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ReintroducingPrac/calLogicToPPEUse:AVideo-BasedSurvey
DrSu-yinHor1,4,DrMaryWyer1,ProfLynGilbert1,2,DrRachelUrwin1,DrMargoTurnbull2,MsMargaretMurphy3,A/ProfChrisHneJorm2,andMsRuthBarraM2
Acknowledgements
Background: EmergencyDepartment(ED)staffareatgreaterriskthanotherstaff,ofacquiringinfecHousdiseasesandinadvertentlytransmiUngpathogenspriortodiagnosis.PersonalprotecHveequipment(PPE)iscrucialinreducingtheserisks,butwhatPPEisbothsufficientlyprotecHveandpracHcableforrouHneuseiscontested.
Aim: TocontributeknowledgetowardsdevelopingrecommendaHonsforminimumappropriatePPEadherenceforfrontlineEDstaff,whenassessingnewlyadmiMedpaHentswithunknowninfecHousrisks.
Method: AnaHonalvideo-basedonlinesurvey.Respondents(n=270)were:83IPCpracHHoners,36EDdoctors,90EDnurses,51infecHousdiseasephysiciansand10nurses
SCENARIO1(abbreviated)• 40y.o.male;triagecategory2(seewithin10mins)• PresenHngcomplaint:2daysSOB;producHvecough;fever;lethargy• Recentoverseastravel.• O/E:drowsy,producHvecough;pale;temp.38.5oC;HR140;RR35;BP135/70;GCS14;SpO295%.
ThenursecanseethroughthewindowthatthepaHentispale,breathlessandiscoughingviolently;hisoxygenmaskhasfallenoff.ThenursedonsPPEbeforeenteringtheroom
SCENARIO2(abbreviated)• 80y.o.female;triagecategory3(seewithin30mins)• PresenHngcomplaint:24hoursfever;waterydiarrhea(approx.hourly)• Livesinagedcarefacility;broughtinbyambulance• O/E:pale,drymucousmembranes;c/onausea;temp37.5oC;HR109;RR16;BP105/82;GCS15;SpO295%.
ThedoctorcanseethroughthewindowthatthepaHentislyinginherbedwithhereyesclosed,holdinganemesisbagbuthasclearlyvomitedonthebedclothes.ThedoctordonsPPEbeforeenteringtheroom.
CONSENSUS
• Wearingalong-sleevedorfluid-resistantgown• WearingeyeprotecHon• Removinggloves,gogglesandgowninsidepaHentroom• UndoinggownHesintheordershown
• Wearingamask,wearingasurgicalmask• WearingeyeprotecHon• UndoinggownHesinordershown
CONTENTIONS
Respondentswereevenlysplitonwhethertheproceduresshowninthevideowere
PRACTICALorIMPRACTICAL
(exceptdoffinginScenario2)
49%
12%
36%
Scenario2Donning
PracHcalNeitherImpracHcalUnsure
54%
14%
28%
Scenario2Doffing
44%
11%
42%
Scenario1Donning
PracHcalNeitherImpracHcalUnsure
48%
12%
37%
Scenario1Doffing
Therewasgeneralagreementaboutthelikelyroutesoftransmission,andthatthesePPEelementswereALWAYSREQUIREDfortherespecHvescenarios
(>75%ofrespondents)
Items:• Mask• Gloves
Handhygiene:• Beforegowning• Aierremovinggloves• Aierremovinggown• Aierremovingmask• Aiertouchingdoorhandleinroom
Items:• Fluid-resistant
gown• Gloves
Handhygiene:• Beforegowning• Aierremovinggloves• Aierremovingmask
Process:• DonningPPEoutsideroom• DonningPPEinthesequenceshown
Process:• DonningPPEoutsidetheroom• Removingthemaskoutsidetheroom
Methodsof:• Applying&fit-checkingmask• Removinggloves,gownand
mask
Methodsof:• Applyinggloves• Removinggloves
andgown
<60%ofrespondentsidenHfiedthesePPEelementsasALWAYSREQUIREDfortheir
respecHvescenarios
• ICPsandIDphysiciansweremorelikelytosayitwaspracHcalthanEDdoctorsandnurses(p<.05on3outof4quesHons)• EDnursesweremorelikelytosayitwaspracHcalthanEDdoctors(p<.05onall4quesHons)
1TheWestmeadInsHtuteForMedicalResearch,Westmead,Australia,2TheUniversityofSydney,Camperdown,Australia,3WesternSydneyLocalHealthDistrict,Australia,4FacultyofHealth,UniversityofTechnology,Sydney,Australia
Youarebusyandrushedandsome1mesdon’thavethecorrect
informa1on
Ifyourlifedependsonit,yoursafetycomesfirst
ScantheseQRcodestowatchthevideos:
55%
34%
86%
2%0%
100%
Es/matedroute(s)oftransmission(Scenario1)
9%
94%
37%
1%0%
100%
Es/matedroute(s)oftransmission(Scenario2)
QUESTION: WhatPPEdohealthcareworkersthinkisrequiredandprac/cal,whenexaminingEDpaHentswithunknowninfecHousrisks?
METHOD: Onlinesurveyof270cliniciansnaHonally(83IPCpracHHoners,36EDdoctors,90EDnurses,51infecHousdiseasephysiciansand10nurses),presenHngtwoscenarios,andvideoclipsofexperiencedcliniciansdonninganddoffingPPEforeachscenario.
ScantheseQRcodestowatchthevideos:
Amajority(75%)ofthosewhoselectedairborneand/ordroplet(andnotcontact)transmissioninScenario1,neverthelessrequiredgownsand/orgloves.
However,7%ofthosewhoselectedcontacttransmissioninScenario2,alsoindicatedthatgownsand/orgloveswereeitheropHonalornotrequired.
Severalrespondents(14inscenario1;9inscenario2)suggestedanaddiHonalhandhygienemoment,
justpriortodonninggloves.
Ifthereisbloodorbodyfluidcontactan1cipated[Iwould]wearglovesandifIhavetobeupandclosewiththepa1entI
willwearanapron.
Staffwillputthemselvesatriskifthepa1entisrapidlydeteriora1ng,ratherthantaketheallocated1meto
wearPPE
Glovesononlyifcomingintocontactwithblood/
bodyfluids&[Iwould]doninsidethepa1entzone.
GOWNS&GLOVESàRisk-assessedratherthanpre-determined?
Probablydifficulttodo-butisn'tthatwhatwe
saidabouthandhygienein2009whencompliance
wasbelow30%?
ThePPEtrolleyisnotre-stocked,oTenusedasadumpinggroundforextraitems(suchas
urinejars,pa1entmealsetc).
I'veneverwatchedsomeoneusealcoholbasedhandrubfor
thatlong
WithEDhavingarushculture.Staffdon't
wanttobeseentobelazyorslow.
Ifthepa1entisnotcrashing,then
it'sprac1cal.