the need for quantitative, scientific investigations of infection prevention practices, such as doffing PPE.
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Affiliation(s)
- Brandon A Berryhill
- Department of Biology, Emory University, Atlanta, GA, USA
- Program in Microbiology and Molecular Genetics (MMG), Graduate Division of Biological and Biomedical Sciences (GDBBS), Laney Graduate School, Emory University, Atlanta, GA, USA
| | - Kylie B Burke
- Department of Biology, Emory University, Atlanta, GA, USA
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Andrew P Smith
- Department of Biology, Emory University, Atlanta, GA, USA
| | | | | | | | - Jay B Varkey
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Emory Healthcare, Atlanta, GA, USA
| | - Joel M Mumma
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Colleen S Kraft
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Emory Healthcare, Atlanta, GA, USA
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Falana ROA, Ogidan OC, Fajemilehin BR. Barriers to infection prevention and control implementation in selected healthcare facilities in Nigeria. Infect Dis Now 2024; 54:104877. [PMID: 38395258 DOI: 10.1016/j.idnow.2024.104877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 12/01/2023] [Accepted: 02/20/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVE While infection prevention and control are of paramount importance, up until recently an assessment of implementation challenges and performance gaps was lacking. This study explored the barriers to infection prevention and control implementation at selected healthcare facilities, the objective being to find ways to improve their programs. MATERIAL AND METHOD A qualitative approach was applied. Purposive sampling was used to select thirty-three healthcare facilities in Ekiti State, Nigeria. They were globally assessed, and an Infection Prevention and Control team, represented by the Infection Prevention and Control referent in each of the selected facilities trained the participants. Data were collected using the Key Informant Interview Guide and analyzed by means of content and thematic analyses using Atlas.ti software. RESULTS Inadequate infection prevention and control materials, poor waste management, non-compliance of patients with infection prevention and control protocols, and poor infrastructure were identified as major barriers to infection prevention and control implementation. CONCLUSION The study concluded that a number of identified factors hindering infection prevention and control implementation in healthcare facilities in Ekiti State needed to be addressed.
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Affiliation(s)
- Rachael O A Falana
- Department of Nursing Science, Obafemi Awolowo University, Osun State, Nigeria.
| | - Oluwakemi C Ogidan
- Department of Nursing Science, Ekiti State University, Ado Ekiti, Ekiti State, Nigeria
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Lazar MS, Ganesh V, Naik B N, Singh A, Puri GD, Kaur S. Efficacy of remote audio-visual system versus standard onsite buddy system to monitor the doffing of personal protective equipment during COVID-19 pandemic: An observational study. Int J Health Plann Manage 2024; 39:530-540. [PMID: 38163283 DOI: 10.1002/hpm.3754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 09/17/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVES Literature states a higher self-contamination rate among healthcare workers (HCWs) while doffing personal protective equipment (PPE). During the Covid-19 pandemic, onsite trained observers were not always available to monitor PPE compliance. The remote audio-visual doffing surveillance (RADS) system has the potential to overcome this limitation. We aimed to compare the efficacy of this real-time RADS system against the onsite buddy system for monitoring the doffing of PPE. METHODS This prospective, observational study was carried out at our tertiary care centre in northern India. 200 HCWs who cared for Covid-19 patients in the intensive care units/operation theatres were included. Group A included HCWs who performed doffing with the help of an onsite trained observer and group B included HCWs who performed doffing with the RADS system. An independent observer noted the error at any step using the CDC doffing checklist, in both groups. An online questionnaire to analyse the level of satisfaction post-doffing was also surveyed. RESULTS The proportion of errors committed during doffing was significantly lower in group B compared to group A with a low relative risk of 0.34 (95% CI 0.22-0.51) (p < 0.001) (Figure 1A,B). In both groups, there was no difference in HCWs feedback regarding the ease of the system and fear of committing an error. Though the perceived quality of monitoring was felt better with onsite buddy, the overall confidence rating of being safe after doffing was better with the RADS system. CONCLUSION Real-time RADS system may be more effective than the onsite buddy system for ensuring the safety of HCWs during doffing PPE. HCWs level of satisfaction related to the ease and anxiety with the monitoring systems were comparable. RADS system can reduce reliance on HCW resources and can integrate well into existing healthcare systems.
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Affiliation(s)
- Michelle Shirin Lazar
- Department of Anaesthesia & Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Venkata Ganesh
- Department of Anaesthesia & Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Naik B
- Department of Anaesthesia & Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Singh
- Department of Anaesthesia & Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - G D Puri
- Department of Anaesthesia & Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sukhpal Kaur
- National Institute of Nursing Education, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Audet CM, Seabi T, Oyekunle T, Hove J, Wagner RG. A individually randomized controlled trial comparing Healer-led vs. clinician- led training to improve personal protective equipment use among traditional healers in South Africa. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002945. [PMID: 38394119 PMCID: PMC10889871 DOI: 10.1371/journal.pgph.0002945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 01/26/2024] [Indexed: 02/25/2024]
Abstract
Like allopathic healthcare workers, healers are also exposed to patients' blood and body fluids. A widespread practice is the traditional "injection," in which the healer performs subcutaneous incisions to rub herbs directly into the bloodied skin, resulting in 1,500 blood exposures over their lifetime. We tested the impact of healer-led PPE training, staffed by trained traditional healers who reported using PPE during each risky clinical encounter vs. healthcare worker (HCW)-led PPE training sessions. We randomized 136 healers into one of the two study arms (67 in the healer-led group, 69 in the HCW-led group) and assessed the impact of trainer on PPE skills and use over a six-month period. All healers received one in-person day of didactic and practical training followed by three sessions at the healers' home. Participants were largely female (80%), averaged 51 years old, and practiced as a healer for an average of 17 years. Almost 44% either disclosed themselves as HIV+ or received a positive HIV test result at study initiation. Healers in the HCW arm showed equivalent PPE scores as those trained by traditional healers at baseline and at seven months. Healers in both arms self-reported high levels of glove use during"injections," with no statistical difference of use by study arm. When we assessed actual gloves and razor blades disposed of each month, a similar trend emerged. No one seroconverted during the study period. The need for PPE support among traditional healers cannot be ignored. Traditional healers can be trained to effectively disseminate PPE knowledge and skills to other traditional healers. With an estimated 200,000 traditional healers in South Africa, it is imperative that all of them have access to PPE training and supplies to prevent HIV, HCV, or HBV infections. Trial registration: ClinicalTrials.gov, NCT04440813. Registered 17 June 2020, https://clinicaltrials.gov/ct2/show/NCT04440813.
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Affiliation(s)
- Carolyn M. Audet
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, TN, United States of America
| | - Tshegofatso Seabi
- MRC/Wits Agincourt Research Unit, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Taofik Oyekunle
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, TN, United States of America
| | - Jennifer Hove
- MRC/Wits Agincourt Research Unit, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Ryan G. Wagner
- MRC/Wits Agincourt Research Unit, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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Liu Y, Tan F, Yao Q, Wang S, Zhou P, Sun Y, Li L. Contributing Risk Factors to Self-Contamination During the Process of Donning and Doffing Personal Protective Equipment. Disaster Med Public Health Prep 2024; 18:e19. [PMID: 38329113 DOI: 10.1017/dmp.2023.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
OBJECTIVE The goal of this study is to explore the risk factors associated with self-contamination points during personal protective equipment (PPE) donning and doffing among health care workers (HCWs). METHODS In total, 116 HCWs were randomly sampled and trained to don and doff the whole PPE set. We smeared the whole PPE set with the fluorescent powder. After each participant finished PPE doffing, the whole body was irradiated with ultraviolet light in order to detect contamination points and record the position and quantity. Sociodemographic characteristics and previous infection prevention control (IPC) training experience, among others, were collected by using electronic questionnaires. Poisson regression was used in identifying risk factors that are associated with the number of contamination points, and the relative risk (RR) and its 95% confidence interval (CI) were calculated. RESULTS About 78.5% of participants were contaminated. Ever training experience (RR = 0.37; 0.26, 0.52), clinical departments (RR = 0.67; 0.49, 0.93), body mass index (BMI) (RR = 1.09; 1.01, 1.18), and shoulder width (RR = 1.07; 1.01, 1.13) were associated with the number of contamination points. CONCLUSIONS Previous IPC training experience, department types, BMI, and shoulder width were associated with self-contamination points after the PPE was removed.
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Affiliation(s)
- Yunyun Liu
- Department of Infection Control and Management, The Second Affiliated Hospital of Soochow University, Suzhou, PR China
- School of Public Health, Zhejiang University, Hangzhou, PR China
| | - Fengling Tan
- Department of Infection Control and Management, The Second Affiliated Hospital of Soochow University, Suzhou, PR China
| | - Qiu Yao
- Department of Infection Control and Management, The Second Affiliated Hospital of Soochow University, Suzhou, PR China
| | - Shuqi Wang
- Department of Infection Control and Management, The Second Affiliated Hospital of Soochow University, Suzhou, PR China
| | - Ping Zhou
- Department of Infection Control and Management, The Second Affiliated Hospital of Soochow University, Suzhou, PR China
| | - Yihui Sun
- Department of Infection Control and Management, The Second Affiliated Hospital of Soochow University, Suzhou, PR China
| | - Liubing Li
- Department of Infection Control and Management, The Second Affiliated Hospital of Soochow University, Suzhou, PR China
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Sulmonte CJ, Flinn JB, Yusuf H, Martin E, Luciano NJ, Kim H, Choe PG, Das A, Garibaldi BT, Hynes NA. Preparing the Frontlines: Delivering Special Pathogen Training to Maryland Hospital Staff. Health Secur 2024; 22:65-73. [PMID: 38241511 DOI: 10.1089/hs.2023.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024] Open
Abstract
Healthcare workers (HCWs) at community hospitals, also known as frontline hospitals (FLHs), may encounter patients with possible infectious diseases, including those caused by high-consequence pathogens such as Zaire ebolavirus. We created and piloted a 1-day, in-person, didactic and skills training program to determine the feasibility and acceptability of implementing an educational program to enhance the knowledge and skills needed to respond when a patient with a potential high-consequence pathogen presents to an FLH. The Maryland Department of Health queried all 104 state FLHs to identify their interest in participating in the pilot training program. HCWs from 12 (75%) of the 16 interested FLHs participated in the program before it was interrupted by the COVID-19 pandemic. In addition to pathogen-specific training based on the Identify, Isolate, and Inform framework, we provided skills training in the proper use of personal protective equipment, spill cleanup, and removal of an incapacitated HCW from an isolation area. We conducted a paired pretraining and posttraining knowledge assessment and measured a significant learning gain among 135 participants (2-tailed t test, P<.05). Over 95% of the participants reported that the training was relevant to their daily work and the clinical simulations and reference material were useful and appropriate for their learning level. Findings from this pilot program demonstrated the feasibility and acceptability of a 1-day combined didactic and skills training program focused on high-consequence pathogens. We plan to reengage the original FLHs and add regional FLHs in an updated training effort based on our findings.
