Hall Andrew C, Silver Benjamin H, Ellis Wayne, Manjaly Joseph G, Utoomprurkporn Nattawan, Blencowe Natalie, Birchall Martin, Patel Anil
From the University Hospital for Wales (A.C.H.), Cardiff; University College London Ear Institute (B.H.S., W.E., J.G.M., N.U., M.B., A.P.); University College Hospital (B.H.S., W.E., J.G.M., M.B., A.P.); Faculty of Medicine (N.U.), Chulalongkorn University; Centre for Surgical Research (N.B.), School for Social and Community Medicine, Bristol; and Division of Surgery (N.B.), University Hospitals Bristol, NHS Foundation Trust, Bristol, UK.
Simul Healthc. 2023 Feb 1;18(1):64-70. doi: 10.1097/SIH.0000000000000646. Epub 2022 Mar 21.
Recent work has highlighted communication difficulties when wearing personal protective equipment (PPE) in the clinical setting, but currently, there are little objective data on its effects. We assessed the impact of PPE on verbal communication in a simulated operating room and evaluated use of an audio communication device.
Frontline health professionals across specialties including surgery, anesthetics, and nursing undertook speech discrimination testing with and without standardized levels of PPE in a simulated operating room environment. Background noise (30- and 70-a-weighted decibel multitalker babble) at 2 distances (2 and 4 m) were selected representative of operating room environments. Bamford-Kowal-Bench (BKB) scoring (192 sentences per participant) was performed. A Digital Multichannel Transceiver System (DMTS) was evaluated. We assessed the effects of PPE use, distance, and use of the DMTS with pairwise comparisons, using a Bonferroni correction, and assessed participant experience via Likert scales.
Thirty-one healthcare professionals were tested. Without PPE in 70-a-weighted decibel "babble," median BKB sentence scores were 90% and 76% at 2 and 4 m (adjusted P < 0.0005). The median BKB sentence scores dropped to 8% and 4% at 2 and 4 m in PPE (adjusted P < 0.0005). Improved speech discrimination was achieved with DMTS use to 70% and 76% at 2 and 4 m. Personal protective equipment led to a statistically significant reduction in BKB scores across all conditions compared with baseline. Overall participant confidence in PPE clinical communication was low.
Addition of PPE dramatically impairs speech discrimination and communication in high levels of background noise characteristic of clinical environments, which can be significantly improved using DMTS. Measures should be taken by teams through both through reduction of background noise and consideration of assistive technologies maximizing patient safety. This may be further rehearsed in a simulation environment.
近期研究强调了在临床环境中佩戴个人防护装备（PPE）时存在的沟通困难，但目前关于其影响的客观数据较少。我们评估了PPE对模拟手术室中言语交流的影响，并评估了一种音频通信设备的使用情况。
包括外科、麻醉和护理等专业的一线医护人员在模拟手术室环境中，分别在佩戴和不佩戴标准化水平PPE的情况下进行言语辨别测试。选择了2种距离（2米和4米）下的背景噪声（30和70 A加权分贝的多人交谈嘈杂声），以代表手术室环境。进行了Bamford-Kowal-Bench（BKB）评分（每位参与者192个句子）。对数字多通道收发器系统（DMTS）进行了评估。我们通过成对比较评估了PPE使用、距离和DMTS使用的影响，并采用Bonferroni校正，通过李克特量表评估参与者的体验。
对31名医护人员进行了测试。在70 A加权分贝的“嘈杂声”中，不佩戴PPE时，2米和4米处的BKB句子中位数得分分别为90%和76%（校正P<0.0005）。佩戴PPE时，2米和4米处的BKB句子中位数得分降至8%和4%（校正P<0.0005）。使用DMTS后，2米和4米处的言语辨别能力提高到70%和76%。与基线相比，在所有条件下，个人防护装备均导致BKB得分在统计学上显著降低。总体而言，参与者对PPE临床沟通的信心较低。
添加PPE会显著损害临床环境中高水平背景噪声下的言语辨别和沟通能力，而使用DMTS可显著改善这一情况。团队应采取措施，包括降低背景噪声以及考虑使用辅助技术，以最大限度地提高患者安全。这可以在模拟环境中进一步演练。
