Personal Protective Equipment Procedures Research Articles

Effectiveness of Virtual Reality Training in Teaching Personal Protective Equipment Skills

Training on the proper use of personal protective equipment (PPE) is critical for infection prevention among health care workers. Traditional methods, such as face-to-face and video-based training, can strain resources and present challenges. To determine the effectiveness of 360° virtual reality (VR) training for PPE donning and doffing compared with face-to-face and video training in enhancing the PPE use skills of prospective health care practitioners. A blinded, prospective, and randomized noninferiority clinical trial was conducted from August to December 2021 at Teikyo University School of Medicine in Tokyo, Japan, with a mixed population of medical students. Participants were second- to fourth-year medicine, medical technology, or pharmacy students aged 20 years or older with no prior PPE training. Participants were randomized into 1 of 3 training groups (VR, face-to-face, or video) based on their enrollment order. An intention-to-treat analysis was conducted. A 30-minute lecture on PPE procedures was delivered to all participants before the training. After the lecture, the VR group trained with an immersive 360° VR tool, the face-to-face group trained with actual PPE, and the video group trained by watching video footage on a computer and a projector. After 3 days, a standardized practical skills test was administered. The primary outcome was the mean score on a 20-point practical skills test, and the secondary outcome was the percentage of correct execution. A total of 91 participants were recruited and randomized into 3 groups: VR (n = 30), face-to-face (n = 30), and video (n = 31) training. After excluding 1 participant due to illness, 90 participants (mean [SD] age, 24.2 [3.15] years; 54 males [60.0%]) completed the assessment. The mean (SD) scores were 17.70 (2.10) points for the VR group, 17.57 (2.45) points for the face-to-face group, and 15.87 (2.90) points for the video group. The VR group demonstrated no significant difference in performance from the face-to-face group. However, the VR group had significantly higher effectiveness than the video group (17.70 vs 15.87 points; P = .02). Results of this trial indicate that VR training was as effective as face-to-face training in enhancing PPE donning and doffing skills and was superior to video training. The findings suggest that VR training is a viable resource-conserving training option. Japan Registry of Clinical Trials Identifier: jRCT103021029.

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.

Single centre experience of 800 gynaecologic oncology cases in 2020: influence of pandemy on cancer surgeries

We aimed to evaluate the gynaecological oncology surgeries in the COVID-19 pandemic. A total of 800 operations performed between January and December 2020 were retrieved. Since the COVID-19 pandemic affected operations as of April 1 2020, we compared the cases of the last nine months of the year with the first three months. Of the operations, 265 (33.1%) were performed between January and March and 535 (66.9%) between April and December. Of 168 malignant operations; 78 (46%) were uterine cancer, 58 (35%) ovarian cancer, 28 (17%) cervical cancer and four (2%) vulvar cancer. If we compared the last nine months of the year with the first three months, a significant increase was observed in the rates of malignant and premalignant, while a significant decrease was detected in benign operations (p<.001). Gynaecological oncology surgeries performed with open or laparoscopic approaches during the COVID-19 pandemic should continue by taking preventive measures. Impact Statement What is already known on this subject? During the COVID-19 pandemic, many international associations and organisations recommended the suspension of elective surgeries. It is still controversial whether the gynaecologic oncology surgical procedures to be performed in this unprecedented time should be laparoscopic or laparotomic. What do the results of this study add? The malignant and premalignant gynaecological oncology surgeries should be safely performed laparoscopically or by laparotomy in the COVID-19 pandemic. What are the implications of these findings for clinical practice and/or further research? Gynaecologic oncology surgeries can be safely performed by attaching appropriate personal protective equipment procedures with pre-operative COVID-19 PCR testing in the COVID-19 era.

