Donning Of Personal Protective Equipment Research Articles

Infection Risks Faced by Public Health Laboratory Services Teams When Handling Specimens Associated With Coronavirus Disease 2019 (COVID-19).

Infection risks of handling specimens associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by public health laboratory services teams were assessed to scrutinize the potential hazards arising from the work procedures. Through risk assessments of all work sequences, laboratory equipment, and workplace environments, no aerosol-generating procedures could be identified except the procedures (mixing and transfer steps) inside biological safety cabinets. Appropriate personal protective equipment (PPE) such as surgical masks, protective gowns, face shields/safety goggles, and disposable gloves, together with pertinent safety training, was provided for laboratory work. Proper disinfection and good hand hygiene practices could minimize the probability of SARS-CoV-2 infection at work. All residual risk levels of the potential hazards identified were within the acceptable level. Contamination by gloved hands was considered as a major exposure route for SARS-CoV-2 when compared with eye protection equipment. Competence in proper donning and doffing of PPE accompanied by hand washing techniques was of utmost importance for infection control.

Problems and solutions of personal protective equipment doffing in COVID-19.

The progress of the coronavirus disease 2019 (COVID-19) pandemic is still severe. While everyone has been striving very hard to combat the pandemic, some healthcare professionals have shown varying degrees of infection symptoms and even died. The Chinese Army Medical Aid Team arrived in Wuhan on January 25, 2020, and quickly entered the battle against the pandemic after a short and rigorous training. As one of the earliest medical teams to enter the pandemic area, researchers have been exploring effective infection control measures that are currently in practice. Through observation and research, it has been noticed that layers of protective equipment have a hidden danger of infection while protecting the safety of the personnel. The members of each medical team have typically focused on the standard use of personal protective equipment (PPE). However, after a long period of intensive diagnosis and treatment in clinics and due to physical exertion and tiredness, problems such as improper operation are prone to occur during the tedious PPE doffing, thereby producing a relatively high risk of infection. This study primarily analyzes PPE doffing procedures, existing problems, and measures for improvement to explore methods to improve PPE donning and doffing and reduce the risk of infection.

How to Manage Pediatric Orthopaedic Patients: Strategies to Provide Safer Care During the COVID-19 Outbreak in Wuhan, People's Republic of China.

How to Manage Pediatric Orthopaedic Patients: Strategies to Provide Safer Care During the COVID-19 Outbreak in Wuhan, People's Republic of China.

Intensive Care Unit Setup for COVID-19

The coronavirus pandemic has become a challenge to all the healthcare systems in the world. Urgent creation of an intensive care unit (ICU) for the same is the need of the hour. The ideal ICU for COVID -19 should be isolated, fully equipped with invasive and noninvasive monitoring, with 24/7 trained medical personnel, nursing staff and laboratory support. As the coronavirus infection is transmitted by droplets and is highly contagious, protection of healthcare workers is crucial. Personnel working inside the ICU should get personal protective equipment (PPE). Strict guidelines for donning and doffing of PPE should be followed to prevent cross-contamination. Respiratory failure being the commonest complication of COVID-19, knowing the ventilator management for the same is essential. It is of great importance to meticulously manage all the resources to combat this contagion.

Teaching Adequate Prehospital Use of Personal Protective Equipment During the COVID-19 Pandemic: Development of a Gamified e-Learning Module.

BackgroundThe coronavirus disease (COVID-19) pandemic has led to increased use of personal protective equipment (PPE). Adequate use of this equipment is more critical than ever because the risk of shortages must be balanced against the need to effectively protect health care workers, including prehospital personnel. Specific training is therefore necessary; however, the need for social distancing has markedly disrupted the delivery of continuing education courses. Electronic learning (e-learning) may provide significant advantages because it requires neither the physical presence of learners nor the repetitive use of equipment for demonstration.ObjectiveInclusion of game mechanics, or “gamification,” has been shown to increase knowledge and skill acquisition. The objective of this research was to develop a gamified e-learning module to interactively deliver concepts and information regarding the correct choice and handling of PPE.MethodsThe SERES framework was used to define and describe the development process, including scientific and design foundations. After we defined the target audience and learning objectives by interviewing the stakeholders, we searched the scientific literature to establish relevant theoretical bases. The learning contents were validated by infection control and prehospital experts. Learning mechanics were then determined according to the learning objectives, and the content that could benefit from the inclusion of game mechanics was identified.ResultsThe literature search resulted in the selection and inclusion of 12 articles. In addition to gamification, pretesting, feedback, avoiding content skipping, and demonstrations using embedded videos were used as learning mechanics. Gamification was used to enhance the interactivity of the PPE donning and doffing sequences, which presented the greatest learning challenges. The module was developed with Articulate Storyline 3 to ensure that it would be compatible with a wide array of devices, as this software generates HTML5-compatible output that can be accessed on smartphones, tablets, and regular computers as long as a recent browser is available.ConclusionsA gamified e-learning module designed to promote better knowledge and understanding of PPE use among prehospital health care workers was created by following the SERES framework. The impact of this module should now be assessed by means of a randomized controlled trial.

