Naik B Naveen, Singh Ajay, Lazar Michelle S, Ganesh Venkata, Soni Shiv L, Biswal Manisha, Das Karobi, Kaur Sukhpal, Puri Goverdhan
Department of Anaesthesiology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND.
Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND.
Cureus. 2021 Sep 18;13(9):e18071. doi: 10.7759/cureus.18071. eCollection 2021 Sep.
Background Very little has been reported about health care workers' (HCWs) adherence to the Centers for Disease Control and Prevention (CDC) guidelines of doffing personal protective equipment (PPE) amid the COVID-19 pandemic. Real-time remote audio-visual doffing surveillance (RADS) system for assisting doffing might reduce the risk of self-contamination. We used this system to determine the incidence of the breach in biosafety during doffing of PPE among HCWs involved in the care of Covid-19 patients. Methods A total of 100 HCWs were enrolled in this observational study who performed duties in the COVID intensive care unit (ICU) of our tertiary care centre. With a real-time RADS system, trained observers from remote locations assisted HCWs during doffing of PPE and noted breach at any step using the CDC doffing checklist. The breach was considered major if committed during removal of gloves/gown/N-95 or if ≥3 errors occurred in any other steps. Results Overall, 40% of the HCWs committed a breach during doffing at least one step. The majority of the errors were observed during hand hygiene (34%), followed by glove removal (12%) and N-95 removal (8%). Nineteen percent of HCWs committed the major breach, out of which 37.5% were done by house-keeping sanitation staff (p = 0.008 and RR 2.85; 95% CI of 1.313-6.19), followed by technicians (22.5%), nursing staff (16.7%) and resident doctors (6.5%). Conclusions Performing doffing using a real-time RADS system is associated with a relatively low incidence of a breach in biosafety compared with earlier studies using an onsite standard observer. Overall adherence of HCWs to the CDC guidelines of doffing PPE was satisfactory. This study highlights the importance of the RADS system during doffing of PPE in a health care setting amid the COVID-19 pandemic.
关于在新冠疫情期间医护人员遵守美国疾病控制与预防中心（CDC）脱卸个人防护装备（PPE）指南的情况，此前报道甚少。用于辅助脱卸的实时远程视听监测（RADS）系统可能会降低自我污染的风险。我们使用该系统来确定参与新冠患者护理的医护人员在脱卸PPE过程中违反生物安全规定的发生率。方法：本观察性研究共纳入100名在我们三级医疗中心的新冠重症监护病房（ICU）工作的医护人员。通过实时RADS系统，来自远程地点的经过培训的观察员在医护人员脱卸PPE时提供协助，并使用CDC脱卸检查表记录任何步骤中的违规情况。如果在摘除手套/防护服/N95口罩时出现违规，或在任何其他步骤中出现≥3个错误，则视为重大违规。结果：总体而言，40%的医护人员在脱卸至少一个步骤时出现违规。大多数错误出现在手部卫生环节（34%），其次是摘除手套（12%）和摘除N95口罩（8%）。19%的医护人员出现重大违规，其中37.5%由保洁卫生人员造成（p = 0.008，相对危险度2.85；95%置信区间为1.313 - 6.19），其次是技术人员（22.5%）、护理人员（16.7%）和住院医生（6.5%）。结论：与早期使用现场标准观察员的研究相比，使用实时RADS系统进行脱卸与生物安全违规发生率相对较低相关。医护人员对CDC脱卸PPE指南的总体遵守情况令人满意。本研究凸显了在新冠疫情期间医疗环境中脱卸PPE时RADS系统的重要性。