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Affiliation(s)
- Christopher J Sulmonte
- Christopher J. Sulmonte Jr, MHA, is Administrative Director of Biocontainment, Department of Medicine, The Johns Hopkins Hospital, Baltimore, MD
| | - Jade B Flinn
- Jade B. Flinn, MSN, RN, is Unit Director, Biocontainment Unit; Department of Medicine, The Johns Hopkins Hospital, Baltimore, MD
| | - Hasiya Yusuf
- Hasiya Yusuf, MD, MPH, is a Resident, Department of Internal Medicine, Jacobi Medical Center, Bronx, NY, MPH Students at the Johns Hopkins Bloomberg School of Public Health when the research described was carried out
| | - Elena Martin
- Elena Martin, MPH, is a Medical Student, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, MPH Students at the Johns Hopkins Bloomberg School of Public Health when the research described was carried out
| | - Nicholas J Luciano
- Nicholas J. Luciano, MPH, is a Medical Student, Tulane University School of Medicine, New Orleans, LA, MPH Students at the Johns Hopkins Bloomberg School of Public Health when the research described was carried out
| | - Hyungwoo Kim
- Hyungwoo Kim, MD, MPH, is Global Medical Director, Early Pipeline Vaccines, Rockville Center for Vaccines Research, Rockville, MD, MPH Students at the Johns Hopkins Bloomberg School of Public Health when the research described was carried out
| | - Pyoeng Gyun Choe
- Pyoeng Gyun Choe, MD, PhD, MPH, is a Professor, Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea, MPH Students at the Johns Hopkins Bloomberg School of Public Health when the research described was carried out
| | - Asar Das
- Asar Das, MD, MPH, is a Resident Physician, MercyOne Northeast Iowa Family Medicine and Residency, Waterloo, IA, MPH Students at the Johns Hopkins Bloomberg School of Public Health when the research described was carried out
| | - Brian T Garibaldi
- Brian T. Garibaldi, MD, is an Associate Professor, Division of Pulmonary and Critical Care, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Noreen A Hynes
- Noreen A. Hynes, MD, MPH, is an Associate Professor, Division of Infectious Diseases; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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Altabbaa G, Pidhorney C, Beran T, Kim J, Ledgerwood D, Cowan M, Paolucci EO. Personal protection equipment: Preliminary evidence of effectiveness from a three-phase simulation program. J Infect Prev 2023; 24:244-251. [PMID: 37969467 PMCID: PMC10638951 DOI: 10.1177/17571774231208118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 09/29/2023] [Indexed: 11/17/2023] Open
Abstract
Background Healthcare providers carry the occupational risk of being exposed to pathogens. Personal Protection Equipment (PPE) requires proficiency whenever used. Yet, evidence shows significant errors and variation in competency when applying PPE. Objective In this study, we developed a three-phase intervention to promote PPE proficiency. Methods Education and assessment of participants' PPE knowledge and skills occurred at a large academic university in Western Canada. Participants first completed an online module; second, they experienced one-on-one coaching and deliberate practice with infection control professionals; and third, participants managed a COVID-19 clinical simulation scenario. The measured outcomes include a 15-item pre- and post-knowledge test and a pre- and post-skills assessment of donning and doffing behaviors. These behaviors were observed from video recordings and were assessed using two standardized checklists. Results Knowledge and donning/doffing post-test scores (11.73, 0.95, and 0.96, respectively) were significantly higher after completing all three phases of the educational intervention, p < .001. Conclusions An online module alone is insufficient for PPE knowledge and skill development. Rather, a module followed by practice and simulation allows learners to gain proficiency.
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Affiliation(s)
- Ghazwan Altabbaa
- University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | | | - Tanya Beran
- University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Joseph Kim
- University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Donna Ledgerwood
- University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Michèle Cowan
- University of Calgary Cumming School of Medicine, Calgary, AB, Canada
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Stutz L, Koertgen B, Scheier T, Klaentschi T, Junge H, Kolbe M, Grande B. Improving compliance with isolation measures in the operating room: a prospective simulation study comparing the effectiveness and costs of simulation-based training vs video-based training. J Hosp Infect 2023; 141:167-174. [PMID: 37696472 DOI: 10.1016/j.jhin.2023.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/29/2023] [Accepted: 07/30/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Different isolation measures are required according to the routes of transmission of pathogens. Few studies have compared different forms of hygiene training in terms of efficiency and/or improvement of perception towards hygiene measures. This study aimed to evaluate the benefits of different forms of isolation training in the operating room, and their respective effects on the perception of hygiene measures by comparing simulation training with video-based training. METHODS This multi-centre, prospective, randomized, controlled trial compared hygiene knowledge, psychological safety and perception of training among healthcare workers after in-centre simulation training and conventional video-based training. RESULTS Neither type of training led to a significant improvement in knowledge or perceived psychological safety (F=0.235, P=0.629, η2=0.003). Participants in the simulation group reported higher levels of willingness to speak up in the depicted scenario compared with participants who received video-based training. Participants perceived the simulation-based training significantly more positively than the video-based training. CONCLUSION Clear definition of the goals of training based on the pre-existing level of knowledge of the participants is crucial. For future studies, it would be interesting to investigate the long-term effect and continuing benefits concerning the implementation of hygiene regulations after different types of training.
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Affiliation(s)
- L Stutz
- Institute of Anaesthesiology, Cantonal Hospital Grisons, Chur, Switzerland
| | - B Koertgen
- Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland; Simulation Centre, University Hospital Zurich, Zurich, Switzerland
| | - T Scheier
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - T Klaentschi
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - H Junge
- Institute of Anaesthesiology, Cantonal Hospital Grisons, Chur, Switzerland; Grisons Institute for Patient Safety and Simulation, Chur, Switzerland
| | - M Kolbe
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland; Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - B Grande
- Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland; Simulation Centre, University Hospital Zurich, Zurich, Switzerland; Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.
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Deng H, Lin L. Application of the 6S management strategies. Nurs Open 2023; 10:7066-7072. [PMID: 37574659 PMCID: PMC10495733 DOI: 10.1002/nop2.1966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 06/26/2023] [Accepted: 07/29/2023] [Indexed: 08/15/2023] Open
Abstract
AIM To explore the value of the 6S management strategies in COVID-19 wards. DESIGN Nurses from the first Fujian medical team in aiding Hubei Province at Wuhan Jinyintan Hospital (2 February, 2020-24 March, 2020) were recruited and instructed to adopt the 6S management strategies for nursing management. METHODS The paired-sample t-test was performed to compare the nursing quality, core capabilities of nurses, nursing preparation time, and nursing error rates before and after implementation. RESULTS After implementation of the 6S management strategies, a total of 93 nurses experienced significant improvements in nursing quality, especially in workplace stress, material preparation, and medication management (p < .001). Adoption of the 6S model for nursing management in COVID-19 wards effectively improves nursing quality, enhances the core capabilities of nurses, reduces nursing preparation time, and lowers nursing error rates.
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Affiliation(s)
- Haiying Deng
- Department of Traditional Chinese Medicine NursingFujian Medical University Union HospitalFuzhouChina
| | - Lizhen Lin
- Department of Traditional Chinese Medicine NursingFujian Medical University Union HospitalFuzhouChina
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Sato S, Iijima S. Evaluation of a Web-based learning system for skills in removing personal protective equipment for highly infectious diseases-A randomized controlled trial. Infect Control Hosp Epidemiol 2023; 44:1131-1136. [PMID: 38013414 DOI: 10.1017/ice.2022.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Which educational method is best for 3-month retention of proper skills in removing personal protective equipment (PPE) in the setting of highly infectious diseases is unclear. We evaluated the effectiveness of a Web-based learning system after 3 months of use. SETTING One general hospital in Japan. INTERVENTION We conducted a randomized, nonblinded, parallel-group trial with 35 nurses using the substitution block method. At baseline, both groups received face-to-face training in putting on and removing PPE. The intervention group was given access to the Web-based learning system we developed using Modular Object-Oriented Dynamic Learning Environment (Moodle). After 3 months, we assessed both groups regarding knowledge and skills in removing PPE using a 34-point test, fluorescent markers, and video recordings. RESULTS Overall, 34 participants completed the trial: 16 in the intervention group and 18 in the control group. Postintervention knowledge test scores (1.3 vs -0.8; P = .013; effect size r = .42) and deviations from the required procedure (-5.4 vs 1.9; P = .001; effect size r = .55) were significantly better in the intervention group than in the control group. The number of contaminated sites (-0.5 vs 0.4; P = .128; effect size r = .26) and contaminated participants (-18.7% vs 11.1% decreased in the intervention group, and increased in the control group, although this was not significant (P = .242; effect size ϕ = .47). CONCLUSIONS This learning system was an effective educational method in maintaining and improving knowledge of proper PPE removal skills. The number of deviations from the required procedure decreased, and this reduction continued after 3 months. CLINICAL TRIALS IDENTIFIER Evaluation of the Web materials for learning PPE removal skills in the setting of highly infectious diseases. University Hospital Medical Information Network, UMIN000042725: https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000048767.
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Affiliation(s)
- Shota Sato
- Graduate School of Health Care and Nursing, Juntendo University, Urayasu, Japan
- National Defense Medical College, Saitama, Japan
| | - Sachiko Iijima
- Graduate School of Health Care and Nursing, Juntendo University, Urayasu, Japan
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Abdulrahman Yusuf K, Isa SM, Al-Abdullah AF, AlHakeem HA. Assessment of knowledge, accessibility, and adherence to the use of personal protective equipment and standard preventive practices among healthcare workers during the COVID-19 pandemic. J Public Health Res 2023; 12:22799036231180999. [PMID: 37333032 PMCID: PMC10264851 DOI: 10.1177/22799036231180999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 04/16/2023] [Indexed: 06/20/2023] Open
Abstract
Background Healthcare workers are at risk of acquiring infectious agents while providing services to patients. Thus, the need for evaluating and closely monitoring healthcare worker knowledge, perception, and adherence levels is critical. This study evaluates the knowledge, accessibility, and adherence regarding personal protective equipment (PPE) and preventive protocols among healthcare workers during the COVID-19 pandemic. Design and methods A web-based cross-sectional survey was conducted from March to September 2021. The study participants were 187 healthcare workers who replied to a 31-item questionnaire using an online tool. Results A total of 187 participants responded to the questionnaire. Most of the participants 102 (54.5%) were in the age group of 25-34 years. Of the 187 participants, 98 (52.4%) were medical doctors, and 92 (49.2%) had correct knowledge regarding donning and doffing of PPE. The vast majority (93.7%) had access to essential PPE. The average adherence level was 82.1%. Accessibility (p = 0.003) and adherence (p < 0.01) were found to be significantly high in older age participants. Conclusion The study showed most of the healthcare workers had appropriate knowledge and, they also adhered to the proper use of PPE and infection control protocols. However, few of them identified with poor knowledge about COVID-19, inappropriate doffing of PPE, non-adherence to the protocol, and unacceptable practices. We recommend the provision of adequate training that will lead to minimizing the risk of exposure to and transmission of COVID-19 among healthcare providers.
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Affiliation(s)
- Khalifa Abdulrahman Yusuf
- Department of Internal Medicine, Bahrain Defence Force Royal Medical Services, Riffa, Kingdom of Bahrain
| | - Saad Mohamed Isa
- Department of ENT, Bahrain Defence Force Royal Medical Services, Riffa, Kingdom of Bahrain
| | | | - Hala Abdulmalek AlHakeem
- Family and Community Medicine Department, Bahrain Defence Force Royal Medical Services, Riffa, Kingdom of Bahrain
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Demirag ME, Akyil M, Karasal M, Bayram S, Metin SK, Tokgoz FA, Baysungur V, Evman S. Prospective analysis of the physiological changes caused by prolonged use of N95-type masks. Ann Thorac Med 2023; 18:86-89. [PMID: 37323373 PMCID: PMC10263074 DOI: 10.4103/atm.atm_429_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/29/2023] [Accepted: 02/09/2023] [Indexed: 06/17/2023] Open
Abstract
INTRODUCTION The clinical and physiological effects of long-duration use of N95-type masks without ventilation valves, on health-care workers during the coronavirus disease-2019 (COVID-19) pandemic, were evaluated. METHODS All volunteering personnel working in operating theater or intensive care unit, using nonventilated N95 type respiratory masks, minimum for a 2-h noninterrupted duration were observed. The partial oxygen saturation (SpO2) and heart rate (HR) were recorded before wearing the N95 mask and at 1st and 2nd h. Volunteers were then questioned for any symptoms. RESULTS A total of 210 measurements were completed in 42 (24 males and 18 females) eligible volunteers, each having 5 measurements, on different days. The median age was 32.7. Premask, 1st h, and 2nd h median values for SpO2 were 99%, 97%, and 96%, respectively (P < 0.001). The median HR was 75 premask, 79 at 1st h, and 84/min at 2nd h (P < 0.001). A significant difference between all three consecutive measurements of HR was achieved. Statistical difference was only reached between premask and other SpO2 measurements (1st and 2nd h). Complaints seen in the group were head ache (36%), shortness of breath (27%), palpitation (18%), and nausea feeling (2%). Two individuals took off their masks to breathe, on 87th and 105th min, respectively. CONCLUSIONS Long duration (>1 h) use of N95-type masks causes a significant reduction in SpO2 measurements and increase in HR. Despite being an essential personal protective equipment in COVID-19 pandemic, it should be used with short intermittent time periods in health-care providers with known heart disease, pulmonary insufficiency, or psychiatric disorders.