Lasting lessons learnt in the radiology department from the battle with COVID-19

Lasting lessons learnt in the radiology department from the battle with COVID-19

A Practical Guide to a Safe Sequence of Donning and Doffing of Personal Protective Equipment in Relation to COVID-19

When caring for patients with suspected or confirmed COVID-19 (coronavirus disease 2019), especially when involved in procedures that generate aerosol, personal protective equipment (PPE) with full-body coverage is recommended. The Centers for Disease Control and Prevention emphasizes and recommends the following principles with regard to donning and doffing of PPE: (1) training and education (rigorous and repeated training of the health care workers [HCWs]), (2) all HCWs must exhibit competency in the PPE donning and doffing, and (3) PPE doffing should be done in a manner that prevents self-contamination or self-inoculation with contaminated PPE or hands (remove the most contaminated PPE items first, perform hand hygiene at each stage of doffing, and discard disposable items in containers for biomedical waste).

Tracheotomy in Ventilated Patients With COVID-19.

Tracheotomy in Ventilated Patients With COVID-19.

Surgical Infection Society Guidance for Operative and Peri-Operative Care of Adult Patients Infected by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2).

Background: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-associated viral infection (coronavirus disease 2019, COVID-19) is a virulent, contagious viral pandemic that is affecting populations worldwide. As with any airborne viral respiratory infection, surgical and non-surgical patients may be affected. Methods: Review and synthesis of pertinent English-language literature pertaining to COVID-19 infection among adult patients. Results: COVID-19 disease that requires hospitalization results in critical illness approximately 25% of the time and requires mechanical ventilation with positive airway pressure. Acute kidney injury, a marked hypercoagulable state, and sometimes myocarditis can be features of COVID-19 in addition to the characteristic severe acute lung injury. Even if not among the most seriously afflicted, older patients with medical comorbidities are both predisposed to infection and risk increased morbidity and mortality, however, all persons presenting for surgical intervention should be suspected of infection (and thus transmissibility) even if asymptomatic. Although most elective surgery has been curtailed by administrative or governmental fiat, patients will still need urgent or emergency operative intervention for time-sensitive disease processes such as malignant neoplasia or for true emergencies such as perforated viscus or traumatic injury. It is possible to provide safe surgical care for SARS-CoV-2-positive patients and minimize nosocomial transmission to healthcare workers. Conclusions: This guidance will facilitate appropriate protection of patients and staff, and maintenance of infection control measures to assist surgical personnel and facilities to prepare for COVID-19-infected adult patients requiring urgent or emergent operative intervention and to provide optimal patient care.

A Randomized Trial of Instructor-Led Training Versus Video Lesson in Training Health Care Providers in Proper Donning and Doffing of Personal Protective Equipment.

This study compared live instructor-led training with video-based instruction in personal protective equipment (PPE) donning and doffing. It assessed the difference in performance between (1) attending 1 instructor-led training session in donning and doffing PPE at 1 month prior to assessment, and (2) watching training videos for 1 month. This randomized controlled trial pilot study divided 21 medical students and junior doctors into 2 groups. Control group participants attended 1 instructor-led training session. Video group participants watched training videos demonstrating the same procedures, which they could freely watch again at home. After 1 month, a doctor performed a blind evaluation of performance using checklists. Nineteen participants were assessed after 1 month. The mean donning score was 84.8/100 for the instructor-led group and 88/100 for the video group; mean effect size was 3.2 (95% CI: -7.5 to 9.5). The mean doffing score was 79.1/100 for the instructor-led group and 73.9/100 for the video group; mean effect size was 5.2 (95% CI: -7.6 to 18). Our study found no significant difference in donning and doffing scores between instructor-led and video lessons. Video training could be a fast and resource-efficient method of training in PPE donning and doffing in responding to the COVID-19 pandemic.

A Cross-Sectional Study on Knowledge, Attitude, and Practices of Donning and Doffing of Personal Protective Equipment: An Institutional Survey of Health-Care Staff during the COVID-19 Pandemic.

