Doffing Of Personal Protective Equipment Research Articles

Using Video-Reflexive Methods to Develop a Provider Down Protocol for the New South Wales Biocontainment Center.

The New South Wales Biocontainment Centre is a statewide referral facility for patients with high-consequence infectious disease (HCID). The facility collaborates with researchers to adapt existing HCID procedures such as donning and doffing of personal protective equipment (PPE). However, information on how to respond safely to collapse of a healthcare provider in full PPE within a contaminated zone is scarce. To address this gap, we adapted Nebraska Medicine's "provider down" protocol on paper and then simulated and video recorded the process, iteratively, in the facility. Clinicians analyzed the recordings collaboratively in researcher-facilitated reflexive discussions. Our primary aim was to ascertain how to maintain optimal infection prevention and control while providing urgent care for the healthcare provider. We tested participants' suggested modifications, in repeated video recorded simulations, until consensus on optimal practice was achieved. Our secondary aim was to assess the utility of video-reflexive methods to enhance clinicians' awareness and understanding of infection prevention and control in a rare and complex scenario. Six adaptations and simulations were discussed in video-reflexive sessions before consensus was reached; the final version of the protocol differed considerably from the first. Viewing footage of simulations in situ enabled participants to (1) identify infection and occupational risks not identified on paper or during verbal postsimulation debriefs and (2) test alternative perspectives on safe procedure. Video-reflexivity enables context-sensitive and consensus-building codesign of policies and procedures, critical to protocol development in a new unit. It contributes to a culture of teamwork, preparedness, and confidence before, rather than in the heat of, a crisis.

ChatGPT in hospital infection prevention and control – assessing knowledge of an AI model based on a validated questionnaire

Introduction and aim. An AI model like ChatGPT is a good source of knowledge. We can explore the potential of AI models to complement the expertise of healthcare professionals by providing real-time, evidence-based information in infection prevention and control (IPC). Material and methods. This study involved 110 queries related to IPC, validated by subject experts in IPC. The responses from ChatGPT were evaluated using Bloom’s taxonomy by experienced microbiologists. The scores were divided as 4 as a good response. Statistical analysis was done by correlation coefficient and Cohen’s Kappa. Results. The overall score was 4.33 (95% CI, q1 3.65–q3 4.64) indicating ChatGPT’s substantial IPC knowledge. A good response (i.e.>4 score) was found in 70 (63.6%) questions, while in 10 (9%) questions, it showed a poor response. The poor response was seen in needle stick injury and personal protective equipment (PPE) doffing-related questions. The overall correlations were found to be significant. Cohen’s Kappa confirmed moderate to substantial agreement between evaluators. Conclusion. ChatGPT demonstrated a commendable understanding of IPC principles in various domains and the study identifies specific instances where the model may require further refinement especially in critical scenarios such as needlestick injuries and PPE doffing.

Development of an Automated and Scalable Virtual Assistant to Aid in PPE Adherence: A Study with Implications for Applications within Anesthesiology.

Virtual assistants (VAs) are conversational agents that are able to provide cognitive aid. We developed a VA device for donning and doffing personal protective equipment (PPE) procedures and compared it to live human coaching to explore the feasibility of using VAs in the anesthesiology setting. An automated, scalable, voice-enabled VA was built using the Amazon Alexa device and Alexa Skills application. The device utilized voice-recognition technology to allow a touch-free interactive user experience. Audio and video step-by-step instructions for proper donning and doffing of PPE were programmed and displayed on an Echo Show device. The effectiveness of VA in aiding adherence to PPE protocols was compared to traditional human coaching in a randomized, controlled, single-blinded crossover design. 70 anesthesiologists, anesthesia assistants, respiratory therapists, and operating room nurses performed both donning and doffing procedures, once under step-by-step VA instructional guidance and once with human coaching. Performance was assessed using objective performance evaluation donning and doffing checklists. More participants in the VA group correctly performed the step of "Wash hands for 20 seconds" during both donning and doffing tests. Fewer participants in the VA group correctly performed the steps of "Put cap on and ensure covers hair and ears" and "Tie gown on back and around neck". The mean doffing total score was higher in the VA group; however, the donning score was similar in both groups. Our study demonstrates that it is feasible to use commercially available technology to create a voice-enabled VA that provides effective step-by-step instructions to healthcare professionals.