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Affiliation(s)
- Melis E. Demirag
- Department of Otorhinolaryngology, Kartal Lutfi Kirdar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mustafa Akyil
- Department of Thoracic Surgery, Sureyyapasa Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Merve Karasal
- Department of Thoracic Surgery, Sureyyapasa Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Serkan Bayram
- Department of Thoracic Surgery, Sureyyapasa Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Serda Kanbur Metin
- Department of Thoracic Surgery, Sureyyapasa Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Fatma A. Tokgoz
- Department of Pulmonology, Yedikule Chest Diseases Hospital, University of Health Sciences, Istanbul, Turkey
| | - Volkan Baysungur
- Department of Thoracic Surgery, Sureyyapasa Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Serdar Evman
- Department of Thoracic Surgery, Sureyyapasa Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Assessing efficacy of instructor based orientation to donning doffing protocols and modifications to doffing area infrastructure in reducing SARS-CoV-2 infection among Doctors assigned to COVID-19 patient care. Infect Prev Pract 2023; 5:100279. [PMID: 37006320 PMCID: PMC10027291 DOI: 10.1016/j.infpip.2023.100279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 03/14/2023] [Indexed: 03/24/2023] Open
Abstract
Background We assess the efficacy of orientation programmes for doctors of proper donning, doffing techniques for personal protective equipment (PPE) and safe practices inside the COVID-19 hospital in reducing the COVID-19 infection rate among doctors. Methods A total of 767 resident doctors and 197 faculty visits on weekly rotation were recorded over a six month period. Doctors were guided through orientation sessions before their entry into the COVID-19 hospital from 1 August 2020.The infection rate among doctors was used to study the efficacy of the programme. McNemars Chi-square test was used to compare the infection rate in the two groups before and after orientation sessions were commenced. Discussion A statistically significant reduction in SARS-CoV-2 infection was seen among resident doctors after orientation programmes and infrastructure modification (3% vs 7.4%, p=0.03). Twenty-eight of 32 (87.5%) doctors who tested positive developed asymptomatic to mild infection. The infection rate was 3.65% and 2.1% among residents and faculty respectively. There was no mortality recorded. Conclusion Orientation programme for healthcare workers for PPE donning and doffing protocols with practical demonstration and trial of PPE usage can significantly reduce COVID-19infection. Such sessions should be mandatory for all workers on deputation in designated area for Infectious Diseases and in pandemic situations.
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Greaves SW, Alter SM, Ahmed RA, Hughes KE, Doos D, Clayton LM, Solano JJ, Echeverri S, Shih RD, Hughes PG. A Simulation-based PPE orientation training curriculum for novice physicians. Infect Prev Pract 2023; 5:100265. [PMID: 36536774 PMCID: PMC9753485 DOI: 10.1016/j.infpip.2022.100265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/24/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
Background Personal protective equipment (PPE) is effective in preventing coronavirus disease (COVID-19) infection. Resident knowledge of proper use and effective training methods is unknown. We hypothesise that contamination decreases and knowledge increases after a formalised PPE educational session. Methods Participants included first year interns during their residency orientation in June 2020. Before training, participants took a knowledge test, donned PPE, performed a simulated resuscitation, and doffed. A standardised simulation-based PPE training of the donning and doffing protocol was conducted, and the process repeated. Topical non-toxic highlighter tracing fluid was applied to manikins prior to each simulation. After doffing, areas of contamination, defined as discrete fluorescent areas on participants' body, was evaluated by ultraviolet light. Donning and doffing were video recorded and asynchronously rated by two emergency medicine (EM) physicians using a modified Centers for Disease Control and Prevention (CDC) protocol. The primary outcome was PPE training effectiveness defined by contamination and adherence to CDC sequence. Results Forty-eight residents participated: 24 internal medicine, 12 general surgery, 6 EM, 3 neurology, and 3 psychiatry. Before training, 81% of residents were contaminated after doffing; 17% were contaminated after training (P<0.001). The most common contamination area was the wrist (50% pre-training vs. 10% post-training, P<0.001). Donning sequence adherence improved (52% vs. 98%, P<0.001), as did doffing (46% vs. 85%, P<0.001). Participant knowledge improved (62%-87%, P <0.001). Participant confidence (P<0.001) and preparedness (P<0.001) regarding using PPE increased with training. Conclusion A simulation-based training improved resident knowledge and performance using PPE.
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Affiliation(s)
- Spencer W. Greaves
- Department of Emergency Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, USA
| | - Scott M. Alter
- Department of Emergency Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, USA
| | - Rami A. Ahmed
- Department of Emergency Medicine, Division of Simulation, Indiana University School of Medicine, USA
| | - Kate E. Hughes
- Department of Emergency Medicine, University of Arizona, USA
| | - Devin Doos
- Department of Emergency Medicine, Division of Simulation, Indiana University School of Medicine, USA
| | - Lisa M. Clayton
- Department of Emergency Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, USA
| | - Joshua J. Solano
- Department of Emergency Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, USA
| | - Sindiana Echeverri
- Clinical Skills Simulation Center, Florida Atlantic University Charles E. Schmidt College of Medicine, USA
| | - Richard D. Shih
- Department of Emergency Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, USA
| | - Patrick G. Hughes
- Department of Emergency Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, USA,Corresponding author. Florida Atlantic University at Bethesda Health, Department of Emergency Medicine, GME Suite, Lower Level, 2815 South Seacrest Blvd, Boynton Beach, FL 33435, USA. Tel.: +(561) 733 5933; fax: +(866) 617 8268
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Chen K, Xu B, Tang Y, Cao J, Wang R, Tian Y, Gao C, Chu M. Management of SARS-CoV-2 Omicron Variant Community Screenings in Shanghai, China: A Cross-Sectional Study. Risk Manag Healthc Policy 2023; 16:111-120. [PMID: 36755747 PMCID: PMC9901467 DOI: 10.2147/rmhp.s392697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/11/2023] [Indexed: 02/04/2023] Open
Abstract
Background Community screening for SARS-CoV-2 Omicron variant plays a significant role in controlling the spread of infection. However, loopholes may exist in the current management of community screening in Shanghai, China. The objective of this study was to discover loopholes in the management of community screening for SARS-CoV-2 Omicron variant in Shanghai, China and provide targeted solutions. Methods The cross-sectional study was carried out April 4 to April 30, 2021, among residential committee directors from the Putuo District, Pudong District, and Minhang District of Shanghai, China. Data were collected using a self-designed questionnaire about the management of nucleic acid testing (NAT) sampling in communities through the network platform powered by www.wjx.cn. Results A total of 203 residential committee directors responded to the survey. Of them, 47.3% were not accepted training and 40.4% were not aware of cross-infection. Comparison among sampling sites and communities, high-risk group contained lower proportion of community training (P = 0.093~0.200), higher awareness of cross-infection (P = 0.039~0.777), more medical workers (P = 0.007~0.724) and more tests performed (P = 0.001~0.992). Larger communities had more medical workers, sampling sites, sampling tables (P = 0.000) and higher awareness of cross-infection (P = 0.009), but lower proportion of community training (P = 0.051). Conclusion Overall, community training and awareness of infection control were inadequate. Government or institutions should organize the community training and raise the awareness of infection control. Significant differences exist in NAT management patterns between sampling sites, as well as communities of different sizes. Residential community directors minimize high-risk sampling point settings in the future. Special personnel designated by the government or institutions should tour to guide each sampling site.
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Affiliation(s)
- Keyu Chen
- Department of Thoracic Surgery, Jiangsu Province Hospital and The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People’s Republic of China
| | - Bin Xu
- Neurosurgical Intensive Care Unit, Jiangsu Province Hospital and The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People's Republic of China
| | - Yifan Tang
- Nursing Department, Jiangsu Province Hospital and The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People’s Republic of China
| | - Juan Cao
- Department of Thoracic Surgery, Jiangsu Province Hospital and The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People’s Republic of China
| | - Rong Wang
- Nursing Department, Jiangsu Province Hospital and The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People’s Republic of China
| | - Yali Tian
- Nursing Department, Jiangsu Province Hospital and The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People’s Republic of China
| | - Chunhong Gao
- Nursing Department, Jiangsu Province Hospital and The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People’s Republic of China,Correspondence: Chunhong Gao, Nursing Department, Jiangsu Province Hospital and The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu Province, People’s Republic of China, Tel +862568305379, Email
| | - Ming Chu
- Department of Nosocomial Infection, Jiangsu Province Hospital and The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People’s Republic of China,Ming Chu, Department of Nosocomial Infection, Jiangsu Province Hospital and The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu Province, People’s Republic of China, Tel +862568306917, Email
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Taher A, Glazer P, Culligan C, Crump S, Guirguis S, Jones J, Dharamsi A, Chartier LB. Improving safety and communication for healthcare providers caring for SARS-COV-2 patients. Int J Emerg Med 2022; 15:62. [PMCID: PMC9652974 DOI: 10.1186/s12245-022-00464-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 10/23/2022] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Decreasing healthcare provider (HCP) exposure to the severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) virus in emergency departments (EDs) is crucial. Approaches include limiting the HCP presence and ensuring sealed isolation rooms, which can result in communication difficulties. This quality improvement (QI) initiative aimed to decrease by 50% duration of isolation room door opening and increasing HCP-perceived communication clarity by one point on a five-point Likert scale.
Methods
This was a prospective, multi-stage project with three Plan-Do-Study-Act (PDSA) cycles between May and July 2020: (1) an educational intervention, (2) the introduction of a novel transceiver communication device, and (3) utilizing a clinical champion. Statistical Process Control XbarR charts were used to assess for special cause variation, and two-tailed Mann-Whitney U tests were used for statistical significance between Likert survey means. Qualitative responses underwent thematic analysis.
Results
Observation of 174 patient encounters was completed over 33 days, with 95 meeting the inclusion criteria. Door opening decreased from baseline (n=40; mean 72.97%) to PDSA 3 (n=21; mean 1.58%; p<0.0001). HCP-perceived communication clarity improved from baseline (n=36; mean 3.36) to PDSA-3 (n=49; mean 4.21; p<0.001). Survey themes included positive effects on communication and workflow, with some challenges on the integration of the new device into the clinical workflow. HCP-perceived errors, workarounds, and workflow pauses showed significant improvements.
Conclusion
This QI initiative with a novel transceiver showed significant decreases in isolation room door opening and increases in communication clarity. Future work will expand to operating rooms and intensive care units.
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Reske KA, Park D, Bach TH, Stewart HB, Vogt LC, Arter OG, Stoeckel D, Steinkamp HM, Liang SY, Durkin MJ, Kwon JH. Assessment of dental health care personnel protocol deviations and self-contamination during personal protective equipment donning and doffing. J Am Dent Assoc 2022; 153:1070-1077.e1. [PMID: 36175202 PMCID: PMC9511115 DOI: 10.1016/j.adaj.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/24/2022] [Accepted: 08/02/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Dental health care personnel (DHCP) may be at increased risk of exposure to severe acute respiratory syndrome coronavirus 2, the virus that causes COVID-19, as well as other clinically important pathogens. Proper use of personal protective equipment (PPE) reduces occupational exposure to pathogens. The authors performed an assessment of PPE donning and doffing practices among DHCP, using a fluorescent marker as a surrogate for pathogen transmission. METHODS Participants donned PPE (that is, disposable gown, gloves, face mask, and eye protection) and the fluorescent marker was applied to their palms and abdomen. DHCP then doffed PPE according to their usual practices. The donning and doffing processes were video recorded, areas of fluorescence were noted, and protocol deviations were assessed. Statistical analyses included frequency, type, and descriptions of protocol deviations and factors associated with fluorescence. RESULTS Seventy DHCP were enrolled. The donning and doffing steps with the highest frequency of protocol deviations were hand hygiene (66% of donning and 78% of doffing observations involved a deviation) and disposable gown use (63% of donning and 60% of doffing observations involved a deviation). Fluorescence was detected on 69% of DHCP after doffing, most frequently on hands. An increasing number of protocol deviations was significantly associated with increased risk of fluorescence. DHCP with a gown doffing deviation, excluding doffing out of order, were more likely to have fluorescence detected. CONCLUSIONS DHCP self-contamination was common with both donning and doffing PPE. PRACTICAL IMPLICATIONS Proper use of PPE is an important component of occupational health.
