Impact Of Personal Protective Equipment Research Articles

Impact of personal protective equipment on prehospital endotracheal intubation performance in simulated manikin

BackgroundTracheal intubation in COVID-19 patients is a potentially high-risk procedure for healthcare professionals. Personal protective equipment (PPE) is recommended to minimize contact with critical patients with COVID-19 infection. This study aimed to primarily examine the effect of PPE use on intubation time and success rate among prehospital healthcare professionals; additionally, we compared intubation times among prehospital health care professionals using PPE with direct laryngoscopy and video laryngoscopy assistance. MethodsIn this prospective simulation study, we compared the intubation times and success rates among prehospital healthcare professionals who were or were not using PPE. Furthermore, demographic data, previous intubation experience, and previous intubation experience with PPE were recorded. ResultsOverall time to intubation with PPE use was 51.28±3.89s, which was significantly higher than that without PPE use (33.03±2.65s; p<0.001). In addition, the overall success rate with PPE use was 74.4%, which was significantly lower than that without PPE use (93%;p<0.001). PPE use increased the average intubation time by 19.73±2.59s with direct laryngoscopy and by 16.81±2.86s with video laryngoscopy (p<0.001). ConclusionsPPE use is associated with increased intubation time and decreased success rate. Video laryngoscopy assistance in cases where PPE use is required facilitates faster endotracheal intubation than does direct laryngoscopy assistance.

Personal Protective Equipment in COVID-19: Impacts on Health Performance, Work-Related Injuries, and Measures for Prevention.

Objective:To assess impact of personal protective equipment (PPE) on healthcare providers (HCPs) in caring for COVID-19 patients.Methods:A cross-sectional survey was conducted over 50 hospitals in China. Descriptive analyses and Chi-square tests were performed on the collected data.Results:All 104 frontline HCPs report negative impacts of PPE on their clinical performance, 97% of them experienced discomfort and injuries caused by wearing PPE for long hours. Frontline HCPs provided suggestions to alleviate the negative impacts and to enhance communication between healthcare staff and patients. Two hundred eighty two non-frontline HCPs also revealed similar problems; however, we recorded a few discrepancies between answers given by frontline and non-frontline HCPs.Conclusions:Wearing PPE for long hours degrades health performance. Measures were suggested to improve the design of PPE for protecting HCPs and enhancing their services to COVID patients.

Bystanders are less willing to resuscitate out-of-hospital cardiac arrest victims during the COVID-19 pandemic

AimThe COVID-19 pandemic may influence the willingness of bystanders to engage in resuscitation for out-of-hospital cardiac arrest. We sought to determine if and how the pandemic has changed willingness to intervene, and the impact of personal protective equipment (PPE). MethodsWe distributed a 12-item survey to the general public through social media channels from June 4 to 23, 2020. We used 100-point scales to inquire about participants’ willingness to perform interventions on “strangers or unfamiliar persons” and “family members or familiar persons”, and compared mean willingness during time periods prior to and during the COVID-19 pandemic using paired t-tests. ResultsSurvey participants (n=1360) were from 26 countries; the median age was 38 years (IQR 24–50) and 45% were female. Compared to prior to the pandemic, there were significant decreases in willingness to check for breathing or a pulse (mean difference −10.7% [95%CI −11.8, −9.6] for stranger/unfamiliar persons, −1.2% [95%CI −1.6, −0.8] for family/familiar persons), perform chest compressions (−14.3% [95%CI −15.6, −13.0], −1.6% [95%CI −2.1, −1.1]), provide rescue breaths (−19.5% [95%CI −20.9, −18.1], −5.5% [95%CI −6.4, −4.6]), and apply an automated external defibrillator (−4.8% [95%CI −5.7, −4.0], −0.9% [95%CI −1.3, −0.5]) during the COVID-19 pandemic. Willingness to intervene increased significantly if PPE was available (+8.3% [95%CI 7.2, 9.5] for stranger/unfamiliar, and +1.4% [95%CI 0.8, 1.9] for family/familiar persons). ConclusionWillingness to perform bystander resuscitation during the pandemic decreased, however this was ameliorated if simple PPE were available.

Impact of personal protective equipment on the effectiveness of chest compression - A systematic review and meta-analysis.