Five core areas to focus infection prevention and transmission risk breaches training based on quarantine staff orientation sessions: A qualitative study

Background & Aim: Breach awareness in relation to types, mitigation, and reporting should be a routine part of infection prevention training. Understanding breaches can reduce risk of disease transmission to staff and communities when contextualized to the infectious disease, environment, and situation. At a large-scale Australian COVID-19 quarantine facility, this study examined the core personal protective equipment and infection prevention breaches new quarantine workers identified during their site orientation to inform future breach training.
 Methods & Materials: Through the application of a qualitative approach, the project implemented a descriptive thematic analysis to identify the different types of breaches staff presented. An additional summative content analysis method was applied to determine if the breaches staff identified were breaching and if the risk level staff allocated to the breach was mapped to the risk of disease transmission. Data were collected from 30 orientation sessions and included 603 breach risk responses for analysis.
 Results: There were five core breach areas identified: donning and doffing of personal protective equipment, failure of personal protective equipment or lack of equipment, environmental factors, staff behaviors, and resident behaviors. The breach allocations by staff demonstrated knowledge deficits across health and non-health staff in disease transmission, particularly in the actual level of the risk for transmission.
 Conclusion: Breaches awareness in relation to types, mitigation and reporting should be a routine part of infection prevention training. The five areas of breaches present an adaptable foundation to base infection prevention breach training for any health facility. When contextualised to the communicable disease, environment and situation, understanding breaches can reduce the risk of disease transmission to staff and communities.

Normalized Deviance from Approved Personal Protective Equipment (PPE) Donning and Doffing Protocol—Towards a Hazard Reduction Index

Introduction:Reusing PPE is not recommended but was common during COVID-19 pandemic. Limited guidance on proper PPE use and its reuse heightened the hazards to health care worker (HCW) safety. Emerging data on PPE use suggests that most HCWs were contaminated by donning and doffing of PPE while adhering to standards of care.Method:A prospective observational study was conducted to understand HCW behaviors in donning, doffing, and reusing PPE. Emergency Department physicians and nurses were video-recorded donning, doffing, and reusing PPE within a simulated acute care environment. Participants performed five donning and doffing PPE procedures. PPE kit included gown, face shields, and N95 respirator masks. Participants had access to disposable gloves and hand sanitizer. Recordings were reviewed and coded independently by two trained coders based on checklist of key behaviors. Agreement between coders was high (81.9%). All participants reported completing PPE training.Results:28 videos of participants capturing 278 procedures were reviewed. None of the participants followed the CDC’s order for donning across five scenarios. Majority of participants failed to perform hand hygiene before donning or re-donning PPE or when doffing PPE. For contaminant spread risk, 92.85% (n=26) touched patient-facing side of PPE during re-donning and/or doffing PPE (M= 3.75, SD= 2.37, Median = 4; 0-9 times). The most common area of self-contamination was hands (n= 111 across all participants in 5 donning/doffing sequences). Touching patient-facing side of PPE was more likely to occur during donning than doffing (70.5% vs. 20.1% of sequences).Conclusion:The study found wide variation in PPE donning/doffing practices among HCW in violation of CDC guidance. This first study to review PPE reuse through a human factors lens, identifyied deviant behaviors that contribute to HCW self-contamination. Efforts are needed to redesign PPE and develop effective ways to train staff using PPE equipment safely.