Background:Personal protective equipment (PPE) is used to protect the health-care professional from bacterial, viral, or other hazards during this COVID-19 pandemic, and they should be made aware of proper usage of this equipment.Aims:The aim was to evaluate how adequate knowledge, attitude, and practices (KAP) of health-care worker toward the appropriate use of PPE, which can prevent them and the community from virus contamination.Methodology:This study was conducted in a tertiary care hospital during the COVID-19 pandemic in a span of approximately 50 days. This cross-sectional questionnaire-based survey was done in 155 health-care providers posted in the COVID-19 area.Statistical Analysis:Data were described in terms of range; mean ± standard deviation, frequencies (number of cases) and relative frequencies (percentages) as appropriate.Results:Health-care workers (HCWs) were aware of the importance and criticality of donning and doffing procedure, but they lack the knowledge about dispersion of virus as 62% responded that virus dispersion occurs more during donning than doffing. Gaps were found in attitude as 51% of HCWs found it inconvenient to don PPE that they sometimes think of compromising their own safety. Nearly 33.5% of HCWs move out of the doffing area without removing gloves and N-95, which needs serious correction in their practice.Conclusion:There were major gaps in KAP at institutional level among the health-care providers with regard to donning and doffing of PPE during the beginning of this pandemic.

Effects of Donning and Wearing Personal Protective Equipment on Tourniquet Use and Conversion.

We sought to gather data about the effects of personal protective equipment (PPE) use on tourniquet interventions by preliminarily developing a way to simulate delay effects, particularly on time and blood loss. Such knowledge might aid readiness. Field calls to emergency departments may indicate donning of PPE before patient arrival. The purpose of this study was to investigate (1) delay effects of donning the PPE studied on field-tourniquet control of hemorrhage and (2) delay effects of wearing the PPE on application of a field tourniquet and its conversion to a pneumatic tourniquet. The experiment simulated 30 tests of nonpneumatic field tourniquet use (http://www.combattourniquet.com/wp -content). The research intervention was the use of PPE. Data were grouped. The control group had no PPE (PPE0). PPE1 and PPE2 groups had mostly improvised and off-the-shelf equipment, respectively. PPE1 included donning a coat, goggles, face covering, cap, booties, and gloves. PPE2 had analogous items. The group order was randomized. A test included paired trials: field tourniquet, followed by conversion. An investigator simulated the caregiver. A task trainer simulated a thigh amputation. Donning delays were evaluated as differences in mean times to stop bleeding compared with PPE0. Blood loss results from donning PPE were calculated as the delay multiplied by its bleeding rate, 500mL/min. PPE0 had no delay: its mean blood loss was 392mL. PPE1 had 805mL more blood loss than PPE0 did. PPE2 exceeded PPE0 by 1004mL. Donning time (blood loss) for PPE1 and PPE2 were 1.4 minutes (712mL) and 1.7 minutes (863mL), respectively. The wearing of PPE did not slow down field tourniquet application or its conversion. How long it took to don PPE delayed the time to stop bleeding and increased blood loss, but wearing PPE slowed down neither field tourniquet application nor its conversion.

Infection Control in Operating Rooms during COVID 19 Viral Pandemic. A Narrative Review

Health care workers and in specific Anesthesiologists are prone to the risk of infection particularly during aerosol-generating procedures as air way management or high flow nasal oxygen therapy for very sick patients. Personal protective equipment (PPE) and appropriate face masks are essential when managing COVID 19 virus infected patients. Droplet and aerosol transmission is considered the main method for contracting this virus infection. Decontamination of disposables and the proper donning and doffing of PPE will help reduce future viral outbreaks in the medical facilities.

All India difficult airway association (AIDAA) consensus guidelines for airway management in the operating room during the COVID-19 pandemic.

Severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) which causes coronavirus disease (COVID-19) is a highly contagious virus. The closed environment of the operation room (OR) with aerosol generating airway management procedures increases the risk of transmission of infection among the anaesthesiologists and other OR personnel. Wearing complete, fluid impermeable personal protective equipment (PPE) for airway related procedures is recommended. Team preparation, clear methods of communication and appropriate donning and doffing of PPEs are essential to prevent spread of the infection. Optimal pre oxygenation, rapid sequence induction and video laryngoscope aided tracheal intubation (TI) are recommended. Supraglottic airways (SGA) and surgical cricothyroidotomy should be preferred for airway rescue. High flow nasal oxygen, face mask ventilation, nebulisation, small bore cannula cricothyroidotomy with jet ventilation should be avoided. Tracheal extubation should be conducted with the same levels of precaution as TI. The All India Difficult Airway Association (AIDAA) aims to provide consensus guidelines for safe airway management in the OR, while attempting to prevent transmission of infection to the OR personnel during the COVID-19 pandemic.

