PP05 Creating a cheap and replicable VIOLET Mk 2 manikin for high consequence infectious diseases and personal protective equipment training

Abstract

Aim: To build a manikin that vomits, excretes diarrhoea, produces blood from IV arm, sweats and coughs. Objectives: Make a cheap and replicable system that will attach easily onto any other manikin. Create plans and alternative easier plans for others to build. Summary of work undertaken: Initial work included identifying the requirements of the fluid delivery system flow rates and cough spray pattern required. After testing, it was evident that the pumps needed to be mounted in a frame with wheels and the cough delivery system mounted in the same cage. A large bore hose pipe was used to transport of fluids from pumps to manikin. We have been involved in undertaking research funded by HSE to ensure correct selection and use of Personal Protective Equipment (PPE) to protect front line medical staff against infectious diseases. The objectives were to evaluate the PPE ensembles used in the HCID network, develop and validate a unified PPE ensemble, and devise a training package for safe removal of potentially contaminated PPE. To do this, a clinical training manakin was adapted to deliver synthetic bodily fluids (vomit, sweat, diarrhoea, cough), each containing a different coloured fluorescent tracer visible under the HSE-SRC Fluorescence Interactive Video Exposure System (FIVES) UV light system1. For portability we hoped to build a standalone manikin, and everything built inside. However, we found that the flow rate and ease of refill required would not be possible if internally mounted. Instead, a cheap, readily available device to transport what would clearly have to be some sort of water pump. A generator frame with wheels worked well and still limit portability problems by just having the metal frame and the manikin. A couple of plastic containers to hold the Fluorochrome fluid coupled with a few holes and water butt taps made for the perfect fluid container. The two water pumps delivering the right amount of fluid and a few bits of hose pipe and I had a good base for the vomit and diarrhoea. The sneeze part took a lot of testing with spray gun nozzles. Initially powered by a 50ml syringe (cheap, easy etc) mounted in the pump frame, it is easy fillable and can be pumped as and when. The length of the sneeze would be considered inconsistent currently and it is manually operated rather than switched on for the same length of time. This starts to sway over into a bit more expensive and difficult to replicate. This also applies to the two fluid pumps. They are switch on and off by the operator. I then sourced a device rather like a mains timer for a plug. Only on a very shorter scale, this allows power to be delivered in seconds rather than minutes or hours and it does it on demand rather than a pre-set time for full control of when the manikin relieves itself. The sweat was simply applied on the manikin and the blood is delivered from a Leuer-lock syringe connected to the latex tube ‘veins’ of the manikins venepuncture arm. The exit side of the veins are connected to a second Leuer-lock syringe. The blood then can be pushed into the veins and the residue captured in the second syringe. By depressing the syringe plungers further pressure can be created in the latex tubes to simulate blood pressure. Common errors could be identified and remedied, leading to an evidence-based safe PPE ensemble. By bringing together all hospitals in the HCID network, the outcome was an agreement on a unified, national PPE ensemble and donning/doffing protocol. Adoption of this will lead to an improved, common approach to training, ensuring staff can work safely in any NHS Trust.1 Impact on practice: Users can see under UV light what fluid they are covered in depending on the colour. The impact on users and candidate of the new course are instantly mindful of how much contaminated body fluid they are covered in. Candidates are more aware of what PPE is used and how it is used thus improving outbreaks of any future virus, all through evidenced based simulation. References Poller B, Hall S, Bailey C, Gregory S., Clark R., Roberts P, Tunbridge A, Poran, V, Crook B, Evans C. ‘VIOLET’: a fluorescence-based simulation exercise for training healthcare workers in the use of personal protective equipment. Journal of Hospital Infection 2018;99(2):pp.229–235.