Background and objectivesTo assess the impact of personal protective equipment (PPE) on different aspects of chest compression (CC) during cardiopulmonary resuscitation, we conducted this study.MethodsThis systematic review was performed according to the PRISMA. We searched PubMed, EMBASE and Web of Science from inception to June-6, 2020, limiting to the studies that reported the comparison of the effectiveness of CC in terms of CC rate, CC depth, the proportion of adequate CC rate, the proportion of adequate CC depth or proportion of adequate recoil; in study arms with or without PPE. Risk of bias was assessed by the ROB-2 and ROBINS-I tool. Quantitative data synthesis was done using the generic inverse variance method and the fixed-effects model.ResultsFive simulation-based studies were finally included. A Significant decrease in CC rate (SMD: -0.28, 95%CI: −0.47 to −0.10) and CC depth (SMD: -0.26, 95%CI: −0.44 to −0.07) were observed in the PPE arm as compared to the no-PPE arm. The difference in CC rate was more prominently seen in adult CPR than in paediatric CPR. Without PPE, the proportion of adequate CC rate delivered was 0.74, which reduced significantly to 0.60 after use of PPE (p − 0.035). Similarly, the proportion of adequate CC depth was significantly lesser (p − 0.001) in PPE arm (0.55), as compared to that of the no-PPE arm (0.78).ConclusionThe use of PPE compromises the quality of CC during CPR significantly, and newer ways to deliver chest compression has to be investigated.This study was prospectively registered in PROSPERO (CRD42020192031).

Impact of Personal Protective Equipment on Surgical Performance During the COVID-19 Pandemic.

BackgroundThe Severe Acute Respiratory Syndrome Coronavirus 2 pandemic has exposed surgeons to hazardous working conditions, imposing the need for personal protective equipment (PPE) use during surgery. The use of such equipment may affect their non-technical skills, augment fatigue, and affect performance. This study aimed to assess the surgeons’ perceptions of the impact of wearing PPE during emergency surgery throughout the pandemic.MethodsAn international cooperation group conducted an anonymous online survey among surgeons from over 30 countries, to assess perceptions about the impact of PPE use on non-technical skills, overall comfort, decision making, and surgical performance during emergency surgery on COVID-19 patients.ResultsResponses to the survey (134) were received from surgeons based on 26 countries. The vast majority (72%) were males. More than half of the respondents (54%) felt that their surgical performance was hampered with PPE. Visual impairment was reported by 63%, whereas 54% had communication impediments. Less than half (48%) felt protected with the use of PPE, and the same proportion perceived that the use of such equipment influenced their decision making. Decreased overall comfort was cited by 66%, and 82% experienced increased surgical fatigue.ConclusionsSurgeons perceived impediment for both visibility and communication, and other non-technical skills while using PPE on emergency surgery in COVID-19 patients. Their perceived lack of protection and comfort and increased fatigue may have inhibited their optimal surgical performance. More attention should be placed in the design of more user-friendly equipment, given the possibility of a second wave of the pandemic.

Impact of Personal Protective Equipment on the Performance of Emergency Pediatric Procedures by Prehospital Providers.

Personal protective equipment (PPE) is worn by prehospital providers (PHPs) for protection from hazardous exposures. Evidence regarding the ability of PHPs to perform resuscitation procedures has been described in adult but not pediatric models. This study examined the effects of PPE on the ability of PHPs to perform resuscitation procedures on pediatric patients. This prospective study was conducted at a US simulation center. Paramedics wore normal attire at the baseline session and donned full Level B PPE for the second session. During each session, they performed timed sets of psychomotor tasks simulating clinical care of a critically ill pediatric patient. The difference in time to completion between baseline and PPE sessions per task was examined using Wilcoxon signed-rank tests. A total of 50 paramedics completed both sessions. Median times for task completion at the PPE sessions increased significantly from baseline for several procedures: tracheal intubation (+4.5 s; P = 0.01), automated external defibrillator (AED) placement (+9.5 s; P = 0.01), intraosseous line insertion (+7 s; P < 0.0001), tourniquet (+8.5 s; P < 0.0001), intramuscular injection (+21-23 s, P < 0.0001), and pulse oximetry (+4 s; P < 0.0001). There was no significant increase in completion time for bag-mask ventilation or autoinjector use. PPE did not have a significant impact on PHPs performing critical tasks while caring for a pediatric patient with a highly infectious or chemical exposure. This information may guide PHPs faced with the situation of resuscitating children while wearing Level B PPE.

