Somri Mostafa, Hochman Ohad, Somri-Gannam Lina, Gaitini Luis, Paz Alona, Bumard Tami, Gómez-Ríos Manuel Á
From the Department of Anesthesia (M.S., L.S.-G., L.G.), Bnai Zion Medical Center, Haifa, Israel; Faculty of Medicine (M.S., L.G.), Technion, Israel Institute of Technology, Haifa, Israel; Bnai Zion Medical Center (O.H.), Haifa, Israel; Infectious Disease and Infection Control Unit (A.P., T.B.), Bnai Zion Medical Center, Haifa, Israel; Department of Anesthesia and Perioperative Medicine (M.A.G.-R.), Complejo Hospitalario Universitario de A Coruña, A Coruña, Galicia, Spain; and Spanish Difficult Airway Group (GEVAD) (M.A.G.-R.), A Coruña Spain.
Simul Healthc. 2024 Jun 1;19(3):137-143. doi: 10.1097/SIH.0000000000000726. Epub 2023 Apr 26.
Personal protective equipment (PPE) reduces the risk of pathogens reaching the skin and clothing of health care personnel. We hypothesize that doffing PPE following verbal instructions by a supervisor is more effective in reducing contamination compared with doffing without verbal instructions. Our primary aim was to determine contamination rates with and without supervised doffing. The secondary aim was to determine the number and localization of contaminated body sites and PPE removal times in both groups.
Staff members of Bnai Zion Medical Center participated in this single-center, randomized simulation study (NCT05008627). Using a crossover design, all participants donned and doffed the PPE twice, once under guidance from a trained supervisor and then independently without supervision (group A), or vice versa (group B). Participants were randomized to either group A or B using a computer-generated random allocation sequence. The PPE was "contaminated" with Glo Germ on the thorax, shoulders, arms, hands, legs, and face shield. After doffing the PPE, the participant was examined under ultraviolet light to detect traces of contamination. The following variables were collected: contamination rates, the number and localization of contaminated body sites, and PPE doffing time.
Forty-nine staff members were included. In group A, the contamination rate was significantly lower (8% vs. 47%; χ 2 = 17.19; p < 0.001). The sites most frequently contaminated were the neck and hands. Mean PPE doffing time under verbal instructions was significantly longer [mean (SD): 183.98 (3.63) vs. 68.43 (12.75) seconds, P < 0.001] compared with unsupervised doffing.
In a simulated setting, PPE doffing following step-by-step verbal instructions from a trained supervisor reduces the rate of contamination but prolongs doffing time. These findings could have important implications for clinical practice and could further protect health care workers against contamination from emerging and high-consequence pathogens.
个人防护装备（PPE）可降低病原体接触医护人员皮肤和衣物的风险。我们假设，与无口头指示的脱卸相比，在上级口头指示下脱卸PPE在减少污染方面更有效。我们的主要目的是确定有监督脱卸和无监督脱卸时的污染率。次要目的是确定两组中受污染身体部位的数量和位置以及PPE脱卸时间。
贝纳伊锡安医疗中心的工作人员参与了这项单中心随机模拟研究（NCT05008627）。采用交叉设计，所有参与者穿戴和脱卸PPE两次，一次在训练有素的上级指导下，然后在无监督的情况下独立进行（A组），或反之（B组）。使用计算机生成的随机分配序列将参与者随机分为A组或B组。PPE在胸部、肩部、手臂、手部、腿部和面罩上被“污染”了发光细菌。脱卸PPE后，在紫外线下检查参与者以检测污染痕迹。收集了以下变量：污染率。受污染身体部位的数量和位置，以及PPE脱卸时间。
纳入了49名工作人员。在A组中，污染率显著更低（8%对47%；χ2 = 17.19；p < 0.001）。最常被污染的部位是颈部和手部。与无监督脱卸相比，在口头指示下的平均PPE脱卸时间显著更长[平均值（标准差）：183.98（3.63）对68.43（12.75）秒，P < 0.001]。
在模拟环境中，按照训练有素的上级的逐步口头指示脱卸PPE可降低污染率，但会延长脱卸时间。这些发现可能对临床实践具有重要意义，并可进一步保护医护人员免受新出现的高后果病原体的污染。