SG-APSIC1200: Infection prevention control along the fast track: Supporting the construction, operation, and closure of a COVID-19 community treatment facility in an F1 Pit

Objectives: The infection prevention team (IPT) was tasked with providing technical guidance for the construction and setup of a community treatment facility in 3 weeks at a Formula 1 (F1) racing pit to house elderly SARS-CoV-2–positive cases. Methods: The facility was setup with 737 beds including an isolation unit and a resuscitation bay. The multidisciplinary team decided on zone segregation (ie, green and hot zones) and discussed the clean–dirty workflow. IPC measures were revisited, especially regarding the layout of the donning and doffing station, as the facility expanded to accommodate patients with more comorbidities and those who needed dialysis. IPC training for nominated infection control liaison officers (ICLOs) was conducted using a “train the trainer” approach for mask fitting, hand hygiene, donning and doffing of personal protective equipment (PPE). Enhanced IPC measures, including weekly audit and staff surveillance, were mandatory, and monitoring was performed according to MOH guidelines. Linen and waste management and the cleaning and disinfection process were established at the beginning of the project. Results: Construction was completed within 3 weeks. The setup was completed in November 2021 for 737 beds. There were 758 admissions during the 4-month operation. In total, 12 trained ICLOs oversaw the training of 200 healthcare workers. They conducted 12 IPC audits and provided feedback to all staff. Compliance with PPE practices was inconsistent, and findings were shared during daily after-action reviews for improvement. The greatest challenges were converting the F1 facility to a healthcare facility, training staff with no IPC knowledge, and monitoring IPC on the ground. The trained ICLOs were successful in implementing, practicing, and monitoring IPC measures with minimal assistance from the infection prevention team. Conclusions: Operation began on November 5, 2021, and ceased on March 9, 2022. The community treatment facility construction, setup, and operations were completed within a short timeframe due to the efforts of various stakeholders. We faced many challenges, but we managed to implement and uphold IPC standards from beginning to end.

Staying proper with your personal protective equipment: How to don and doff

IntroductionThe global COVID-19 pandemic highlighted the importance of protecting frontline healthcare workers from novel respiratory infections while also exposing the limited instruction that medical students receive on proper donning of personal protective equipment (PPE) and more importantly the safe doffing of contaminated PPE to minimize their risk of nosocomial infection. The best methods of providing this kind of instruction have not yet been determined. MethodsAnesthesiology interns and CA-1 residents were trained on proper PPE donning and doffing for AGPs using a methodology based on Miller's pyramid and following a “knows-knows how-shows-does” progression. Participants donned PPE without instruction and were sprayed with Glo Germ® to identify areas of contamination, after which they received both video and in-person instruction on best practices for donning and doffing PPE for AGPs. Following instruction, they again donned PPE and were sprayed with Glo Germ® to identify areas of contamination. Results54 participants completed the study. Before training, overall donning compliance was 60% and overall doffing compliance was 48%. Overall, 70% were contaminated after PPE doffing, with 46% having multiple sites of contamination. After training, donning compliance increased by nearly 30% (P < 0.001), doffing compliance increased by over 20% (P < 0.001), and overall contamination decreased by nearly 30% (P = 0.029), with multiple-site contamination decreasing to only 6% (P = 0.013). DiscussionWhile best methods for providing instruction regarding topics such as PPE donning and doffing have not yet been determined, we have demonstrated that the underlying knowledge base from medical school regarding proper donning and doffing for respiratory isolation is insufficient for preventing self-contamination, and that Miller's pyramid-based training using both video and in-person instruction combined with task execution by learners can improve compliance with PPE donning and doffing protocols and more importantly decrease skin contamination among a group of early training anesthesiology residents.

