reintroducing prac/cal logic to ppe use · 2020. 6. 3. · reintroducing prac/cal logic to ppe use:...

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