Impact of Personal Protective Equipment on the Performance of Emergency Pediatric Tasks.

Personal protective equipment (PPE) is worn by health care providers (HCPs) to protect against hazardous exposures. Studies of HCPs performing critical resuscitation tasks in PPE have yielded mixed results and have not evaluated performance in care of children. We evaluated the impacts of PPE on timeliness or success of emergency procedures performed by pediatric HCPs. This prospective study was conducted at 2 tertiary children's hospitals. For session 1, HCPs (medical doctors and registered nurses) wore normal attire; for session 2, they wore full-shroud PPE garb with 2 glove types: Ebola level or chemical. During each session, they performed clinical tasks on a patient simulator: intubation, bag-valve mask ventilation, venous catheter (IV) placement, push-pull fluid bolus, and defibrillation. Differences in completion time per task were compared. There were no significant differences in medical doctor completion time across sessions. For registered nurses, there was a significant difference between baseline and PPE sessions for both defibrillation and IV placement tasks. Registered nurses were faster to defibrillate in Ebola PPE and slower when wearing chemical PPE (median difference, -3.5 vs 2 seconds, respectively; P < 0.01). Registered nurse IV placement took longer in Ebola and chemical PPE (5.5 vs 42 seconds, respectively; P < 0.01). After the PPE session, participants were significantly less likely to indicate that full-body PPE interfered with procedures, was claustrophobic, or slowed them down. Personal protective equipment did not affect procedure timeliness or success on a simulated child, with the exception of IV placement. Further study is needed to investigate PPE's impact on procedures performed in a clinical care context.

Impact of Clinician Personal Protective Equipment on Medical Device Use During Public Health Emergency: A Review

The aim of this systematic review is to evaluate the impact of personal protective equipment (PPE) on medical device use during public health emergency responses. We conducted a systematic literature search of peer-reviewed journals in PubMed, Web of Science, and EBSCO databases. Twenty-nine of 92 articles published between 1984 and 2015 met the inclusion criteria for the review. Although many medical device use impacts were reported, they predominantly fell into 3 categories: airway management, drug administration, and diagnostics and monitoring. Chemical, biological, radiological, and nuclear (CBRN)-PPE increased completion times for emergency clinical procedures by as much as 130% and first attempt failure rates by 35% (anesthetist) versus 55% (non-anesthetist). Effects of CBRN-PPE use depend on device, CBRN-PPE level, and clinician experience and training. Continuous clinical training of responders in CBRN-PPE and device modifications can improve safety and effectiveness of medical device use during public health emergency response.

Impact of doffing errors on healthcare worker self-contamination when caring for patients on contact precautions.

We assessed the impact of personal protective equipment (PPE) doffing errors on healthcare worker (HCW) contamination with multidrug-resistant organisms (MDROs). Prospective, observational study. The study was conducted at 4 adult ICUs at 1 tertiary-care teaching hospital. HCWs who cared for patients on contact precautions for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococci, or multidrug-resistant gram-negative bacilli were enrolled. Samples were collected from standardized areas of patient body, garb sites, and high-touch environmental surfaces in patient rooms. HCW hands, gloves, PPE, and equipment were sampled before and after patient interaction. Research personnel observed PPE doffing and coded errors based on CDC guidelines. We enrolled 125 HCWs; most were nurses (66.4%) or physicians (19.2%). During the study, 95 patients were on contact precautions for MRSA. Among 5,093 cultured sites (HCW, patient, environment), 652 (14.7%) yielded the target MDRO. Moreover, 45 HCWs (36%) were contaminated with the target MDRO after patient interactions, including 4 (3.2%) on hands and 38 (30.4%) on PPE. Overall, 49 HCWs (39.2%) made multiple doffing errors and were more likely to have contaminated clothes following a patient interaction (risk ratio [RR], 4.69; P = .04). All 4 HCWs with hand contamination made doffing errors. The risk of hand contamination was higher when gloves were removed before gowns during PPE doffing (RR, 11.76; P = .025). When caring for patients on CP for MDROs, HCWs appear to have differential risk for hand contamination based on their method of doffing PPE. An intervention as simple as reinforcing the preferred order of doffing may reduce HCW contamination with MDROs.