Effectiveness of structured teaching programme on knowledge and practice regarding donning and doffing of personal protective equipment among B.Sc. nursing students of college of nursing, RIMS, Imphal

Personal protective equipment referred to as 'PPE' is an equipment which is worn to minimize the exposure to hazards that cause serious workplace injuries and illness. It offers protection by preventing microorganism from contaminating hands, eyes, clothing, hair and shoes. PPE includes gloves, protective eye wear, apron, gown, boots/shoe cover, hair cover. PPE should be used by all health care providers, student nurses, laboratory staffs and family members who provide care to patients in situations where they are exposed to blood, body fluids, secretions or excretions.Emergent infectious diseases are a challenge to any health system. The current pandemic of the Coronavirus Diseases 2019 (COVID-19), caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), is the best recent example of this challenge. Originated in Wuhan, Hubei, china, in December 2019, this emerging infectious disease became a World Health Organization (WHO)-declared pandemic. Till May 13, 2020, this new infection has a worldwide distribution, with more than 4.34 million people infected and more than 296 thousand people dead.7

A cross-sectional study on knowledge, attitude, and practices of donning and doffing of personal protective equipment: an institutional survey on interns during the COVID-19 pandemic

Background: Personal protective equipment (PPE) is a physical barrier that healthcare workers (HCW) wear to stop the transmission of a pathogen from a pathologic specimen or a confirmed or suspected case. It prevents the spread of disease from patient to HCWs as well as the other way around. Eyewear, face shield, surgical mask, particulate respirators, glove, disposable gowns and boots, and head coverings are some examples of these physical barriers. The primary objective of the study is to assess the knowledge, attitude and practices (KAP) of interns towards appropriate use of PPE and secondary objective is to find the role of training on donning and doffing of PPE of interns towards appropriate use of PPE.Methods: This is an institutional based, analytical cross-sectional study. Data was collected from interns (n=130) posted in COVID-19 ward using a universal sampling method. A predesigned questionnaire was used for study. The data was analyzed using SPSS 26 trial versionResults: Interns were aware of the importance and criticality of donning and doffing procedure, overall level of KAP of donning and doffing of PPE were 96.90%, 73.10% and 86.20% respectively. We found that there was statistically significant mean difference between the KAP scores with respect to training of PPE.Conclusions: There were some gaps in KAP at institutional level among the interns with regards to donning and doffing of PPE during the beginning of this pandemic.

1922. Outbreak and Management of COVID-19 and Infection Prevention Control Practices at a Community Living Center in Veterans Administration Hospital, North Texas

Abstract Background The increase in SARS-CoV-2 cases due to the omicron wave led to significant utilization of healthcare resources and reduced acute care hospital beds at the Veterans Administration Hospital, North Texas Health Care System (VANTHCS). As a result, veterans with non-severe disease were managed at a VANTHCS community living center (CLC) during a COVID-19 outbreak. Methods Veterans residing at the CLC with laboratory-confirmed cases of SARS-CoV-2 (the virus that causes COVID-19) by polymerase chain reaction diagnosed from January 1 to February 15, 2022, were included in the descriptive analysis. We described resident characteristics and outcomes and infection control practices (IPC) implemented to control the outbreak. Resident data was ascertained from the COVID-19 facility dashboard and medical record system. Results From January 1–February 15, 2022, 33 adults residing at the CLC were diagnosed COVID-19. Most infections (93.9%) occurred between January 12–24 (figure 1). The median age was 76 years [interquartile range, 71–80 years] and 30 (90.9%) were men and 25 (75.8%) were white and 5 (15.2%) African American (table 1). Among the total cases, 9 (27.3%) resided in the dementia unit. Nineteen of 33 (57.6%) were asymptomatic. Overall, 28 (84.8%) were documented to be fully vaccinated against SARS-CoV-2 and 24 (72.7%) were boosted. Obesity, ischemic heart disease, chronic obstructive pulmonary disease, and stroke were the most common comorbidities. Residents were cohorted based on COVID-19 results. A multidisciplinary team was convened, and staff were fit tested for appropriate personal protective equipment (PPE) and received refresher training on hand hygiene, donning and doffing of PPE. Most residents were determined to have mild or moderate COVID-19 and managed at the CLC while 7 (21.2%) were hospitalized in the acute care hospital. For management of COVID-19, 11 (33.3%) received dexamethasone and 25 (75.8%) received remdesivir. Overall, 32 (97%) residents survived while one hospice resident was transferred to acute care and died; only 1 resident required ICU admission. Epidemic curve of laboratory-confirmed coronavirus disease 2019 (COVID-19) disease at a Community Living Center, Veterans Administration Hospital, North Texas Health Care System, January–February 2022. Table 1Epidemiological Characteristics, and Outcomes of Laboratory-confirmed COVID-19 cases (N=33)Abbreviation: BMI, body mass index; COPD, Chronic Obstructive Pulmonary Disease; ESRD, end stage renal disease1Other comorbidity (asthma n=1 and chronic liver disease n=2) Conclusion It is feasible to administer COVID-19 therapies to high-risk residents with mild-moderate disease in a CLC with a multidisciplinary team and IPC strategies. Disclosures All Authors: No reported disclosures.