Practices and Barriers for Personal Protective Equipment among Health Care Workers during COVID-19 Pandemic Management at Tertiary Care Government Hospital of South Gujarat, India

Introduction: The recent COVID-19 pandemic has prompted concern about the compatibility of IPC guidelines with health care workers, their working practices and behaviours. These guidelines can be difficult and time-consuming to adhere to in practice. By identifying barriers and facilitators to IPC guideline adherence, especially using personal protective equipment (PPE), we can identify focussed strategies that will support health care workers to undertake the IPC measures needed at such a critical time in health care internationally. Material & Methods: This was a cross-sectional study designed during the COVID-19 pandemic management in the South Gujarat region, to analyse the knowledge, attitude and practices of health care workers about their usage of personal protective equipment. A semi-structured questionnaire-based study was prepared, deriving pointers from our previous experience of seasonal flu outbreaks. 225 participants enrolled who were doctors, resident doctors, nurses, lab technicians, ward boys and food distributors. Result: Analysis of the barriers-related questions show good preparedness by the medical institution. Overall we found good knowledge, attitude and practice related to PPE during COVID-19 pandemic management. There are few gaps found in the knowledge of donning of PPE (p-0.0075), N-95 mask related knowledge (p-0.01) and the attitude that PPE use causes discomfort while nursing patients (0.0001).

Effectiveness of a multisite personal protective equipment (PPE)-free zone intervention in acute care.

Determine the effectiveness of a personal protective equipment (PPE)-free zone intervention on healthcare personnel (HCP) entry hand hygiene (HH) and PPE donning compliance in rooms of patients in contact precautions. Quasi-experimental, multicenter intervention, before-and-after study with concurrent controls. All patient rooms on contact precautions on 16 units (5 medical-surgical, 6 intensive care, 5 specialty care units) at 3 acute-care facilities (2 academic medical centers, 1 Veterans Affairs hospital). Observations of PPE donning and entry HH compliance by HCP were conducted during both study phases. Surveys of HCP perceptions of the PPE-free zone were distributed in both study phases. A PPE-free zone, where a low-risk area inside door thresholds of contact precautions rooms was demarcated by red tape on the floor. Inside this area, HCP were not required to wear PPE. We observed 3,970 room entries. HH compliance did not change between study phases among intervention units (relative risk [RR], 0.92; P = .29) and declined in control units (RR, 0.70; P = .005); however, the PPE-free zone did not significantly affect compliance (P = .07). The PPE-free zone effect on HH was significant only for rooms on enteric precautions (P = .008). PPE use was not significantly different before versus after the intervention (P = .15). HCP perceived the zone positively; 65% agreed that it facilitated communication and 66.8% agreed that it permitted checking on patients more frequently. HCP viewed the PPE-free zone favorably and it did not adversely affect PPE or HH compliance. Future infection prevention interventions should consider the complex sociotechnical system factors influencing behavior change.

A Study on the Process of Donning and Doffing Personal Protective Equipment of Health Care Workers (HCWs) in China

Introduction:Personal protective equipment (PPE) is a necessary item in the period of unknown and high risk emerging infectious disease. It is not only the necessary requirement of strict isolation but also the last line of defense to protect medical staff.Aim:To determine the frequency and sites of contamination of personnel during the process of using Chinese PPE.Methods:Recruit 56 health care workers (HCWs) who worked in front-line clinical to test PPE issued by the Chinese Center for Disease Control for preventing Ebola virus. Eight batches of HCWs were divided to conduct simulations of contaminated PPE removal using fluorescent lotion. Then the frequency and sites of contamination of personnel were recorded after removal of contaminated PPE. The method of visual observation was used to determine contamination.Results:The frequency of easily contaminated parts included: left hand and wrist (7 times), left calf (7 times), front chest center, left and right chest (6 times each), and left abdomen (5 times). Mistakes in the process of wearing PPE included: clothing touching the ground (20.00%), N95 air mask tightness not checked (13.33%), glove air-tightness not checked (4.44%), protective clothing zipper not checked (4.44%). Mistakes in doffing PPE included: clothes touching the ground or the inner surface is polluted (20.00%), the wrong method of removing N95 mask (14.44%), touching the pollution goggles mirror with hands (12.22%), incomplete washing steps, insufficient time and frequency of hand hygiene (11.11%).Discussion:It is necessary to carry out training on PPE donning and doffing for Chinese medical workers.

