Does my personal protective equipment really work? A simulation‐based approach

The problem that was addressed was the need for refresher training for personal protective equipment (PPE) during the coronavirus disease (COVID-19) pandemic. Reports that many health care workers contracted COVID-19 despite wearing suggested PPE resulted in substantial concerns about the effectiveness of the PPE.1, 2 Staff desired both refresher training with individual feedback of their abilities to don and doff effectively and assurance that if they donned and doffed correctly that their equipment was effective. In order to detect contamination, we utilised a non-toxic fluorescent solution during the PPE training of health care personnel. To begin, a highlighter refill was placed in a warm water bath for 15 minutes to create a fluorescent solution. This solution is only visible under ultraviolet light. Health care personnel donned PPE, which included a cap, gown, gloves, eye protection, face shield and N95 mask. In order to conserve PPE, supplies were wiped off and reused for multiple trainings. Once the workers donned their PPE, they went into a room to care for a simulated patient sprayed down with the invisible simulated contagion. Additionally, we added the fluorescent solution to a simulated albuterol nebuliser treatment that was given to the high-fidelity simulator during the scenario (not in a negative pressure room). After completing the simulated case, the staff remained in their PPE and were led into another room. The room lights were then turned off prior to doffing to allow identification of widespread simulated contagion on the PPE, both on the gloves and gowns from directly touching the simulated patient and on the face shields and masks from the aerosolised solution. A blacklight flashlight was used to examine each health care worker and identify the presence of any fluorescent solution. Learners then completed the doffing procedure. The presence of fluorescent solution on the learner’s skin represented an exposure to the contagion and indicated an error was made in the donning or doffing process. The most common error was contaminating the face or forearms during PPE removal. However, those who donned and doffed according to guidelines had no signs of the fluorescent contagion on their skin or face. This novel training technique achieved its primary aim of reinforcing the importance of using proper technique to don and doff PPE when caring for patients during the COVID-19 pandemic. It vividly demonstrated how aerosol-generating procedures can lead to exposure if proper technique and procedures are not followed. This training method allows educators and learners to easily visualise any contamination on themselves after they fully doff their PPE. Educators are able to make immediate corrections to each individual’s technique based on visual evidence of the exposure. By providing learners with visual evidence of protection during patient encounters with high-risk aerosol-generating procedures, this innovative training method inspires trust in their training and PPE. It demonstrated that following the 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 at any hospital

Disease · Face masks · Face shield · Health care · Medical emergency · Occupational exposure · Pathology · Personal protective equipment · Respirator · Simulated patient · COVID-19 and healthcare impacts · COVID-19 and Mental Health · Infection Control and Ventilation · Medicine · Nursing

• Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China

  Dawei Wang, Bo Hu et al.•JAMA•2020

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• Covid-19 and Italy

  Open Access•Andrea Remuzzi, Giuseppe Remuzzi•The Lancet•2020

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