Gloucestershire Health and Care NHS Foundation Trust, Montpellier Unit, Wotton Lawn Hospital, UK.
Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, UK.
Med Sci Law. 2021 Oct;61(4):275-285. doi: 10.1177/00258024211000805. Epub 2021 Mar 9.
Restraint is widely practised within inpatient mental health services and is considered a higher-risk procedure for patients and staff. There is a sparsity of evidence in respect of the efficacy of personal protective equipment (PPE) used during restraint for reducing risk of infection.
A series of choreographed restraint episodes were used to simulate contact contamination in research participants playing the roles of staff members and a patient. For comparison, one episode of simulated recording of physical observations was taken. Ultraviolet (UV) fluorescent material was used to track the simulated contact contamination, with analysis undertaken using established image registration techniques of UV photographs. This was repeated for three separate sets of PPE.
All three PPE sets showed similar performance in protecting against contamination transfer. For teams not utilising coveralls, this was dependent upon effective cleansing as part of doffing. There were similar patterns of contamination for restraint team members assigned to specific roles, with hands and upper torso appearing to be higher-risk areas. The restraint-related contamination was 23 times higher than that observed for physical observations.
A second layer of clothing that can be removed showed efficacy in reducing contact contamination. PPE fit to individual is important. Post-restraint cleansing procedures are currently inadequate, with new procedures for face and neck cleansing required. These findings leave scope for staff to potentially improve their appearance when donning PPE and engaging with distressed patients.
约束在住院精神卫生服务中广泛实施，被认为对患者和工作人员来说是一种风险较高的程序。在约束过程中使用个人防护设备（PPE）以降低感染风险的效果方面，证据稀缺。
一系列精心编排的约束事件被用来模拟研究参与者扮演工作人员和患者角色时的接触污染。为了进行比较，还进行了一次模拟身体观察记录的事件。紫外线（UV）荧光材料用于跟踪模拟的接触污染，并使用已建立的 UV 照片图像配准技术进行分析。这对三组不同的 PPE 进行了重复测试。
所有三组 PPE 都表现出类似的性能，可防止污染转移。对于不使用全身防护服的团队，这取决于脱除过程中的有效清洁。对于分配到特定角色的约束团队成员，污染模式相似，手和上躯干似乎是高风险区域。与身体观察相比，约束相关的污染高出 23 倍。
可去除的第二层衣物显示出减少接触污染的效果。适合个人的 PPE 很重要。约束后的清洁程序目前不足，需要新的面部和颈部清洁程序。这些发现为工作人员在佩戴 PPE 并与情绪困扰的患者接触时，有可能改善其外观提供了空间。
