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Elizabeth Beam, RN, MSN UNMC College of Nursing Special thanks to Dr. Gibbs, Kate Boulter, Marcia Beckerdite, and Dr. Philip Smith MD. A Method for Evaluating Personal Protective Equipment Technique by Healthcare Workers. The plan. Key concepts in PPE for healthcare. Describe study.
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Elizabeth Beam, RN, MSN UNMC College of Nursing Special thanks to Dr. Gibbs, Kate Boulter, Marcia Beckerdite, and Dr. Philip Smith MD A Method for Evaluating Personal Protective Equipment Technique by Healthcare Workers
The plan • Key concepts in PPE for healthcare. • Describe study. • Results and discussion. • Future directions. • Questions? • If time…video review simulation.
Key concepts in personal protection for healthcare… • Proper order for donning PPE • What PPE to wear • Contact • Contact & Droplet • Contact & Airborne • How to protect yourself while in the patient room • Proper order for doffing PPE
A pilot study… • A study was conducted to examine the feasibility of employing a simulated healthcare environment to assess the technique of healthcare workers in the use of standard airborne and contact isolation precautions without the potential for harm to real patients. • Powdered fluorescent marker tracking and digital video recording were used to assess compliance with current guidelines. • An expanded research study will be needed to further examine these commonly noted contamination and exposure pathways.
Guidelines… • Centers for Disease Control • http://www.cdc.gov/HAI/prevent/ppe.html • World Health Organization • http://www.who.int/csr/resources/publications/WHO_CDS_HSE_2008_2/en/index.html
Scenarios… • Registered Nurses hung an intravenous (IV) medication (IV line into bag under gown) and performed a head-to-toe assessment on the patient. • Respiratory Therapists assessed the patient and administered a nebulizer treatment (saline only). • Nursing Technicians repositioned the patient from bed to chair, took vital signs, and conducted input and output assessment.
Poster used in study… • Color copies • Posted at donning and doffing areas.
Summary of study design… • Simulation Room • Cameras (in room, outside room) • Simulated Patient (yours truly) • Glo Germ • Job-specific procedures (simulated) • Nurse: IV med • RT: Nebulizer treatment • Patient care tech: Reposition, I & 0, VS • Randomized: Guideline poster available
Participants: • Healthcare workers (n=10) • Convenience sample • Good skill mix (med-surg, ICU, ER, etc.) • Had experience with simulation • Multiple genders, roles, etc.
Video Results… • Each of the 10 participants committed at least one breach of standard airborne and contact isolation precautions • Donning: • Most common: not conducting a seal check on the respirator, failing to tie the gown at both the neck and the waist, and improper sequence. • Doffing: • Most common: improper sequence, the method for removing the respirator, and removing potentially contaminated items from the room. • In room: • Touching self with dirty gloves. • Touching surfaces in room for no apparent reason.
Glo germ results… • Glo Germ noted with UV light and digital photographs taken: • Contamination noted in 8 of the 10 participants. • 6 hand area; 3 back of head. • One had contamination on both their hands and their head.
Discussion… • Our study was not large enough to determine if poster impacted behavior, but… • Is it Glo Germ or is it paper towel debris? • Video capture: Good quality. Interesting data. Camera position matters. • Simulation lab vs. regular hospital room with mounted digital cameras?
Dissemination… Beam, E., Gibbs, S., Boulter, K., Beckerdite, M., & Smith, P. (2011). A method for evaluating personal protective equipment technique by healthcare workers. American Journal of Infection Control, 39, 415-420.
Future directions… • “Body of Work” creates questions: • What are the common errors? • Are there facility-specific errors? • Do physical characteristics matter? • Why are the poor behaviors seen? • What are the beliefs among healthcare workers about PPE? • Could reflective practice improve performance?
Mixed Methods Study Investigating Infection Control Behavior Population: Registered Nurses expected to care for patients in isolation in the hospital. Sample Size: Minimum 30. Pre-simulation data: Collect demographic information, occupational history, and physical characteristics/flexibility assessment. Simulation Experience: Review video with ‘Think Aloud’ Recording Video Record Patient Care + Sequential Explanatory Design: Simulation will be reviewed and scored (as per Beam, et al., 2011). Think Aloud recordings will be qualitatively analyzed (Max QDA). Long Term Follow Up (at One Month): Interview asking about change in practice.