Hand Hygiene Compliance Behavior and Glove Use in the Pediatric Intensive Care Unit During COVID-19 Pandemic

Background: The condition of Covid-19 pandemic potentially influences hand hygiene compliance as aresult of workload changes, increased awareness of healthcare workers (HCWs) and personal protectiveequipment procedures, especially in terms of hand glove use,Objective to know the adherence of healthcare workers at the pediatric intensive care unit (PICU) to complywith hand hygiene and glove use during the pandemic.Methods An observational prospective study was carried out including all HCWs stationed at the PICU DrSoetomo General Hospital during January 2021. All participants were to sign an informed consent beforethe study took place. A target of 500 opportunities was estimated during the observation, and recorded usinginfra-red cameras placed at ten points. Hand hygiene compliances were evaluated according to the videosurveillance records by an independent auditor. Compliance was measured by dividing total number ofobserved appropriate hand hygiene by the sum of opportunities. Data were analysed using Chi Square testat a significance of p&lt;0.05.Results: A total of 28 HCWs were eligible for the study; 9 were excluded. The majority were female(21; 75%), the mean age was 37.9 (SD 5.2) years. During 72 hours’ observation among 526 glove-useopportunities 104 (19.7%) actual glove-use episodes were evident. The hand hygiene compliance was lower(41.3%) when wearing gloves as compared to those with no glove use (68.2%) (p&lt;0.001).

Use of In Situ Simulation to Improve Emergency Department Readiness for the COVID-19 Pandemic.

During the world-wide coronavirus disease 2019 (COVID-19) outbreak, there is an urgent need to rapidly increase the readiness of hospitals. Emergency departments (EDs) are at high risk of facing unusual situations and need to prepare extensively in order to minimize risks to health care providers (HCPs) and patients. In situ simulation is a well-known method used in training to detect system gaps that could threaten safety. One objective is to identify gaps, test hospital systems, and inform necessary modifications to the standard processes required by patients with COVID-19 presenting at the hospital. The other objective is to improve ED staff confidence in managing such patients, and to increase their skills in basic and advanced airway management and proper personal protective equipment (PPE) techniques. This is a quasi-experimental study in which 20 unannounced mock codes were carried out in ED resuscitation and isolation rooms. A checklist was designed, validated, and used to evaluate team performances in three areas: donning, basic and advanced airway skills, and doffing. A pre- and post-intervention survey was used to evaluate staff members' perceived knowledge of ED procedures related to COVID-19 and their airway management skills. A total of 20 mock codes were conducted in the ED. Overall, 16 issues that posed potential harm to staff or patients were identified and prioritized for immediate resolution. Approximately 57.4% of HCPs felt comfortable dealing with suspected/confirmed, unstable COVID-19 cases after mock codes, compared with 33.3% beforehand (P = .033). Of ED HCPs, 44.4% felt comfortable performing airway procedures for suspected/confirmed COVID-19 cases after mock codes compared with 29.6% beforehand. Performance of different skills was observed to be variable following the 20 mock codes. Skills with improved performance included: request of chest x-ray after intubation (88.0%), intubation done by the most experienced ED physician (84.5%), and correct sequence and procedure of PPE (79.0%). Mock codes identified significant defects, most of which were easily fixed. They included critical equipment availability, transporting beds that were too large to fit through doors, and location of biohazard bins. Repeated mock codes improved ED staff confidence in dealing with patients, in addition to performance of certain skills. In situ simulation proves to be an effective method for increasing the readiness of the ED to address the COVID-19 pandemic and other infection outbreaks.

COVID-19 Preparedness in a Neonatal Unit at a Tertiary Hospital in Johannesburg, South Africa

