Abstract
Background: Restraint is widely practiced within inpatient mental health and is considered a higher risk procedure for patients and staff. There is a sparsity of evidence in respect of the efficacy of Personal Protective Equipment (PPE) used during restraint for reducing risk of infection.Methods: A series of choreographed restraint episodes were used to simulate contact contamination in research participants playing the roles of staff members and a patient. For comparison, one episode of simulated recording of physical observations was taken. UV fluorescent material was used to track the simulated contact contamination, with analysis undertaken using established image registration techniques of UV photographs. This was repeated for three separate sets of PPE.Outcomes: All three PPE sets showed similar performance in protecting against contamination transfer. For teams not utilising coveralls, this was dependent upon effective cleansing as part of doffing. There were similar patterns of contamination for restraint team members assigned to specific roles, with hands and upper torso appearing to be higher risk areas. The restraint related contamination was 23 times higher than that observed for physical observations.Interpretation: A second layer of clothing that can be removed showed efficacy in reducing contact contamination. PPE fit to individual is important. Post-restraint cleansing procedures are currently inadequate with new procedures for face and neck cleansing required. These findings leave scope for staff to potentially improve their appearance when donning PPE and engaging with distressed patients.Funding: The evaluation was funded by Gloucestershire Health and Care NHS Foundation Trust.Conflict of Interest: None.Ethical Approval: The evaluation design did not involve any patients or patient related data and therefore is considered part of standard procedure and equipment evaluation not requiring ethical approval. Valid consent to take part in the evaluation was provided by all involved.
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