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How Can Personal Protective Equipment Be Best Used and Reused: A Closer Look at Donning and Doffing Procedures. Disaster Med Public Health Prep 2022; 17:e272. [PMID: 36155649 DOI: 10.1017/dmp.2022.209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The aim of this study was to examine safety-related contamination threats and risks to health-care workers (HCWs) due to the reuse of personal protective equipment (PPE) among emergency department (ED) personnel. METHODS We used a Participatory Design (PD) approach to conduct task analysis (TA) of PPE use and reuse. TA identified the steps, risks, and protective behaviors involved in PPE reuse. We used the Centers for Disease Control and Prevention (CDC) guidance for PPE donning and doffing specifying the recommended task order. Then, we convened subject matter experts (SMEs) with relevant backgrounds in Patient Safety, Human Factors and Emergency Medicine to iteratively identify and map the tasks, risks, and protective behaviors involved in the PPE use and reuse. RESULTS Two emerging threats were associated with behaviors in donning, doffing, and re-using PPE: (i) direct exposure to contaminant, and (ii) transmission/spread of contaminant. Protective behaviors included: hand hygiene, not touching the patient-facing surface of PPE, and ensuring a proper fit and closure of all PPE ties and materials. CONCLUSIONS TA was helpful revealed that the procedure for donning and doffing of re-used PPE does not protect ED personnel from contaminant spread and risk of exposure, even with protective behaviors present (e.g., hand hygiene, respirator use, etc.). Future work should make more apparent the underlying risks associated with PPE use and reuse.
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Obuhoro O, Jones RM. Assessing Patterns of Body Contamination after Personal Protective Equipment Removal among Healthcare Workers: A Scoping Review. Am J Infect Control 2022:S0196-6553(22)00674-5. [PMID: 36116680 DOI: 10.1016/j.ajic.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND It is now widely recognized that healthcare personnel (HCP) are at risk of contamination with pathogens during personal protective equipment (PPE) doffing. Studies of this phenonemona, have utilized a variety of PPE ensembles, doffing methods and experimental methods. METHODS A scoping review was performed, consistent with PRISMA guidance. The PubMed and sciVerse Scopus databases were searched using an a priori search strategy. Data were extracted for analysis using the matrix method, and then a narrative analysis performed. Articles were classified based on PPE ensemble. RESULTS Only 19 of 151 articles were included in the final anlaysis. All included studies reported some post-doffing contamination, and this contamination was most frequently observed on the hands, wrist, face and neck. Reviewed studies used a variety of tracer contaminants, PPE ensembles, doffing protocols, tracer assessment locations and methods, making it difficult to identify patterns across studies. DISCUSSION&CONCLUISONS Additional research is needed to improve study methodology related to the selection and placement of tracers to ensure sensitive detection of post-doffing contamination, compare how specific doffing procedures or pieces of PPE influence post-doffing contamination, and to understand what post-doffing contamination means for patient and HCP infection risk.
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Affiliation(s)
- Olosengbuan Obuhoro
- Department of Family and Preventive Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT
| | - Rachael M Jones
- Department of Family and Preventive Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT; Department of Environmental Health Sciences, Fielding School of Public Health, University of California, Los Angeles, CA.
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Human–machine collaboration using artificial intelligence to enhance the safety of donning and doffing personal protective equipment (PPE). Infect Control Hosp Epidemiol 2022; 44:732-735. [DOI: 10.1017/ice.2022.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Objectives:
To compare the accuracy of monitoring personal protective equipment (PPE) donning and doffing process between an artificial intelligent (AI) machine collaborated with remote human buddy support system and an onsite buddy, and to determine the degree of AI autonomy at the current development stage.
Design and setting:
We conducted a pilot simulation study with 30 procedural scenarios (15 donning and 15 doffing, performed by one individual) incorporating random errors in 55 steps. In total, 195 steps were assessed.
Methods:
The human–AI machine system and the onsite buddy assessed the procedures independently. The human–AI machine system performed the assessment via a tablet device, which was positioned to allow full-body visualization of the donning and doffing person.
Results:
The overall accuracy of PPE monitoring using the human–AI machine system was 100% and the overall accuracy of the onsite buddy was 99%. There was a very good agreement between the 2 methods (κ coefficient, 0.97). The current version of the AI technology was able to perform autonomously, without the remote human buddy’s rectification in 173 (89%) of 195 steps. It identified 67.3% of all the errors independently.
Conclusions:
This study provides preliminary evidence suggesting that a human–AI machine system may be able to serve as a substitute or enhancement to an onsite buddy performing the PPE monitoring task. It provides practical assistance using a combination of a computer mirror, visual prompts, and verbal commands. However, further studies are required to examine its clinical efficacy with a diverse range of individuals performing the donning and doffing procedures.
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Paquay M, Dubois N, Diep AN, Graas G, Sassel T, Piazza J, Servotte JC, Ghuysen A. “Debriefing and Organizational Lessons Learned” (DOLL): A Qualitative Study to Develop a Classification Framework for Reporting Clinical Debriefing Results. Front Med (Lausanne) 2022; 9:882326. [PMID: 35814768 PMCID: PMC9263566 DOI: 10.3389/fmed.2022.882326] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/26/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe COVID-19 crisis has radically affected our healthcare institutions. Debriefings in clinical settings provide a time for the clinicians to reflect on the successes (pluses) and difficulties (deltas) encountered. Debriefings tend to be well-received if included in the broader management of the unit. The goal of this study was to develop a framework to categorize these debriefings and to assess its worthiness.MethodsA qualitative approach based on a grounded theory research method was adopted resulting in the “Debriefing and Organizational Lessons Learned” (DOLL) framework. Debriefings were conducted within two Emergency Departments of a Belgian University Hospital during an 8-week period. In the first step, three researchers used debriefing transcripts to inductively develop a tentative framework. During the second step, these three researchers conducted independent categorizations of the debriefings using the developed framework. In step 3, the team analyzed the data to understand the utility of the framework. Chi-square was conducted to examine the associations between the item types (pluses and deltas) and the framework's dimensions.ResultsThe DOLL is composed of seven dimensions and 13 subdimensions. Applied to 163 debriefings, the model identified 339 items, including 97 pluses and 242 deltas. Results revealed that there was an association between the frequency of pluses and deltas and the dimensions (p < 0.001). The deltas were mainly related to the work environment (equipment and maintenance) (p < 0.001) while the pluses identified tended to be related to the organization of the unit (communication and roles) (p < 0.001). With leadership's support and subsequent actions, clinicians were more enthusiastic about participating and the researchers anecdotally detected a switch toward a more positive organizational learning approach.ConclusionThe framework increases the potential value of clinical debriefings because it organizes results into actionable areas. Indeed, leadership found the DOLL to be a useful management tool. Further research is needed to investigate how DOLL may work in non-crisis circumstances and further apply the DOLL into incident reporting and risk management process of the unit.
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Affiliation(s)
- Méryl Paquay
- Department of Emergency, Quartier Hôpital, University Hospital of Liege, Liège, Belgium
- Center for Medical Simulation of Liege, Quartier Hôpital, University of Liege, Liège, Belgium
- *Correspondence: Méryl Paquay
| | - Nadège Dubois
- Center for Medical Simulation of Liege, Quartier Hôpital, University of Liege, Liège, Belgium
| | - Anh Nguyet Diep
- Biostatistics Unit, Quartier Hôpital, University of Liège, Liège, Belgium
| | - Gwennaëlle Graas
- Center for Medical Simulation of Liege, Quartier Hôpital, University of Liege, Liège, Belgium
| | - Tamara Sassel
- Center for Medical Simulation of Liege, Quartier Hôpital, University of Liege, Liège, Belgium
| | - Justine Piazza
- Department of Emergency, Quartier Hôpital, University Hospital of Liege, Liège, Belgium
- Center for Medical Simulation of Liege, Quartier Hôpital, University of Liege, Liège, Belgium
| | | | - Alexandre Ghuysen
- Department of Emergency, Quartier Hôpital, University Hospital of Liege, Liège, Belgium
- Center for Medical Simulation of Liege, Quartier Hôpital, University of Liege, Liège, Belgium
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Impact of Face-to-Face Teaching in Addition to Electronic Learning on Personal Protective Equipment Doffing Proficiency in Student Paramedics: Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19053077. [PMID: 35270768 PMCID: PMC8910255 DOI: 10.3390/ijerph19053077] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 01/04/2023]
Abstract
Personal protective equipment doffing is a complex procedure that needs to be adequately performed to prevent health care worker contamination. During the COVID-19 pandemic, junior health care workers and students of different health care professions who had not been trained to carry out such procedures were often called upon to take care of infected patients. To limit direct contact, distance teaching interventions were used, but different trials found that their impact was rather limited. We therefore designed and carried out a randomized controlled trial assessing the impact of adding a face-to-face intervention using Peyton's four-step approach to a gamified e-learning module. Sixty-five student paramedics participated in this study. The proportion of doffing sequences correctly performed was higher in the blended learning group (33.3% (95%CI 18.0 to 51.8) versus 9.7% (95%CI 2.0 to 25.8), p = 0.03). Moreover, knowledge and skill retention four to eight weeks after the teaching intervention were also higher in this group. Even though this study supports the use of a blended learning approach to teach doffing sequences, the low number of student paramedics able to adequately perform this procedure supports the need for iterative training sessions. Further studies should determine how often such sessions should be carried out.
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Vahabzadeh‐Hagh AM, Patel SH, Stramiello JA, Weissbrod PA. Patient-worn endoscopy mask to protect against viral transmission. Laryngoscope Investig Otolaryngol 2022; 7:190-196. [PMID: 35155797 PMCID: PMC8823177 DOI: 10.1002/lio2.708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/25/2021] [Accepted: 11/26/2021] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES To design and evaluate patient-worn personal protective equipment (PPE) that allows providers to perform endoscopy while protecting against droplet and airborne disease transmission. STUDY DESIGN Single subject study. METHODS Mask efficacy was evaluated using a cough simulator that sprays dye visible under ultra-violet light. User-testing was performed on an airway trainer mannequin where each subject performed the endoscopy with and without the mask in random orders. Their time to completion and number of attempts before successful completion were recorded, and each subject was asked to fill out a NASA Task Load Index (TLX) form with respect to their experience. RESULTS The mask has a filtration efficiency of 97.31% and eliminated any expelled particles with the cough simulator. Without the mask, a simulated cough is visualized as it progresses away from the cough origin. Subjects who performed trans-nasal endoscopy spent 27.8 ± 8.0 s to visualize the vocal cords for the no mask condition and 28.7 ± 13.6 s for the mask condition (mean ± SD, p > .05). There was no statistically significant difference found in the mental demand, physical demand, temporal demand, performance, effort, and frustration of endoscopy under the no mask and mask conditions (all p > .05). CONCLUSION The designed PPE provides an effective barrier for viral droplet and airborne transmission while allowing the ability to perform endoscopy with ease. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
| | - Shiv H. Patel
- School of Medicine Simulation Training CenterUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Joshua A. Stramiello
- Department of OtolaryngologyUniversity of California‐San DiegoSan DiegoCaliforniaUSA
| | - Philip A. Weissbrod
- Department of OtolaryngologyUniversity of California‐San DiegoSan DiegoCaliforniaUSA
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Manggala SK, Tantri AR, Sugiarto A, Sianipar IR, Prasetyono TOH. In situ simulation training for a better interprofessional team performance in transferring critically ill patients with COVID-19: a prospective randomised control trial. Postgrad Med J 2022; 98:617-621. [PMID: 35101969 PMCID: PMC8814429 DOI: 10.1136/postgradmedj-2021-141426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/15/2022] [Indexed: 11/08/2022]
Abstract
Background Transferring critically ill patients with COVID-19 is a challenging task; therefore, well-trained medical team is needed. This study aimed to determine the role of in situ simulation training during pandemic by using high-fidelity manikin to improve interprofessional communication, skills and teamwork in transferring critically ill patients with COVID-19. Methods This single-blinded randomised control trial included 40 subjects allocated into standard low-fidelity simulator (LFS) and high-fidelity simulator (HFS) groups. Subjects, who were not members of multiprofessional team taking care of patients with COVID-19, in each group were assigned into small groups and joined an online interactive lecture session, two sessions of in-situ simulation and a debriefing session with strict health protocols. The first simulation aimed to teach participants the skills and steps needed. The second simulation aimed to assess transfer skills, communication and teamwork performance, that participants had learnt using a validated, comprehensive assessment tool. Data were analysed using unpaired t test or Mann-Whitney test. Results The HFS group showed significantly better overall transfer and communication skills than LFS group (89.70±4.65 vs 77.19±3.6, <0.05 and 100 vs 88.34 (63.33–100), p=0.022, respectively). The HFS group also demonstrated significantly better teamwork performance than the standard LFS group (90 (80–900) vs 80 (70–90), p=0.028). Conclusion In situ simulation training using HFS significantly showed better performance than the standard training using LFS in regards to overall transfer and communication skills as well as teamwork performance. The training using HFS may provide a valuable adjunct to improve interprofessional skills, communication and teamwork performance in transferring critically ill patients with COVID-19. Trial registration number NCT05113823.