ABSTRACTBackground: The novel coronavirus disease 2019 (COVID-19) pandemic has spread to South Africa and poses an infection risk in pregnant women and their newborns, as well as health-care workers and other patients.Objective: To discuss the implementation of international and local recommendations, and any additional actions undertaken at our Neonatal Unit in order to prepare for COVID-19.Discussion: Standard precautions in order to prepare a facility and its personnel to safely care for COVID-19 patients as outlined by the World Health Organization procedures have been implemented. Further actions undertaken in our Neonatal Unit included the creation of standard operating procedures, increased communication between neonatal and obstetric teams, limiting staff exposure, the creation of disposable resuscitation boxes to attend deliveries, reallocation of a triage area in the high care ward to an isolation area for sick newborns of suspected or confirmed maternal COVID-19 cases, staff training on personal protective equipment procedures and initiation of an online resources portal for neonatal staff.Conclusion: A rational approach to suspected cases and infection control in-line with local and international guidelines as well as ongoing education should diminish anxiety amongst health-care professionals and provide the best possible care to patients. South Africa is a low-to-middle income country, and the lack of resources available means we cannot increase our capacity, staffing numbers or available equipment. Yet, we must be as prepared, adaptable and efficient as possible to maximize the resources and equipment we have available to us.

Assessment of relationships between work stress, work-family conflict, burnout and firefighter safety behavior outcomes

IntroductionBurnout, in the context of emotional exhaustion, cynicism and depersonalization, has resulted in detrimental effects to workers. The relationship with safety outcomes, however, has not been fully explored, particularly in the American fire service. The main focus of this study is to delineate the relationships between work stress, work-family conflict, burnout and firefighter safety behavior outcomes. MethodsData were collected from career firefighters in the southeastern United States (n = 208). Path analysis, which allows for the simultaneous modeling of regression relationships, was completed to assess the relationships between work stress, work-family conflict and burnout and the relationships between burnout and multiple firefighter safety behavior outcomes including compliance with personal protective equipment procedures, safe work practices and safety reporting and communication behavior. ResultsAnalyses indicated that both work stress and work-family conflict predicted burnout and burnout negatively influenced personal protective equipment compliance, adherence to safety work practices, and safety reporting and communication. ConclusionsFirefighter burnout significantly impacts firefighter safety performance. Firefighters are less likely to exhibit compliance oriented and self-protective behaviors, which may have implications on overall firefighter safety, health and wellbeing.

Cryptosporidiosis outbreak at an academic animal research laboratory-Colorado, 2014.

After cryptosporidiosis was reported in three workers caring for preweaned calves at an academic research laboratory, we sought to identify cases, determine risk factors, and implement control measures. A cryptosporidiosis case was defined as diarrhea duration ≥72 hr, abdominal cramps, or vomiting in an animal research laboratory worker during July 14-July 31. A confirmed case had laboratory evidence of Cryptosporidium infection. Staff were interviewed regarding illness, potential exposures, training, and personal protective equipment (PPE) standard operating procedures (SOPs). The cryptosporidiosis attack rate (AR) was 74% (20/27); five were laboratory-confirmed. Median job training was 2 hr including respiratory-fit testing. No SOPs existed for doffing PPE. AR for workers who removed their gloves first was 84% (16/19) compared with 20% (1/5) for workers who removed gloves last (risk ratio = 4.2; P < 0.02). This outbreak highlights the importance of adequate training, enforced proper PPE procedures, and promoting a culture of safety. Am. J. Ind. Med. 60:208-214, 2017. © 2017 Wiley Periodicals, Inc.

PROSEDUR PENGGUNAAN ALAT PERLINDUNGAN DIRI DAN BIOSAFETY LEVEL 1 DAN 2

Implementation of the Occupational Health and Safety is one efforts to create a workplace that is safe, healthy, and free from environmental pollution, to reduce occupational accidents and disease, which in turn can improve the efficiency and productivity of labor. This is a descriptive explorative study that discuss about personal protective equipment procedures and biosafety level 1 and 2. Biosafety level is a combination of practice and application of procedures by workers at the laboratory facilities and safety equipment usage when working with dangerous infectious pathogenic agents. Biosafety level term is also used to describe the safe method in handling and managing materials that can infect a laboratory. It can be concluded that biosafety is a discipline in handling and containment system against infectious microorganisms and hazardous biological materials. The principles of biosafety cover the basics of the containment system, including the practice, and the correct laboratory techniques, safety equipment, laboratory facilities to protect workers, the environment and the public from exposure to infectious microorganisms.

Toronto Emergency Medical Services and SARS

Toronto Emergency Medical Services and SARS