Despite the use of personal protective equipment, many healthcare workers have contracted the COVID-19 coronavirus disease during patient care, which raises substantial concerns about the effectiveness of the PPE. Highly sought-after PPE used in hospitals and other healthcare settings is critical in ensuring the safety of those on the front line of pandemic, but only if it is used properly.
A physician from Florida Atlantic University's Schmidt College of Medicine and collaborators from the University of Arizona College of Medicine-Tucson and the Indiana University School of Medicine conducted a novel training technique to reinforce the importance of using proper procedures to put on and take off PPE when caring for patients during the pandemic. Researchers were able to vividly demonstrate how aerosol-generating procedures can lead to exposure of the contagion with improper PPE usage.
To detect contamination, the collaborators used a nontoxic fluorescent solution during a PPE training session for healthcare staff. They placed a highlighter refill in a warm water bath for 15 minutes to create a fluorescent solution, which is only visible under ultraviolet light.
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WHAT'S THE IMPACT?
For the experiment, the researchers instructed healthcare staff to put on PPE, which included a cap, gown, surgical gloves, eye protection, a face shield and an N95 mask. In order to conserve vital PPE, supplies were wiped off and reused for multiple trainings. After staff members donned their PPE, they went into a room to care for a simulated patient sprayed down with the invisible simulated contagion. The researchers also added the fluorescent solution to a simulated albuterol nebulizer treatment, which was given to the mannequins during the scenario (not in a negative pressure room).
After completing the simulated case, the healthcare staff remained in their PPE and were taken to another room, where the lights were turned off prior to removing their PPE. Turning off the lights enabled the identification of widespread simulated contagion on the PPE, both on the gloves and gowns from directly touching the simulated patient and on the face shields and masks from the aerosolized solution. The researchers used a black-light flashlight to examine each healthcare worker and to identify the presence of any fluorescent solution.
Following the flashlight examination, the staff completely removed their PPE. Researchers discovered the presence of fluorescent solution on the staff's skin, which represented an exposure to the contagion and indicated that they made an error while putting on or taking off their PPE.
Results from the experiment revealed that the most common error made by the healthcare staff was contaminating the face or forearms during PPE removal. In contrast, those who put on and took off their PPE according to guidelines had no signs of the fluorescent contagion on their skin or face.
WHAT ELSE YOU SHOULD KNOW
Dr. Patrick Hughes, lead author, director of FAU's emergency medicine simulation program and an assistant professor of Integrated Medical Science at FAU's Schmidt College of Medicine, also conducted this training technique with FAU's emergency medicine resident physicians in the medical school's Clinical Skills Simulation Center, which uses high-tech and high-fidelity patient mannequins in lifelike hospital and emergency room settings.
The center applies sophisticated simulation and trainer technologies to educate medical students, resident physicians, registered nurses, first responders, certified nursing assistants, home health aides and community healthcare providers. The center has created models of hospital rooms, patient-examination rooms, and emergency rooms for simulated patient treatment. The rooms are fully equipped with hospital beds, gurneys or exam tables, monitors, IV poles, defibrillators, blood pressure cuffs, simulated oxygen ports, otoscopes and ophthalmoscopes, and all equipment and supplies required to respond to medical and nursing interventions, including emergencies.
The simulation team uses high-fidelity wireless, full-body male and female mannequins. The simulators track all actions taken and all pharmacological agents given to the patients. If incorrect drugs or dosages are administered, the high-fidelity patient responds exactly as a human patient would respond. Preceptors and session facilitators provide guidance during the simulations.
THE LARGER TREND
In an Office of the Inspector General report published in April, hospitals said their most significant challenges centered on testing and caring for patients with COVID-19 and keeping staff safe. Severe shortages of testing supplies and extended waits for test results limited hospitals' ability to monitor the health of patients and staff, and widespread shortages of PPE are putting both staff and patients at risk. Hospitals also said they were not always able to maintain adequate staffing levels or to offer staff adequate support.
In addition to widespread shortages of critical supplies, ventilators and logistic support, hospitals also described increasing costs and decreasing revenues as a threat to their financial viability, and said that sometimes inconsistent guidance from federal, state and local authorities posed challenges and confused both hospitals and the public.