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Affiliation(s)
- Sidharta Kusuma Manggala
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, DKI Jakarta, Indonesia
| | - Aida Rosita Tantri
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, DKI Jakarta, Indonesia
- SIMUBEAR (Simulation Based Medical Education and Research Center), IMERI (Indonesian Medical Education and Research Institute), Faculty of Medicine, Universitas Indonesia, Jakarta, DKI Jakarta, Indonesia
| | - Adhrie Sugiarto
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, DKI Jakarta, Indonesia
| | - Imelda Rosalyn Sianipar
- SIMUBEAR (Simulation Based Medical Education and Research Center), IMERI (Indonesian Medical Education and Research Institute), Faculty of Medicine, Universitas Indonesia, Jakarta, DKI Jakarta, Indonesia
- Department of Medical Physiology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, DKI Jakarta, Indonesia
| | - Theddeus Octavianus Hari Prasetyono
- Department of Plastic Surgery, Departement of Surgery, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, DKI Jakarta, Indonesia
- ICTEC (Indonesian Clinical Training and Education Center), Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, DKI Jakarta, Indonesia
- Medical Technology Cluste IMERI (Indonesian Medical Education and Research Institute), Faculty of Medicine, IMERI (Indonesian Medical Education and Research Institute), Faculty of Medicine, Universitas Indonesia, Jakarta, DKI Jakarta, Indonesia
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Myers R, Ruszkiewicz DM, Meister A, Atkar-Khattra S, Bartolomeu CL, Thomas CLP, Lam S. Breath collection protocol for SARs-CoV-2 testing in an ambulatory setting. J Breath Res 2022; 16. [DOI: 10.1088/1752-7163/ac4e2c] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/24/2022] [Indexed: 11/12/2022]
Abstract
Abstract
Breath research during the SARS-CoV-2 pandemic offers an opportunity for discovery of a rapid point-of-care screening test, but also introduces a hazard to researchers collecting, transporting and analyzing breath samples not only for COVID -19 research, but all human breath-related research during the ongoing pandemic. Safe workflows to protect study participants and staff collecting and analysing the samples must be determined. We developed a SARS-CoV-2 breath test protocol for collection and processing of breath samples in ambulatory care COVID-19 testing sites and prospectively evaluated the protocol. 528 breath samples from 393 participants at COVID-19 testing sites were safely collected, transported, stored, and analysed with zero transmission to staff. Our method development for the safe collection of samples included the examination of 2 different filters for added safety. We discovered the use of filters leads to increased sample contamination and/or reduction of endogenous features in breath samples. Personal protective equipment (PPE) is essential for all breath collection while SARS-CoV-2 remains wide-spread through the general population. We have demonstrated that use of completely disposable breath collection devices and PPE, are sufficient for safe collection. Filters in the workflow add complexity to an already complex breath matrix and may compromise bio-safety.
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Weissman E, Buchner D, Hemachandra N, Siddeeg K, Samim Soroush M, Rahmanzai AJ, Chikvaidze P, Yassen ZM, Hasan H, Berraho M, Dghoughi N, Hafid H, Zaidi RM, Zulfiqar W, Awes S, Aabroo A, Uzma Q, Fiidow MAHM, Afrah AW, Ali AA, Awadalla AA, El Hassan MMO, Elkheir EB, Diaz T. Benefit-risk analysis of maintaining essential Reproductive, Maternal, Newborn, and Child Health (RMNCH) services against risk of COVID-19 infection. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000176. [PMID: 36962214 PMCID: PMC10021309 DOI: 10.1371/journal.pgph.0000176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 01/09/2022] [Indexed: 11/19/2022]
Abstract
With the COVID-19 pandemic spreading across the world, its disruptive effect on the provision and utilization of non- COVID related health services have become well-documented. As countries developed mitigation strategies to help continue the delivery of essential health services through the pandemic, they needed to carefully weigh the benefits and risks of pursuing these strategies. In an attempt to assist countries in their mitigation efforts, a Benefit-Risk model was designed to provide guidance on how to compare the health benefits of sustained essential reproductive, maternal, newborn and child (RMNCH) services against the risk of SARS-CoV-2 infections incurred by the countries' populations when accessing these services. This article describes how two existing models were combined to create this model, the field-testing process carried out from November 2020 through March 2021 in six countries and the findings. The overall Benefit-Risk Ratio in the 6 countries analyzed was found to be between 13.7 and 79.2, which means that for every 13.7 to 79.2 lives gained due to increased RMNCH service coverage, there was one loss of a life related to COVID-19. In all cases and for all services, the benefit of maintaining essential health services far exceeded the risks associated with additional COVID-19 infections and deaths. This modelling process illustrated how essential health services can continue to operate during a pandemic and how mitigation measures can reduce COVID-19 infections and restore or increase coverage of essential health services. Overall, this Benefit-Risk analysis underscored the importance and value of maintaining coverage of essential health services even during public health emergencies, including the recent COVID-19 pandemic.
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Affiliation(s)
- Eva Weissman
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, World Health Organization, Consultant, New York, New York, United States of America
| | - Denise Buchner
- Reproductive and Maternal Health Unit, World Health Organization Regional Office for the Eastern Mediterranean, Consultant, Calgary, Canada
| | - Nilmini Hemachandra
- Reproductive and Maternal Health Unit, WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Khalid Siddeeg
- Reproductive and Maternal Health Unit, WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | | | | | | | | | - Hanan Hasan
- World Health Organization Country Office, Baghdad, Iraq
| | | | | | - Hachri Hafid
- World Health Organization Country Office, Rabat, Morocco
| | - Raza Mahmood Zaidi
- Ministry of National Health Services, Regulation & Coordination, Islamabad, Pakistan
| | - Wahaj Zulfiqar
- Ministry of National Health Services, Regulation & Coordination, Islamabad, Pakistan
| | - Sayema Awes
- Ministry of National Health Services, Regulation & Coordination, Islamabad, Pakistan
| | - Atiya Aabroo
- Ministry of National Health Services, Regulation & Coordination, Islamabad, Pakistan
| | - Qudsia Uzma
- World Health Organization Country Office Pakistan, Islamabad, Pakistan
| | | | | | | | | | | | | | - Theresa Diaz
- Maternal, Newborn, Child and Adolescent Health and Ageing Department, World Health Organization, Geneva, Switzerland
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Kshirsagar S, Kuttarmare S, Bhalerao P. Awareness of personal protective equipment among frontline postgraduate medical residents who provide care to patients with coronavirus disease-2019. JOURNAL OF THE PRACTICE OF CARDIOVASCULAR SCIENCES 2022. [DOI: 10.4103/jpcs.jpcs_49_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
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Personal protective equipment training for non-healthcare workers in the Covid-19 pandemic: Effectiveness of an evidence-based skills training framework. Infect Dis Health 2021; 27:38-48. [PMID: 34688581 PMCID: PMC8495050 DOI: 10.1016/j.idh.2021.09.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/25/2021] [Accepted: 09/27/2021] [Indexed: 01/25/2023]
Abstract
Background Large-scale quarantine facilities staffed with non-healthcare workers (NHCW) were instrumental in preventing community spread of COVID-19 (coronavirus disease of 2019). The objective of this study was to determine the effectiveness of a newly developed procedural skills training framework in ensuring personal protective equipment (PPE) compliance of PPE-naïve NHCWs. Methods We developed a PPE procedural skills training framework for NHCWs using the Learn, See, Practice, Prove, Do, and Maintain (LSPPDM) framework and international guidelines on PPE for healthcare workers. The NHCWs underwent PPE training using this framework, conducted by a team of Infection Prevention nurses, prior to being stationed within the CCF. Effectiveness of the LSPPDM PPE training framework was assessed using: 1) competency assessment scores for NHCWs, 2) PPE compliance rates from daily audit findings, and, 3) healthcare-associated COVID-19 infection rates of NHCWs. Results A total of 883 NHCWs had completed the PPE training and demonstrated competency in PPE compliance, fulfilling 100% of the checklist requirements. Mean PPE compliance of all NHCWs during the 11-week study period was noted to be >96%. The post-implementation improvement was statistically significant when the compliance was expressed in 3-days blocks) and in bed management staff (P = < 0.05). None of the 883 NHCWs who underwent PPE training via the LSPPDM framework were diagnosed with healthcare-associated COVID-19 infection. Conclusion An evidence-based skills training framework is effective in PPE training of large numbers of NHCWs, resulting in high compliance of appropriate PPE use and prevention of healthcare-associated COVID-19 infection.
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Self-contamination following removal of two personal protective equipment suits: a randomized, controlled, crossover simulation trial. J Hosp Infect 2021; 119:155-162. [PMID: 34606932 DOI: 10.1016/j.jhin.2021.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/16/2021] [Accepted: 09/22/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Healthcare personnel are often at high risk of contamination when participating in airway management and other aerosol-generating procedures. AIM To explore the differences in self-contamination after removal of gown and coverall personal protective equipment (PPE) using an ultraviolet-fluorescent solution. METHODS This prospective, randomized, controlled crossover trial was set in a third-level university health centre in Buenos Aires, Argentina between August and October 2020. The study included 60 anaesthesia personnel volunteers, and no participants were excluded from the study. A two-period/two-intervention design was chosen; each intervention comprised audio-guided placement of PPE, full-body spraying of fluorescent solution, audio-guided removal of PPE, and self-contamination assessment through ultraviolet light scanning. The primary outcome was the mean within-participant difference (any traces) between PPE suits. Statistical significance was tested using t-tests for paired data. The allocation ratio was 25/35 (gown followed by coverall/coverall followed by gown). FINDINGS Self-contamination after removal of coveralls was greater than that after removal of gowns, with a mean within-participant difference of 11.45 traces (95% confidence interval 8.26-14.635; P<0.001). Significant differences were found for the number of self-contaminated body zones, small fluorescent traces and large fluorescent traces. Removal of a gown was associated with a markedly lower risk of self-contamination. CONCLUSIONS Quick one-step removal of a gown and gloves may reduce self-contamination in the arm/hand area. Fluorescent solutions can help to identify self-contamination and compare outcomes between available PPE suits. Repeated training sessions and enhanced knowledge on self-contamination following removal of PPE are paramount. CLINICAL TRIAL REGISTRATION NUMBER NCT04763304 (on ClinicalTrials.gov).
