May 7 2020
According to reports, a majority of health care workers have been infected by the coronavirus (COVID-19) in spite of using personal protective equipment (PPE). Such reports raise significant concerns regarding the effectiveness of the PPE.
An FAU emergency medicine physician and collaborators discovered the presence of fluorescent solution on health care workers’ skin, which represented an exposure to the contagion and indicated that they made an error while putting on or taking off their PPE. Image Credit: Rami A. Ahmed, D.O.
Hospitals and other health care environments use the highly sought after PPE to ensure the safety of individuals who are battling the COVID-19 pandemic, but PPE can be effective only if they are utilized properly.
A physician from Schmidt College of Medicine at Florida Atlantic University (FAU) and colleagues from the Indiana University School of Medicine and the University of Arizona College of Medicine -Tucson have performed a new training method to reinforce the significance of using the right protocols to wear and to take off the PPE while handling the patients during the COVID-19 pandemic.
The scientists were able to clearly show how aerosol-producing protocols can expose an individual to COVID-19 infection with the inappropriate use of PPE.
To identify the contamination, Patrick G. Hughes, D.O., the study’s lead author, director of FAU’s emergency medicine simulation program, and an assistant professor of Integrated Medical Science, FAU’s Schmidt College of Medicine, and his colleagues utilized a nontoxic fluorescent solution while conducting a PPE training session for the health care workers.
The researchers positioned a highlighter refill in a warm water bath for 15 minutes to produce a fluorescent solution, which can only be seen under the ultraviolet light.
To perform the experiment, the scientists informed the health care staff to put on the PPE, which comprised a gown, cap, N95 mask, face shield, eye protection, and surgical gloves. To preserve the crucial PPE, supplies were cleaned and again used for numerous trainings.
As soon as the health care staff—enrolled in the study—wrapped themselves with their PPE, they moved to a room to care for a replicated patient (mannequin) on which the invisible simulated contagion was sprayed on. The scientists also added the fluorescent solution to a replicated albuterol nebulizer treatment, which was administered to the mannequins during the situation but not in a negative pressure room. The experiment has been published in the Medical Education journal.
When the health care staff completed the simulated case, they remained in their PPE and were later shifted to another room, where the lights were switched off before they can remove their PPE.
When the lights were turned off, it allowed the researchers to detect the extensive replicated contagion present on the PPE, both on the gowns and gloves from directly touching the replicated patient, and also on the masks and face shields from the aerosolized solution. The team then utilized a blacklight flashlight to assess the status of each health care worker and to detect the potential presence of any fluorescent solution.
After the flashlight examination, the health care staff were allowed to fully remove their PPE. The scientists identified the presence of fluorescent solution on the skin of the health care staff. The skin indicated contagion exposure and also demonstrated that the health care staff made an error while they were putting on or taking off their PPE.
The experimental results showed that the most usual error made by the health care workers was infecting their forearms or face when removing the PPE. On the other hand, those who wore and removed their PPE as per the guidelines did not show any sign of the fluorescent contagion on their face or skin.
This training method allows educators and learners to easily visualize any contamination on themselves after they fully remove their personal protective equipment. We can make immediate corrections to each individual’s technique based on visual evidence of the exposure.
Patrick G. Hughes, D.O., Study Lead Author and Director of Emergency Medicine Simulation Program, Florida Atlantic University
By offering visual proof of protection to the health care staff, especially during their patient encounters with high-risk aerosol-producing protocols, this novel training approach is helping to inspire confidence in their PPE and training methodologies.
This experiment demonstrated that following PPE training improves workplace safety and decreases the risk of transmission. This simulation-based approach provides an efficient, low-cost solution that can be implemented in any hospital.
Patrick G. Hughes, D.O., Study Lead Author and Director of Emergency Medicine Simulation Program, Florida Atlantic University
Additionally, Hughes performed this training method with FAU’s emergency medicine resident physicians in the medical school’s Clinical Skills Simulation Center, which utilizes high-fidelity and sophisticated patient mannequins in life-like emergency room and hospital settings.
The center applies advanced trainer and simulation technologies to educate resident physicians, medical students, first responders, registered nurses, community health care providers, home health aides, and certified nursing assistants.
The center has also developed the models of emergency rooms, patient examination, and hospital rooms for simulated treatment of patients. All the rooms are completely equipped with exam tables, gurneys, hospital beds, blood pressure cuffs, defibrillators, IV poles, monitors, simulated oxygen ports, ophthalmoscopes, otoscopes, and all supplies and equipment needed to react to nursing and medical interventions, such as emergencies.
High-fidelity wireless, full-body female and male mannequins are used by the simulation team. All actions taken and all pharmacological agents administered to the patients are tracked by the simulators. In case, wrong dosages or drugs are given, the high-fidelity patient will react much the same as a human patient would react. Guidance is provided by session facilitators and preceptors during the simulations.
The study’s co-authors are Kate E. Hughes, D.O., emergency medicine, University of Arizona College of Medicine-Tucson; and Rami A. Ahmed, D.O., emergency medicine, Indiana University School of Medicine, Indianapolis.
Journal Reference:
Hughes, P. G., et al. (2020) Does my PPE really work? A simulation-based approach. Medical Education. doi.org/10.1111/medu.14188.