Comparing Training Techniques in Chemical Disaster Preparedness

Introduction:Currently, there are no universally accepted personal protective equipment (PPE) training guidelines for Emergency Medicine physicians, though many hospitals offer training through a brief didactic presentation. Physicians’ response to hazmat events requires PPE utilization to ensure the safety of victims, facilities, and providers; providing effective and accessible training is crucial. In the event of a real disaster, time constraints may not allow a brief in-person presentation and an accessible video training may be the only resource available.Aim:To assess the effectiveness of video versus in-person training of 20 Emergency Medicine Residents in Level C PPE donning and doffing (chemical-resistant coverall, butyl gloves, boots, and an air-purifying respirator).Methods:A prospective observational study was performed with 20 Emergency Medicine residents as part of Emergency Preparedness training. Residents were divided into two groups, with Group A viewing a demonstration video developed by the emergency preparedness team, and Group B receiving in-person training by a Hazmat Team Member. Evaluators assessed critical tasks of donning and doffing PPE utilizing a prepared evaluation tool. At the drill’s conclusion, all participants completed a self-evaluation to determine their confidence in their respective trainings.Results:Both video and in-person training modalities showed significant improvement in participants’ confidence in doffing and donning a PPE suit (p>0.05). However, no statistically significant difference was seen between training modalities in the performance of donning or doffing (p>0.05).Discussion:Video and in-person training are equally effective in preparing residents for donning and doffing Level C PPE, with similar error rates in both modalities. Future trainings should focus on decreasing the overall rate of breaches across all training modalities.

Self-contamination during doffing of personal protective equipment by healthcare workers to prevent Ebola transmission

BackgroundHealthcare workers (HCWs) use personal protective equipment (PPE) in Ebola virus disease (EVD) situations. However, preventing the contamination of HCWs and the environment during PPE removal crucially requires improved strategies. This study aimed to compare the efficacy of three PPE ensembles, namely, Hospital Authority (HA) Standard Ebola PPE set (PPE1), Dupont Tyvek Model, style 1422A (PPE2), and HA isolation gown for routine patient care and performing aerosol-generating procedures (PPE3) to prevent EVD transmission by measuring the degree of contamination of HCWs and the environment.MethodsA total of 59 participants randomly performed PPE donning and doffing. The trial consisted of PPE donning, applying fluorescent solution on the PPE surface, PPE doffing of participants, and estimation of the degree of contamination as indicated by the number of fluorescent stains on the working clothes and environment. Protocol deviations during PPE donning and doffing were monitored.ResultsPPE2 and PPE3 presented higher contamination risks than PPE1. Environmental contaminations such as those originating from rubbish bin covers, chairs, faucets, and sinks were detected. Procedure deviations were observed during PPE donning and doffing, with PPE1 presenting the lowest overall deviation rate (%) among the three PPE ensembles (p < 0.05).ConclusionContamination of the subjects’ working clothes and surrounding environment occurred frequently during PPE doffing. Procedure deviations were observed during PPE donning and doffing. Although PPE1 presented a lower contamination risk than PPE2 and PPE3 during doffing and protocol deviations, the design of PPE1 can still be further improved. Future directions should focus on designing a high-coverage-area PPE with simple ergonomic features and on evaluating the doffing procedure to minimise the risk of recontamination. Regular training for users should be emphasised to minimise protocol deviations, and in turn, guarantee the best protection to HCWs.

Risk of self-contamination during doffing of personal protective equipment

The aim of this study was to describe the risk of self-contamination associated with doffing of personal protective equipment (PPE) and to compare self-contamination with various PPE protocols. We tested 10 different PPE donning and doffing protocols, recommended by various health organizations for Ebola. Ten participants were recruited for this study and randomly assigned to use 3 different PPE protocols. After donning of PPE, fluorescent lotion and spray were applied on the external surface of the PPE to simulate contamination, and ultraviolet light was used to count fluorescent patches on the skin. After testing 30 PPE sequences, large fluorescent patches were recorded after using "WHO coverall and 95" and "North Carolina coverall and N95" sequences, and small patches were recorded after using "CDC coverall and N95" and "Health Canada gown and N95" sequences. Commonly reported problems with PPE use were breathing difficulty, suffocation, heat stress, and fogging-up glasses. Most participants rated PPE high (18/30) or medium (11/30) for ease of donning/doffing and comfort. PPE sequences with powered air-purifying respirators (PAPRs) and assisted doffing were generally associated with fewer problems and were rated the highest. This study confirmed the risk of self-contamination associated with the doffing of PPE. PAPR-containing protocols and assisted doffing should be preferred whenever possible during the outbreak of highly infectious pathogens.