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Picard C, Edlund M, Keddie C, Asadi L, O'Dochartaigh D, Drew R, Douma MJ, O'Neil CR, Smith SW, Kanji JN. The effects of trained observers (dofficers) and audits during a facility-wide COVID-19 outbreak: A mixed-methods quality improvement analysis. Am J Infect Control 2021; 49:1136-1141. [PMID: 33774100 PMCID: PMC7992300 DOI: 10.1016/j.ajic.2021.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 03/07/2021] [Accepted: 03/08/2021] [Indexed: 01/21/2023]
Abstract
Background In response to a facility-wide COVID-19 outbreak, our tertiary acute care hospital implemented an evidence-based bundle of infection control practices including the use of audits and trained observers “dofficers” to provide real-time constructive feedback. Methods We trained furloughed staff to perform the role of dofficer. They offered support and corrective feedback on proper PPE use and completed 21-point audits during a 4-week intervention period. Audits tracked appropriate signage, placement and availability of supplies (equipment), correct PPE use, enhanced environmental cleaning, along with cohorting and social distancing rates. Audit data was used to provide weekly quality improvement reports to units. Results Nine hundred and sixty two separate audits recorded 36,948 observations, over 7,696 observer-hours. The most common errors were with environmental cleaning and PPE use; the least common were with regards to equipment availability and cohorting and social distancing. Mean error rates decreased from 9.81% to 2.88% (P < .001). The largest reduction, 22.57%, occurred in the category of PPE doffing errors. Conclusions Dofficer led audits effectively identified areas for improvement. Feedback through weekly reports and real-time correction of PPE errors by dofficers led to statistically significant improvements; however, error rates remained high. Further research is needed establish if these relationships are causal.
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Affiliation(s)
- Christopher Picard
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada; Covenant Health, Edmonton, Alberta, Canada.
| | | | | | - Leyla Asadi
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Domhnall O'Dochartaigh
- Alberta Health Services, Calgary, Alberta, Canada; Emergency Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | | | - Matthew J Douma
- Alberta Health Services, Calgary, Alberta, Canada; Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Conar R O'Neil
- Covenant Health, Edmonton, Alberta, Canada; Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Stephanie W Smith
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jamil N Kanji
- Covenant Health, Edmonton, Alberta, Canada; Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Public Health Laboratory, Alberta Precision Laboratories, University of Alberta Hospital, Edmonton, Alberta, Canada
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Naik B N, Singh A, Lazar MS, Ganesh V, Soni SL, Biswal M, Das K, Kaur S, Puri G. Performance of Health Care Workers in Doffing of Personal Protective Equipment Using Real-Time Remote Audio-Visual Doffing Surveillance System: Its Implications for Bio-Safety Amid COVID-19 Pandemic. Cureus 2021; 13:e18071. [PMID: 34692292 PMCID: PMC8523387 DOI: 10.7759/cureus.18071] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2021] [Indexed: 01/28/2023] Open
Abstract
Background Very little has been reported about health care workers' (HCWs) adherence to the Centers for Disease Control and Prevention (CDC) guidelines of doffing personal protective equipment (PPE) amid the COVID-19 pandemic. Real-time remote audio-visual doffing surveillance (RADS) system for assisting doffing might reduce the risk of self-contamination. We used this system to determine the incidence of the breach in biosafety during doffing of PPE among HCWs involved in the care of Covid-19 patients. Methods A total of 100 HCWs were enrolled in this observational study who performed duties in the COVID intensive care unit (ICU) of our tertiary care centre. With a real-time RADS system, trained observers from remote locations assisted HCWs during doffing of PPE and noted breach at any step using the CDC doffing checklist. The breach was considered major if committed during removal of gloves/gown/N-95 or if ≥3 errors occurred in any other steps. Results Overall, 40% of the HCWs committed a breach during doffing at least one step. The majority of the errors were observed during hand hygiene (34%), followed by glove removal (12%) and N-95 removal (8%). Nineteen percent of HCWs committed the major breach, out of which 37.5% were done by house-keeping sanitation staff (p = 0.008 and RR 2.85; 95% CI of 1.313-6.19), followed by technicians (22.5%), nursing staff (16.7%) and resident doctors (6.5%). Conclusions Performing doffing using a real-time RADS system is associated with a relatively low incidence of a breach in biosafety compared with earlier studies using an onsite standard observer. Overall adherence of HCWs to the CDC guidelines of doffing PPE was satisfactory. This study highlights the importance of the RADS system during doffing of PPE in a health care setting amid the COVID-19 pandemic.
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Affiliation(s)
- Naveen Naik B
- Department of Anaesthesiology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Ajay Singh
- Department of Anaesthesiology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Michelle S Lazar
- Department of Anaesthesiology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Venkata Ganesh
- Department of Anaesthesiology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Shiv L Soni
- Department of Anaesthesiology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Manisha Biswal
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Karobi Das
- Department of Nursing Education, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Sukhpal Kaur
- Department of Nursing Education, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Goverdhan Puri
- Department of Anaesthesiology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
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Lee Y, Salahuddin M, Gibson‐Young L, Oliver GD. Assessing personal protective equipment needs for healthcare workers. Health Sci Rep 2021; 4:e370. [PMID: 34522792 PMCID: PMC8425781 DOI: 10.1002/hsr2.370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 07/08/2021] [Accepted: 08/08/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Personal protective equipment (PPE) is critical for healthcare workers (HCWs) since it acts as a barrier to infection transmission; however, current PPE is not ideally suited to their needs due to limitations in protection and comfort. Thus, the purpose of this study was to identify major issues of current PPE for body protection and assess its needs within health care. METHODS An online survey was conducted with a convenience sample of 200 U.S. healthcare professionals who interact with patients. The survey was designed to identify the types of PPE that HCWs currently use, assess current PPE design features for body protection, examine the effect of PPE design features for body protection, and HCWs' years of work experiences on overall PPE acceptability, and explore current PPE maintenance practices. Both quantitative and qualitative data were used for analyses. RESULTS This study showed the need for current PPE improvement in terms of fit, comfort, mobility, and donning and doffing for HCWs' safety and health. Donning and doffing plays an important role in HCWs' overall acceptance of PPE for body protection. This study revealed that most HCWs dispose of their PPE in a trashcan in a healthcare unit and non-disposed PPE is laundered at home, which may expose their family members to a health risk if a proper precaution is not followed. CONCLUSION This study provides critical insights for the needs of (a) novel PPE design research and (b) proper donning and doffing training and its strict regulatory effort to ensure HCWs' safety and health.
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Affiliation(s)
- Young‐A Lee
- Department of Consumer and Design SciencesAuburn UniversityAuburnAlabamaUSA
| | - Mir Salahuddin
- Department of Consumer and Design SciencesAuburn UniversityAuburnAlabamaUSA
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Blaak MJ, Fadaak R, Davies JM, Pinto N, Conly J, Leslie M. Virtual tabletop simulations for primary care pandemic preparedness and response. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2021; 7:487-493. [PMID: 34422296 PMCID: PMC8327409 DOI: 10.1136/bmjstel-2020-000854] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/03/2021] [Indexed: 11/13/2022]
Abstract
Introduction The COVID-19 pandemic prompted widescale use of clinical simulations to improve procedures and practices. We outline our deployment of a virtual tabletop simulation (TTS) method in primary care (PC) clinics across Alberta, Canada. We summarise the quality and safety improvements from this method and report end users’ perspectives on key elements. Methods Our virtual TTS used teleconferencing software alongside digital whiteboards to walk clinic stakeholders through patient scenarios. Participants reviewed and rehearsed their workflows and care practices. The goal was for staff to take ownership over gaps and codesigned solutions. After simulation sessions, follow-up interviews were conducted to collect feedback. Results These sessions helped PC staff identify and codesign solutions for clinical hazards and threats. These included the flow of patients through clinics, communications, redesignation of physical spaces, and adaptation of guidance for cleaning and personal protective equipment use. End users reported sessions provided neutral spaces to discuss practice changes and built confidence in delivering safe care during the pandemic. Discussion TTS has not been extensively deployed to improve clinical practice in outpatient environments. We show how virtual TTS can bridge gaps between knowledge and practice by offering a guided space to rehearse clinical changes. We show that virtual TTS can be used in multiple contexts to help identify hazards, improve safety and build confidence in professional teams adapting to rapid changes in both policies and practices. While our sessions were conducted in Alberta, our results suggest this method may be deployed in other contexts, including low-resource settings.
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Affiliation(s)
- Marlot Johanna Blaak
- W21C Research and Innovation Centre, University of Calgary, Calgary, Alberta, Canada
| | - Raad Fadaak
- School of Public Policy, University of Calgary, Calgary, Alberta, Canada
| | - Jan M Davies
- W21C Research and Innovation Centre, University of Calgary, Calgary, Alberta, Canada.,Department of Anesthesiology, Perioperative and Pain Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Nicole Pinto
- School of Public Policy, University of Calgary, Calgary, Alberta, Canada
| | - John Conly
- W21C Research and Innovation Centre, University of Calgary, Calgary, Alberta, Canada.,Departments of Medicine, Microbiology, Immunology and Infectious Diseases, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.,Infection Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Myles Leslie
- School of Public Policy, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
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Healthcare Workers' Experiences and Views of Using Surgical Masks and Respirators, and Their Attitudes on the Sustainability: A Semi-Structured Survey Study during COVID-19. NURSING REPORTS 2021; 11:615-628. [PMID: 34968337 PMCID: PMC8608101 DOI: 10.3390/nursrep11030059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 02/05/2023] Open
Abstract
A universal mask use was instituted in healthcare during COVID-19 pandemic in 2020. The extensive growth in the consumption of surgical masks and respirators brought new challenges. Healthcare workers had to get accustomed to wearing the facemasks continuously, raising concerns on the patient, occupational, and environmental safety. The aim of this study is to describe frontline healthcare workers and other authorities’ views and experiences on continuous use of surgical masks and respirators (facemasks) and their attitudes towards environmental and sustainability issues. A cross-sectional web-based survey was conducted in Finland during the COVID-19 pandemic in autumn 2020. The respondents(N = 120) were recruited via social media, and the data were collected using a purpose-designed questionnaire. Descriptive statistics and inductive content analysis were used to analyze the quantitative data and qualitative data, respectively. The healthcare workers perceived their own and patient safety, and comfortability of facemasks as important, but according to their experiences, these properties were not evident with the current facemasks. They considered protection properties more important than environmental values. However, biodegradability and biobased material were seen as desired properties in facemasks. Based on the results, the current facemasks do not meet users’ expectations well enough. Especially the design, breathability, and sustainability issues should be taken more into account.
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Lamhoot T, Ben Shoshan N, Eisenberg H, Fainberg G, Mhiliya M, Cohen N, Bisker-Kassif O, Barak O, Weiniger C, Capua T. Emergency department impaired adherence to personal protective equipment donning and doffing protocols during the COVID-19 pandemic. Isr J Health Policy Res 2021; 10:41. [PMID: 34281594 PMCID: PMC8287287 DOI: 10.1186/s13584-021-00477-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 04/21/2021] [Indexed: 12/15/2022] Open
Abstract
Objectives Coronavirus Disease 2019 (COVID-19) is a highly infectious viral pandemic that has claimed the lives of millions. Personal protective equipment (PPE) may reduce the risk of transmission for health care workers (HCWs), especially in the emergency setting. This study aimed to compare the adherence to PPE donning and doffing protocols in the Emergency Department (ED) vs designated COVID-19 wards and score adherence according to the steps in our protocol. Design Prior to managing COVID-19 patients, mandatory PPE training was undertaken for all HCWs. HCWs were observed donning or doffing COVID-19 restricted areas. Setting Donning and doffing was observed in COVID-19 designated Emergency department and compared to COVID-19 positive wards. Participants All HCWs working in the aforementioned wards during the time of observation. Results We observed 107 donning and doffing procedures (30 were observed in the ED). 50% HCWs observed donned PPE correctly and 37% doffed correctly. The ED had a significantly lower mean donning score (ED: 78%, Internal: 95% ICU: 96%, p < 0.001); and a significantly lower mean doffing score (ED: 72%, Internal: 85% ICU: 91%, p = 0.02). Conclusions As hypothesized, HCWs assigned to the designated ED wing made more protocol deviations compared with HCWs positive COVID-19 wards. Time management, acuity, lack of personnel, stress and known COVID-19 status may explain the lesser adherence to donning and doffing protocols. Further studies to assess the correlation between protocol deviations in use of PPE and morbidity as well as improvement implementations are required. Resources should be invested to ensure PPE is properly used. Supplementary Information The online version contains supplementary material available at 10.1186/s13584-021-00477-7.