Assessing knowledge and behavioral pattern of nurses working in wards of four major specialties in Colombo South Teaching Hospital during the COVID-19 outbreak

In the latter part of 2019, a severe respiratory disease was reported in China and was found to be an outbreak of Coronavirus. In March 2020, with the rapid increase of patients in many other countries, World Health Organization (WHO) declared COVID-19 as a pandemic. As one of the frontline workers providing care to patients with COVID-19, nurses are at risk of developing the illness, if not geared up with appropriate Personal Protective Equipment (PPE). The infected number would rise rapidly if no adequate knowledge on basic preventive measures or no appropriate behavior patterns are adopted by the nurses. A descriptive cross-sectional study was conducted from 1st to 31st December 2020, in Colombo South Teaching Hospital to assess knowledge and the impact of the pandemic on the behavioral pattern of nurses using a self-administered questionnaire. The total number of nurses who responded to the study was 155. Study indicates that nurses have sufficient knowledge of COVID-19, its contagiousness, transmission, prevention, and educating patients. The measures taken by the administration along with the relevant authorities in the institution during the initial phase of the pandemic were helpful to acquire such knowledge. Comprehensive training on donning and doffing of PPEs and other infection prevention practices is recommended as a Continuous Professional Development program.

Attitude of the Dental Undergraduate Students and Interns towards Dentistry Post COVID-19

Abstract Introduction The period of coronavirus disease 19 (COVID-19) is a significant period from various aspects such as world health and socioeconomic considerations. The majority of the hospitals involved in dental education had previously limited their clinical practices to dental emergencies, but now are geared up for nonemergent conditions. As teaching modalities shifted to online platforms, students have reported to be anxious with regard to accomplishment of required clinical skills, patient care, and forthcoming graduation. Fresh graduates have reported a delay in the drive, which they would have been able to achieve in the initial stages of their profession. Objectives To assess the attitude of the dental undergraduate students and interns toward dentistry post-COVID-19. Results The majority (80.2%) were prepared for the challenges lying ahead before beginning to work on patients. Also, 16% were willing to treat patients, 28% did not want to treat patients, while 44% were willing to handle emergency cases. Next, 67.8% were scared of infecting themselves while administering dental treatment and 78.9% were concerned that there could be more such pandemics. In total, 21.6% of the respondents who wished that they chose an alternate profession whereas 70.5% of participants felt that the scope of dentistry has not diminished. Also, 90.7% were interested to pursue postgraduation, and 86.3% felt that this was a passing phase and things would be normalized soon. Conclusion With second and third waves being rampant, novel coronavirus has become a public health crisis. Because dental services cannot be stopped for a long time, it is essential for dental students to be well trained to limit the spread of the disease. Owing to the present scenario, appropriate donning and doffing of PPE (personal protective equipment) is a pivotal step in direct patient care, and simulation-based training may help ensure that these skills are acquired by them.