The adverse impact of personal protective equipment on firefighters’ cognitive functioning

Firefighters wear Personal Protective Equipment (PPE) for protection from environmental hazards. However, due to the layers of protective functions, the PPE inevitably adds excessive weight, bulkiness, and thermal stress to firefighters. This study investigated the adverse impact of wearing PPE as an occupational stressor on the firefighter’s cognitive functioning. Twenty-three firefighters who had been involved in firefighting at least for 1 year were recruited. The overall changing trend in the firefighter’s cognitive functioning (short-term memory, long-term memory, and inductive reasoning) was measured by the scores of three standardized cognitive tests at the baseline and the follow-up, after participating in a moderate-intensity physical activity, wearing a full ensemble of the PPE. The study findings evinced the negative impact of the PPE on the firefighter’s cognitive functioning, especially in short-term memory and inductive reasoning. No significant influence was found on the firefighter’s long-term memory. The results were consistent when the participant’s age and BMI were controlled. The outcomes of the present study will not only fill the gap in the literature, but also provide critical justification to stakeholders, including governments, policymakers, academic communities, and industry, for such efforts to improve human factors of the firefighter’s PPE by realizing the negative consequences of the added layers and protective functions on their occupational safety. Study limitations and future directions were also discussed.

Impact of personal protective equipment on clinical output and perceived exertion

Background and aimSafe clinical care within Ebola Virus Disease Treatment Units (EVDTUs) mandate the use of personal protective equipment (PPE), comprising a fluid impermeable hooded suit, visor, gloves and rubber...

The impact of personal protective equipment and breathing apparatus on offshore lifeboat evacuation time

A primary objective of this study was to determine if the 15 minutes of air contained in an emergency breathing apparatus afforded sufficient time to carry out an evacuation from an offshore installation in the event of an uncontrolled hydrogen sulfide (H2S) release. Twenty-four male and 12 female volunteers performed relevant evacuation skills during a simulated evacuation into a 36-person lifeboat. An observational analysis and subjective ratings of difficulty were used to determine potential ergonomic and safety issues. Results indicate that even under the worst-case scenario, all personnel would be able to safely evacuate to the lifeboat and abandon the installation given similar conditions used during this study. It was noted however, that ergonomic improvements to the design of the personal protective and safety equipment could improve usability, thus decrease abandonment times.

Coronary Artery Calcification, ADMA, and Insulin Resistance in CKD Patients

It is known that coronary artery calcification (CAC) develops in chronic kidney disease (CKD) before initiation of renal replacement therapy, and factors associated with CKD mineral and bone disorders (CKD-MBDs) are involved. However, little information is available about any association between plasma levels of asymmetric dimethylarginine (ADMA), insulin resistance, and CAC. A total of 111 CKD patients (79 men, 32 women; glomerular filtration rate [GFR] median, 33.7 ml/min per 1.73 m(2)), free of cardiovascular disease, were consecutively recruited along with 30 age-matched healthy subjects. Coronary artery calcification scores (CACS) were measured by multidetector-row CT according to Agatston score. In CKD patients, CACS was distributed widely from 0 to 2901, while in age-matched, healthy control subjects (n = 30), CACS showed a range from 0 to 307. GFR had a significant negative correlation with CACS. Plasma ADMA levels were negatively correlated with GFR and positively correlated with CACS. When CACS was divided into quartiles (<50, n = 56; 50 to 300, n = 24; 300 to 600, n = 14; >600, n = 17), the patients with CACS >600 had significantly higher values of HOMA-IR, plasma ADMA levels, and fibrinogen along with serum levels of phosphorus, compared with those in patients having CACS <50. Multivariate regression analysis determined HOMA-IR as an independent contributing factor to CACS. CAC becomes more prevalent and severe with a decline in GFR, and plasma ADMA levels and insulin resistance, independent of factors associated with CKD-MBD, are correlated with CAC.