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Affiliation(s)
- Tomer Lamhoot
- Medical Technology and Simulation Center, Tel Aviv Sourasky Medical Center, affiliated to Ministry of Health, Tel Aviv, Israel
| | - Noa Ben Shoshan
- Medical Technology and Simulation Center, Tel Aviv Sourasky Medical Center, affiliated to Ministry of Health, Tel Aviv, Israel
| | - Hagit Eisenberg
- Medical Technology and Simulation Center, Tel Aviv Sourasky Medical Center, affiliated to Ministry of Health, Tel Aviv, Israel
| | - Gilad Fainberg
- Medical Technology and Simulation Center, Tel Aviv Sourasky Medical Center, affiliated to Ministry of Health, Tel Aviv, Israel
| | - Mansour Mhiliya
- Medical Technology and Simulation Center, Tel Aviv Sourasky Medical Center, affiliated to Ministry of Health, Tel Aviv, Israel
| | - Neta Cohen
- Pediatric Emergency Medicine, The hospital for Sick Children, Toronto, Canada.,Pediatric Emergency Medicine, Dana-Dwek Children's Hospital, Tel Aviv, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orly Bisker-Kassif
- Medical Technology and Simulation Center, Tel Aviv Sourasky Medical Center, affiliated to Ministry of Health, Tel Aviv, Israel
| | - Orly Barak
- Department of Geriatrics, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Carolyn Weiniger
- Department of Anesthesia, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tali Capua
- Pediatric Emergency Medicine, Dana-Dwek Children's Hospital, Tel Aviv, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Aurilio C, Sansone P, Paladini A, Barbarisi M, Coppolino F, Pota V, Pace MC. Multidrug Resistence Prevalence in COVID Area. Life (Basel) 2021; 11:601. [PMID: 34201519 PMCID: PMC8303728 DOI: 10.3390/life11070601] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/15/2021] [Accepted: 06/18/2021] [Indexed: 12/30/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, is often complicated by severe acute respiratory syndrome. The new coronavirus outbreak started in China in December 2019 and rapidly spread around the world. The high diffusibility of the virus was the reason for the outbreak of the pandemic viral disease, reaching more than 100 million infected people globally by the first three months of 2021. In the various treatments used up to now, the use of antimicrobial drugs for the management, especially of bacterial co-infections, is very frequent in patients admitted to intensive care. In addition, critically ill patients with SARS-CoV-2 infection are subjected to prolonged mechanical ventilation and other therapeutic procedures often responsible for developing hospital co-infections due to multidrug-resistant bacteria. Co-infections contribute to the increase in the morbidity-mortality of viral respiratory infections. We performed this study to review the recent articles published on the antibiotic bacterial resistance and viruses to predict risk factors of coronavirus disease 2019 and to assess the multidrug resistance in patients hospitalized in the COVID-19 area.
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Affiliation(s)
- Caterina Aurilio
- Department of Women, Child, General and Specialistic Surgery, University of Campania “L. Vanvitelli”, 80138 Napoli, Italy; (P.S.); (F.C.); (V.P.); (M.C.P.)
| | - Pasquale Sansone
- Department of Women, Child, General and Specialistic Surgery, University of Campania “L. Vanvitelli”, 80138 Napoli, Italy; (P.S.); (F.C.); (V.P.); (M.C.P.)
| | | | - Manlio Barbarisi
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Francesco Coppolino
- Department of Women, Child, General and Specialistic Surgery, University of Campania “L. Vanvitelli”, 80138 Napoli, Italy; (P.S.); (F.C.); (V.P.); (M.C.P.)
| | - Vincenzo Pota
- Department of Women, Child, General and Specialistic Surgery, University of Campania “L. Vanvitelli”, 80138 Napoli, Italy; (P.S.); (F.C.); (V.P.); (M.C.P.)
| | - Maria Caterina Pace
- Department of Women, Child, General and Specialistic Surgery, University of Campania “L. Vanvitelli”, 80138 Napoli, Italy; (P.S.); (F.C.); (V.P.); (M.C.P.)
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38
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Robbins T, Kyrou I, Vankad M, Suthantirakumar R, Igharo N, Patel K, Randeva H, Sankar S. Differential perceptions regarding personal protective equipment use during the COVID-19 pandemic by NHS healthcare professionals based on ethnicity, sex and professional experience. Infect Prev Pract 2021; 3:100141. [PMID: 34316583 PMCID: PMC8195686 DOI: 10.1016/j.infpip.2021.100141] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/08/2021] [Indexed: 01/19/2023] Open
Abstract
Objectives To capture perceptions regarding personal protective equipment (PPE) among healthcare professionals during the COVID-19 pandemic, including staff subgroups at high risk for severe COVID-19, such as black and minority ethnic (BAME) groups. Design Electronically distributed survey with semi-quantitative analysis. Survey distributed at a major academic NHS tertiary referral centre in the West Midlands with a diverse medical workforce to medically qualified staff who completed COVID-19 redeployment training. (N=121; 47% female; 49% of BAME background; 26% international medical graduates). Results All demographic groups reported overall good awareness of when and how to use PPE during COVID-19 pandemic. Statistically significant differences in the perceptions regarding PPE use during COVID-19 were noted between BAME vs non-BAME staff, international vs UK medical graduates, and male vs female participants, as well as between professionals at different stages of their career. The differences related to perceptions around availability, degree of protection provided, perceived inconvenience, ability to raise concerns about availability, confidence in sharing underlying health conditions with managers and the impact of full PPE in emergency situations causing delay patient care. Conclusions Amongst medically qualified staff, significant differences exist in the perceptions relating to the, availability and effectiveness of PPE during the COVID-19 pandemic depending on country of training, ethnic background and sex. GAFREC Study Approval Study ID GF0392.
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Affiliation(s)
- Tim Robbins
- University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom.,Institute of Digital Healthcare, WMG, University of Warwick, Coventry, CV4 7AL, United Kingdom
| | - Ioannis Kyrou
- University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom
| | - Maariyah Vankad
- University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom.,Warwick Medical School, University of Warwick, Coventry, CV4 7HL, United Kingdom
| | - Risheka Suthantirakumar
- University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom.,Warwick Medical School, University of Warwick, Coventry, CV4 7HL, United Kingdom
| | - Natalie Igharo
- University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom.,Warwick Medical School, University of Warwick, Coventry, CV4 7HL, United Kingdom
| | - Kiran Patel
- University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom.,Warwick Medical School, University of Warwick, Coventry, CV4 7HL, United Kingdom
| | - Harpal Randeva
- University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom.,Warwick Medical School, University of Warwick, Coventry, CV4 7HL, United Kingdom
| | - Sailesh Sankar
- University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom
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39
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Zhang HL, Yang S, Luo HX, You JP. The Error-Prone Operational Steps and Key Sites of Self-Contamination During Donning and Doffing of Personal Protective Equipment by Health Care Workers. Disaster Med Public Health Prep 2021; 16:1-6. [PMID: 33952368 PMCID: PMC8207547 DOI: 10.1017/dmp.2021.142] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/24/2021] [Accepted: 05/03/2021] [Indexed: 01/25/2023]
Abstract
OBJECTIVE This study aims to identify error-prone operational steps and key sites of self-contamination during donning and doffing of personal protective equipment (PPE). METHODS A total of 56 health care workers, including 37 nurses and 19 physicians, were recruited to don and doff the PPE recommended by the Chinese Center for Disease Control and Prevention. Operational errors and sites of self-contamination were recorded using UV-fluorescent labeling and video surveillance. RESULTS Three main errors during donning were identified: choosing a loose-fitting coverall that was difficult to handle; ignoring to inspect the seal of N95 respirator or gloves; and forgetting to pull up the zipper completely. Four main errors during doffing were identified: removing the N95 respirator in a wrong way; touching the scrubs with contaminated hands and elbows; touching contaminated external surfaces of the goggles; and performing insufficient hand hygiene. Key sites that were easily contaminated during the doffing of PPE included left hand and wrist, left lower leg, chest, and left abdomen. CONCLUSION Identifying the steps prone to errors and key sites of self-contamination in the process of PPE donning and doffing can facilitate the training of PPE use and provide detailed evidence for optimizing standardized protocols to reduce contamination.
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Affiliation(s)
- Hui-Lan Zhang
- Department of Infectious Diseases, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Sha Yang
- Department of Infectious Diseases, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Hong-Xia Luo
- Department of Infectious Diseases, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jian-Ping You
- Department of Infectious Diseases, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
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40
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Bentivegna E, Alessio G, Spuntarelli V, Luciani M, Santino I, Simmaco M, Martelletti P. Impact of COVID-19 prevention measures on risk of health care-associated Clostridium difficile infection. Am J Infect Control 2021; 49:640-642. [PMID: 33031863 PMCID: PMC7534787 DOI: 10.1016/j.ajic.2020.09.010] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 09/29/2020] [Accepted: 09/29/2020] [Indexed: 12/21/2022]
Abstract
Clostridium difficile is the most common pathogen between health care-associated infections and its incidence has increased during the last years. lack of enough evidence about effective hygiene interventions to prevent this disease. Due to the coronavirus disease 2019 (COVID‑19) pandemic, several strategies to reduce microorganism spread were adopted in hospital setting. The objective of this study was to establish whether such strategies can reduce health care associated C difficile infection (HA-CDI) incidence. We found that, during the pandemic (2020) HA-CDI incidence was significantly lower with respect to the previous years. This work demonstrates that maintaining this level of attention regarding control activities related to prevention of microorganism transmission significantly reduce HA-CDI and related expenses in terms of health costs and human lives.
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Affiliation(s)
- Enrico Bentivegna
- Internal Medicine and Emergency Medicine Unit, Sant'Andrea University Hospital and "Sapienza" University of Rome, Rome, Italy.
| | - Giuliano Alessio
- Hospital Direction and Clinical Departments, Sant'Andrea University Hospital and "Sapienza" University of Rome, Rome, Italy
| | - Valerio Spuntarelli
- Emergency Medicine CoViD-19 Unit, Sant'Andrea University Hospital and "Sapienza" University of Rome, Rome, Italy
| | - Michelangelo Luciani
- Internal Medicine and Emergency Medicine Unit, Sant'Andrea University Hospital and "Sapienza" University of Rome, Rome, Italy
| | - Iolanda Santino
- Hospital Direction and Clinical Departments, Sant'Andrea University Hospital and "Sapienza" University of Rome, Rome, Italy; Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital and "Sapienza" University of Rome, Rome, Italy
| | - Maurizio Simmaco
- Hospital Direction and Clinical Departments, Sant'Andrea University Hospital and "Sapienza" University of Rome, Rome, Italy; Department of Neurosciences, Mental Health, and Sensory Organs, "Sapienza" University of Rome, Rome, Italy
| | - Paolo Martelletti
- Internal Medicine and Emergency Medicine Unit, Sant'Andrea University Hospital and "Sapienza" University of Rome, Rome, Italy; Emergency Medicine CoViD-19 Unit, Sant'Andrea University Hospital and "Sapienza" University of Rome, Rome, Italy; Department of Neurosciences, Mental Health, and Sensory Organs, "Sapienza" University of Rome, Rome, Italy
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41
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Bernardes GCS, Godoi APN, de Almeida NA, Nogueira LS, Pinheiro MB. Doffing personal protective equipment in times of COVID-19. Rev Bras Med Trab 2021; 19:88-93. [PMID: 33986785 PMCID: PMC8100761 DOI: 10.47626/1679-4435-2021-605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
COVID-19, a disease caused by a coronavirus (SARS-CoV-2), has worried health authorities in Brazil and worldwide because of its high infectivity and rapid spread. Within this context, health care workers are at greater risk of infection for being in close contact with patients, which is inherent to their work activities. To reduce the risk, protective measures must be adopted and personal protective equipment is essential. However, the process of removing personal protective equipment, named doffing, is as important as its correct use and can be a source of contamination for workers, especially when equipment is lacking in the market and lifespan is increased. Therefore, this review aimed to discuss the process of doffing personal protective equipment and its correct sequence based on data available in the literature.
