reintroducing prac/cal logic to ppe use - cena.org.au · her eyes closed, holding an emesis bag but...

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.