Impact of Non-Face-to-Face Teaching with Passive Training on Personal Protective Equipment Use in Health Science Students: A Randomized Controlled Trial.

Background: In the COVID-19 era, there was a call for the transformation of higher education. Universities had to combine non-face-to-face teaching with traditional procedures. This study analyzed the effectiveness and perceived satisfaction in a cohort of health sciences students of non-face-to-face teaching with passive training versus face-to-face teaching with active training in the proper donning and doffing of personal protective equipment (PPE) in a clinical simulation scenario. Methods: A total of 142 participants were randomized into two groups: (a) non-face-to-face teaching with passive training; (b) face-to-face teaching with active training. The proper protocol for donning and doffing PPE was assessed. Students evaluated their skills before and after training and satisfaction with training received. Results: Significant differences were observed for the statements “I felt more confident in donning after receiving this training” (p = 0.029) and “I felt more confident in doffing after receiving this training” (p = 0.042) in the face-to-face teaching with active training group compared to the non-face-to-face teaching with passive training group, whose number of tasks violated was significantly higher (p = 0.020). Satisfaction was significantly higher in the face-to-face and active training group (p = 0.004). Conclusions: Face-to-face teaching with active training improves effectiveness and satisfaction more than non-face-to-face teaching with passive training for acquiring skills in donning and doffing PPE properly.

A two-ward acute care hospital outbreak of SARS-CoV-2 delta variant including a point-source outbreak associated with the use of a mobile vital signs cart and sub-optimal doffing of personal protective equipment

BackgroundWe conducted a detailed epidemiological investigation of a linked 2-ward COVID-19 Delta variant outbreak to elucidate its source, risk factors, and control measures.MethodsInvestigations included epidemiologic analysis, detailed case review serial SARS-CoV-2 RT-PCR testing of patients and healthcare workers (HCWs), viral culture, environmental swabbing, HCW-unaware personal protective equipment (PPE) audits, ventilation assessments, and the use of whole genome sequencing (WGS).ResultsThis linked 2-ward outbreak resulted in 17 patient and 12 HCW cases, despite an 83% vaccination rate. In this setting suboptimal adherence and compliance to PPE protocols, suboptimal hand hygiene, multi-bedded rooms, and a contaminated vital signs cart (VSC) with potential fomite or spread via the hands of HCWs were identified as significant risk factors for nosocomial COVID-19 infection.Sudden onset of symptoms, within 72h, was observed in 79% of all Ward 2 patients and 93% of all cases (patients and HCWs) on Ward 2 occurred within one incubation period, consistent with a point source outbreak. RT-PCR assays showed low Cycle threshold (Ct) values, indicating high viral load from environmental swabs including the VSC. WGS results with ≤ 3 SNP differences between specimens were observed.ConclusionsOutbreaks on both wards settled rapidly, within 3 weeks, using a ‘back-to-basics’ approach without extraordinary measures or changes to standard PPE requirements. Strict adherence to recommended PPE, hand hygiene, education, assistance from infected cases (interviews and testing), and additional measures such as limiting movement of patients and staff temporarily were all deemed to have contributed to prompt resolution of the outbreak.

Electronic monitoring of doffing using video surveillance to minimise error rate and increase safety at Howard Springs International Quarantine Facility