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Affiliation(s)
| | - Ana Paula Nogueira Godoi
- Universidade Federal de São João del-Rei, Campus Centro-Oeste Dona Lindu, Divinópolis, MG, Brazil
| | | | | | - Melina Barros Pinheiro
- Universidade Federal de São João del-Rei, Campus Centro-Oeste Dona Lindu, Divinópolis, MG, Brazil
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42
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Bumpstead S, Lim ZJ, Kuhn L, Flynn D, Bakos CL, Potter E, Egerton-Warburton D. The sourcing and use of high physical resemblance personal protective equipment to train healthcare workers, improve confidence and conserve medical-grade equipment. J Hosp Infect 2021; 112:104-107. [PMID: 33864893 DOI: 10.1016/j.jhin.2021.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
Abstract
Personal protective equipment (PPE) is essential for healthcare worker (HCW) safety. Conservation of PPE for clinical use during the COVID-19 pandemic reduced its availability for training, necessitating an innovative approach to sourcing high physical resemblance PPE (HPR-PPE). We present a case study of crowd-sourcing of HPR-PPE to train HCWs. Survey results indicated that HPR-PPE enabled high-fidelity practise of PPE application and removal, aided procedure recall, improved user confidence and was sufficiently similar to medical-grade PPE. HPR-PPE provided a novel and cost-effective alternative. We also demonstrated that medical-grade PPE can be sourced from non-medical institutions and businesses during a pandemic.
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Affiliation(s)
- S Bumpstead
- Monash Medical Centre Clayton, Monash Health, Clayton, Victoria, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia; Monash Emergency Research Collaborative, Monash Health, Clayton, Victoria, Australia.
| | - Z J Lim
- Department of Anaesthesia, Austin Hospital, Heidelberg, Victoria, Australia
| | - L Kuhn
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia; Monash Emergency Research Collaborative, Monash Health, Clayton, Victoria, Australia
| | - D Flynn
- Faculty of Art, Design and Architecture, Monash University, Caulfield, Victoria, Australia
| | - C-L Bakos
- MCI Australia Ltd, Melbourne, Victoria, Australia
| | - E Potter
- Faculty of Art, Design and Architecture, Monash University, Caulfield, Victoria, Australia
| | - D Egerton-Warburton
- School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Emergency Medicine Research, Monash Medical Centre, Clayton, Victoria, Australia; Design Health Collab, Faculty of Art, Design and Architecture, Monash University, Caulfield, Victoria, Australia; Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University and Monash Health, Melbourne, Victoria, Australia
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43
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Leaton MB, Ospina K. Caring for critically ill patients with COVID-19. Nursing 2021; 51:24-31. [PMID: 33759859 DOI: 10.1097/01.nurse.0000736896.37125.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The pandemic caused by the novel coronavirus has challenged healthcare systems around the world. Learn how one medical facility incorporated key guiding principles to quickly adapt normal policies and protocols in order to safely care for patients with COVID-19.
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Affiliation(s)
- Mary Beth Leaton
- At Morristown Medical Center in Morristown, N.J., Mary Beth Leaton is a clinical nurse specialist in the surgical, trauma, and medical intensive care units and Kristin Ospina is the nursing director for critical care and oversees the surgical, trauma, and medical intensive care units and the medical/surgical step-down unit
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44
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Wong J, Gallagher M, Friedt J, Trinder K, McKague M, Stevenson K, Cattell V. Health Science Students as PPE Coaches in the Emergency Department - a Pandemic Pilot Project. Infect Prev Pract 2021; 3:100139. [PMID: 34316578 PMCID: PMC8012167 DOI: 10.1016/j.infpip.2021.100139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/23/2021] [Indexed: 11/24/2022] Open
Abstract
PPE is an integral part of reducing transmission of COVID-19. We assessed a 5-week pilot project of utilising health science student volunteers as PPE coaches in the adult and paediatric emergency department (ED) during the pandemic. PPE coaches were provided with training, PPE checklist, area for written observations, and feedback surveys. Overall, correct PPE use improved over time. Coaches felt safe, that training was adequate, and part of the team. Factors that contributed to project effectiveness included institutional support, role clarification, and continuous feedback from staff. Our findings support the utilisation of students in IPC projects.
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Affiliation(s)
- J Wong
- University of Saskatchewan, Canada
| | | | - J Friedt
- Saskatchewan Health Authority, Canada
| | | | | | | | - V Cattell
- University of Saskatchewan, Canada.,Saskatchewan Health Authority, Canada
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45
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Farnsworth CW, Wallace MA, Liu A, Gronowski AM, Burnham CAD, Yarbrough ML. Evaluation of the Risk of Laboratory Microbial Contamination during Routine Testing in Automated Clinical Chemistry and Microbiology Laboratories. Clin Chem 2021; 66:1190-1199. [PMID: 32870987 DOI: 10.1093/clinchem/hvaa128] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/20/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Every clinical specimen is potentially infectious, but data regarding risk for contamination of the laboratory environment during routine testing are scarce. We assessed contamination during routine sample analysis in automated clinical chemistry and microbiology laboratories. METHODS A fluorescent marker was applied to specimen container exteriors to assess the impact of gross contamination. Nonpathogenic MS2 virus was added to remnant blood, urine, and ESwab matrices as a biomarker of cross-contamination. Samples were processed and analyzed using Roche Cobas 8100 and ISE, c502, e602, and c702 modules (blood) and BD Kiestra total laboratory automation (blood, urine, ESwabs) over 3 experiments. Fluorescence transfer to laboratory surfaces and personnel was visualized using ultraviolet light. Surfaces were swabbed and assessed for MS2 cross-contamination by RT-PCR. Adherence to standard precautions by laboratory staff was assessed by observation. RESULTS Fluorescence was observed on 49 of 165 (30%) laboratory surfaces and personnel and 21 of 93 (23%) total laboratory automation instruments. Fluorescence transferred most frequently to gloves (31/40), computer accessories (9/18), and specimen loading racks (12/12). None of 123 areas swabbed were positive for MS2. Improper personal protective equipment use occurred at a rate of 0.36 and 0.15 events per staff per hour in the chemistry and microbiology laboratories, respectively. Hand-washing compliance was observed for 61 of 132 (46%) staff members evaluated. CONCLUSIONS Analysis of grossly contaminated specimens on automated chemistry and microbiology equipment elicits a low likelihood of instrument contamination. However, handling contaminated specimen containers can result in contamination of environmental laboratory surfaces, representing a source of risk that is heightened by low adherence to appropriate personal protective equipment.
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Affiliation(s)
| | - Meghan A Wallace
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
| | - Albert Liu
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
| | - Ann M Gronowski
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
| | - Carey-Ann D Burnham
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
| | - Melanie L Yarbrough
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
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46
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Abstract
Clinicians who care for patients infected with coronavirus disease 2019 (COVID-19) must wear a full suite of personal protective equipment, including an N95 mask or powered air purifying respirator, eye protection, a fluid-impermeable gown, and gloves. This combination of personal protective equipment may cause increased work of breathing, reduced field of vision, muffled speech, difficulty hearing, and heat stress. These effects are not caused by individual weakness; they are normal and expected reactions that any person will have when exposed to an unusual environment. The physiologic and psychologic challenges imposed by personal protective equipment may have multiple causes, but immediate countermeasures and long-term mitigation strategies can help to improve a clinician's ability to provide care. Ultimately, a systematic approach to the design and integration of personal protective equipment is needed to improve the safety of patients and clinicians.
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47
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The Isolation Communication Management System. A Telemedicine Platform to Care for Patients in a Biocontainment Unit. Ann Am Thorac Soc 2021; 17:673-678. [PMID: 32357069 PMCID: PMC7258411 DOI: 10.1513/annalsats.202003-261ip] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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48
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Noor Azhar M, Bustam A, Poh K, Ahmad Zahedi AZ, Mohd Nazri MZA, Azizah Ariffin MA, Md Yusuf MH, Zambri A, Chong JYO, Kamarudin A, Ang BT, Iskandar A, Chew KS. COVID-19 aerosol box as protection from droplet and aerosol contaminations in healthcare workers performing airway intubation: a randomised cross-over simulation study. Emerg Med J 2021; 38:111-117. [PMID: 33219133 PMCID: PMC7681799 DOI: 10.1136/emermed-2020-210514] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND Concerns over high transmission risk of SARS-CoV-2 have led to innovation and usage of an aerosol box to protect healthcare workers during airway intubation in patients with COVID-19. Its efficacy as a barrier protection in addition to the use of a standard personal protective equipment (PPE) is not fully known. We performed a simulated study to investigate the relationship between aerosol box usage during intubation and contaminations on healthcare workers pre-doffing and post-doffing of PPE. METHODS This was a randomised cross-over study conducted between 9 April to 5 May 2020 in the ED of University Malaya Medical Centre. Postgraduate Emergency Medicine trainees performed video laryngoscope-assisted intubation on an airway manikin with and without an aerosol box in a random order. Contamination was simulated by nebulised Glo Germ. Primary outcome was number of contaminated front and back body regions pre-doffing and post-doffing of PPE of the intubator and assistant. Secondary outcomes were intubation time, Cormack-Lehane score, number of intubation attempts and participants' feedback. RESULTS Thirty-six trainees completed the study interventions. The number of contaminated front and back body regions pre-doffing of PPE was significantly higher without the aerosol box (all p values<0.001). However, there was no significant difference in the number of contaminations post-doffing of PPE between using and not using the aerosol box, with a median contamination of zero. Intubation time was longer with the aerosol box (42.5 s vs 35.5 s, p<0.001). Cormack-Lehane scores were similar with and without the aerosol box. First-pass intubation success rate was 94.4% and 100% with and without the aerosol box, respectively. More participants reported reduced mobility and visibility when intubating with the aerosol box. CONCLUSIONS An aerosol box may significantly reduce exposure to contaminations but with increased intubation time and reduced operator's mobility and visibility. Furthermore, the difference in degree of contamination between using and not using an aerosol box could be offset by proper doffing of PPE.
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Affiliation(s)
- Muhaimin Noor Azhar
- Academic Unit of Emergency Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Aida Bustam
- Academic Unit of Emergency Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Khadijah Poh
- Academic Unit of Emergency Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | | | | | - Mohd Hafyzuddin Md Yusuf
- Academic Unit of Emergency Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Aliyah Zambri
- Academic Unit of Emergency Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Johnathan Y O Chong
- Department of Emergency Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Anhar Kamarudin
- Academic Unit of Emergency Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Bin Ting Ang
- Department of Emergency Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Affan Iskandar
- Department of Emergency Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Keng Sheng Chew
- Faculty of Medicine and Health Sciences, University of Malaysia Sarawak, Kota Samarahan, Malaysia
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Reduction of Multidrug-Resistant (MDR) Bacterial Infections during the COVID-19 Pandemic: A Retrospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031003. [PMID: 33498701 PMCID: PMC7908142 DOI: 10.3390/ijerph18031003] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/17/2021] [Accepted: 01/21/2021] [Indexed: 02/07/2023]
Abstract
Multidrug-resistant (MDR) organisms are emerging as some of the main healthcare problems worldwide. During the COVID-19 pandemic, several Infection Prevention and Control (IPC) measures have been adopted to reduce nosocomial microorganism transmission. We performed a case–control study to identify if the incidence of MDR bacterial infections while using pandemic-related preventive measures is lower than in previous years. From 2017 to 2020, we monitored hospital discharges over a four-month period (P #) (1 March to 30 June) in St. Andrea Hospital, Rome. In total, we reported 1617 discharges. Pearson’s chi-squared test was used to identify significant differences. A value of p ≤ 0.05 was considered statistically significant. A significant reduction in the incidence of total MDR bacterial infections was observed during the pandemic compared to in prepandemic years (p < 0.05). We also found a significantly higher incidence of MDR bacterial infections in COVID-19 departments compared with other medical departments (29% and 19%, respectively), with extended-spectrum β-lactamase Klebsiella pneumoniae as the pathogens presenting the highest increase. This study demonstrates that maintaining a high level of preventive measures could help tackle an important health problem such as that of the spread of MDR bacteria.
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50
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Isolation of COVID-19 patients in cohorted wards or single-patient rooms? Advantages and disadvantages to take into consideration. Infect Control Hosp Epidemiol 2021; 42:1392-1394. [PMID: 33427142 PMCID: PMC8485013 DOI: 10.1017/ice.2020.1425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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