BackgroundSafe donning and doffing of personal protective equipment (PPE) are critical to prevent transmission of infectious diseases. Novel strategies to improve infection prevention and control (IPC) adherence can optimise safety. We describe and quantify video surveillance of doffing at an outdoor hotel quarantine facility led by the Australian Medical Assistance Team in the Northern Territory, Australia.MethodsMotion-activated video cameras were installed in seven areas where personnel doffed PPE upon exit from an area dedicated to quarantined residents. Video footage was reviewed daily and compliance issues were identified using a standardised checklist and risk graded to initiate feedback. We collated audit data from 1 February to 18 April 2021 to describe trends by month, staff group, doffing component and risk.ResultsIn 235 h of video footage, 364 compliance issues were identified, of which none were considered high-risk compromising to PPE integrity. Compliance issues were low risk (55/364, 15%) or moderate risk (309/364, 85%) and the most common issue was missed or inadequate hand hygiene (156/364, 43%). Compliance issues per minute of video footage reviewed decreased following introduction of the activity, from 24 per 1000 in February to 7 per 1000 in March and April.ConclusionVideo surveillance with feedback supported rapid response to improve IPC adherence in a challenging ambient environment. The activity focused on perfection to identify compliance issues that would go unreported in most healthcare settings and contributed to a suit of activities that prevented any high-risk PPE breaches or compromises to safety.

Compliance to donning and doffing of personal protective equipment among dental healthcare practitioners during the coronavirus pandemic: a quality improvement plan, do, study and act (PDSA) Initiative

IntroductionWith the emergence of SARS-Cov-2, the Centers for Disease Control and Prevention (CDC) defined mandatory guidelines for donning and doffing personal protective equipment (PPE) among dental healthcare professionals. The study’s...

Risk of self-contamination because of improper doffing of personal protective equipment: A randomised cross-over study.

Many health care staff have been pressed into coronavirus disease-19 patient care with little experience of working in bio-hazard zones because of the overwhelming requirements of manpower. They wear personal protective equipment (PPE) and follow all rules for their safety. However, despite precautions, during doffing, they carry a risk of self-contamination. This randomised cross-over study assessed the risk of self- contamination because of improper doffing of PPEs. A colourless lotion that glows with a bright-green fluorescent hue under ultraviolet light was applied to simulate germ contamination in various health care workers (HCWs) who volunteered for the study. The primary objective of this study was to know the percentage of HCWs getting self-contaminated. The secondary objectives were to assess which portions of the body get maximally contaminated and infestation of germs on which portions of the PPE carry more risk of self-contaminating after doffing. A total of 152 doffings by 76 participants were analysed, and the volunteers self-contaminated in 43 doffings (28.28%). In 18 of these 43 doffings, self-contamination was noted at more than one location. The most commonly contaminated areas were the arms (33%), clothes on the abdomen (24%), and areas in the lower limb (23%). Germ infestation on the upper parts of a PPE is 2.39 times more likely to cause self-contamination after improper doffing. Faulty doffing resulted in self-contamination in 28.28% of all doffings. Risk is 2.39 times more when germs are nested in the upper body portions of the PPE suit.

Effects of Long-Duration Wearing of Personal Protective Equipment with N95 Masks on Blood Oxygen Concentration and Pulse Rate Among Dental Professionals

Background: The importance of personal protective equipment (PPE) for health-care professionals working in an infective environment has been highlighted again in this COVID pandemic. CDC recommends the use of PPE with FFp2/N95 wear in dental health professionals. There are studies revealing the varied physiological as well as psychological impact of long-duration wear of PPE in health professionals. This study aims to evaluate the effects of wearing PPE with N95 mask before donning and after doffing (for 4 h) on the oxygen saturation levels and pulse rate. Materials and Methods: Forty dental surgeons of both sexes with informed consent working at a government dental college, in Kerala, were studied by a standard pulse oximetry test for oxygen saturation and pulse rate before donning and after doffing of PPE with FFP2/N95 respirator over 4 h duration. They were ensured to be hemodynamically stable, breathing room air under standard room temperature, and humidity. Data were entered and evaluated using a standard paired t-test using SPSS version 20. Results: The mean age group of the dental surgeons was 39 ± 9 years, and 60% were male. The mean values of oxygen saturation before donning and after doffing were 97.6 (1.1) and 96.7 (1.2), respectively, and the difference was significant (P &lt; 0.01). The pulse rate before donning and after doffing was found to be 79.7 (6.7) and 81.2 (6.7), respectively, with significance (P &lt; 0.01). However, the difference was not significant according to gender or age groups. Conclusion: The decrease in oxygen saturation and an increase in heart rate among dental surgeons were found to be significant after 4 h wear of PPE with FFP2 respirator. Nevertheless, these data of physiological impact of PPE cannot overshadow the risk-benefit ratio of PPE wear. The cautious use of PPE with improved technology can mitigate the risks involved in its use.

중소병원 간호사의 급성 호흡기 감염병 관련 개인보호장비에 대한 지식, 태도 및 착탈 수행도

This study was conducted to investigate the correlation between knowledge, attitude, performance of donning and doffing of personal protective equipment related to acute respiratory infectious diseases for nurses working in small and medium-sized hospitals. The survey was conducted on 159 nurses working at four small and medium hospitals with less than 300 beds located in B city, from august 10, 2021 to september 7. The collected data were analyzed using the SPSS program. The averages of knowledge, attitude, and performance of donning and doffing of personal protective equipment were 14.13±2.22, 3.98±0.56, and 4.30±0.56, respectively. Attitude showed a significant positive correlation with the performance of donning and doffing(r=.27, p&lt;.001), knowledge did not show a significant correlation with attitude(r=.13, p=.089) and performance of donning and doffing(r=.13, p=.091). As a result of this study, periodic education and simulated training for each situation should be conducted rather than once in order to improve the performance of donning and doffing of nurses in small and medium hospitals on personal protective equipment.

Effectiveness and Utility of Virtual Reality Infection Control Simulation for Children With COVID-19: Quasi-Experimental Study.

BackgroundIt is essential that nurses quickly learn the proper methods for preventing and controlling nosocomial infection and managing intensive care patients during the COVID-19 pandemic, including the donning and doffing of personal protective equipment (PPE). Virtual reality (VR) simulation offers the advantage of learning in a safe environment with a sense of realism similar to that of an actual clinical setting and has been reported to enhance self-efficacy in infection control, safety performance, and learning satisfaction among students.ObjectiveThis study aims to develop a virtual reality infection control simulation (VRICS) program regarding donning and doffing of PPE and respiratory care for pediatric patients admitted to an isolation unit for COVID-19 and to identify the effects of the program on PPE knowledge, infection control performance, and self-efficacy for nursing students. Additionally, the realism of the VRICS program and the students’ level of satisfaction with the program were assessed.MethodsThis was a quasi-experimental study based on a controlled pretest-posttest design. Third- and fourth-year nursing students were divided into an experimental group (n=25) who participated in a VRICS program and a control group (n=25) with no participation. Data were collected from November 13 to December 10, 2021, and analyzed using descriptive statistics and the t test, paired t test, Mann-Whitney U test, and Wilcoxon matched-pair signed-rank test. The VRICS program consisted of a prebriefing, including direct practice of donning and doffing PPE, VR simulation, and debriefing. The VR simulation comprised 3 sessions: donning and inspection of PPE in the dressing room before entering the negative-pressure isolation unit; assessing for suction care, nasopharyngeal suctioning, and checking of COVID-19 patients in the negative-pressure isolation unit; and doffing PPE in the dressing room. The total execution time for the program was 180 min.ResultsCompared with the control group, the experimental group showed significantly greater improvements in PPE knowledge (z=–3.28, P<.001), infection control performance (t48=4.89, P<.001), and self-efficacy (t36.2=4.93, P<.001). The experimental group’s mean scores for realistic immersion and learner satisfaction were 4.49 (SD 0.50) points and 4.75 (SD 0.38) points (on a 5-point Likert scale), respectively.ConclusionsThe VR simulation training program involving pediatric COVID-19 patients combined skills training effectively and enhanced theoretical knowledge, respiratory care skills, and infectious disease preparedness. Thus, it could be applied to training nurses to respond more effectively to public health situations involving infectious diseases, including the COVID-19 pandemic.