Vincent Laura, Ibrahim Mudathir, Kitchin Joanne, Pickering Claire, Wilson Jennie, Sorrentino Enrico, Salvagno Claudia, Earl Laurie, Ma Louise, Simpson Kathryn, Baker Rose, McCulloch Peter
Adult Intensive Care Unit, Oxford University Hospitals Foundation Trust, Oxford, UK.
Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
J Intensive Care Soc. 2023 Aug;24(3):265-276. doi: 10.1177/17511437221116472. Epub 2022 Aug 16.
Current personal protective equipment (PPE) practices in UK intensive care units involve "sessional" use of long-sleeved gowns, risking nosocomial infection transmitted via gown sleeves. Data from the first wave of the COVID19 pandemic demonstrated that these changes in infection prevention and control protocols were associated with an increase in healthcare associated bloodstream infections. We therefore explored the use of a protocol using short-sleeved gowns with hand and arm hygiene to reduce this risk.
ICU staff were trained in wearing short-sleeved gowns and using a specific hand and arm washing technique between patients (experimental protocol). They then underwent simulation training, performing COVID-19 intubation and proning tasks using either experimental protocol or the standard (long-sleeved) control protocol. Fluorescent powder was used to simulate microbial contamination, detected using photographs under ultraviolet light. Teams were randomised to use control or experimental PPE first. During the simulation, staff were questioned on their feelings about personal safety, comfort and patient safety.
Sixty-eight staff and 17 proning volunteers were studied. Experimental PPE completely prevented staff contamination during COVID-19 intubation, whereas this occurred in 30/67 staff wearing control PPE ( = .003, McNemar). Proning volunteers were contaminated by staff in 15/17 control sessions and in 1/17 with experimental PPE ( = .023 McNemar). Staff comfort was superior with experimental PPE (< .001, Wilcoxon). Their personal safety perception was initially higher with control PPE, but changed towards neutrality during sessions ( < .001 start, 0.068 end). Their impressions of patient safety were initially similar ( = .87), but finished strongly in favour of experimental PPE ( < .001).
Short-sleeved gowns with hand and forearm cleansing appear superior to sessional long-sleeved gowns in preventing cross-contamination between staff and patients.
英国重症监护病房当前的个人防护装备（PPE）使用方法包括“阶段性”使用长袖隔离衣，这存在通过隔离衣袖口传播医院感染的风险。新冠疫情第一波的数据表明，这些感染预防与控制方案的改变与医疗相关血流感染的增加有关。因此，我们探索了使用一种配备洗手和手臂卫生措施的短袖隔离衣方案以降低这种风险。
对重症监护病房的工作人员进行穿戴短袖隔离衣以及在患者之间使用特定洗手和洗手法的培训（实验方案）。然后他们接受模拟培训，使用实验方案或标准（长袖）对照方案执行新冠气管插管和俯卧位操作任务。使用荧光粉模拟微生物污染，通过紫外线照射下的照片进行检测。各小组被随机分配先使用对照或实验性个人防护装备。在模拟过程中，询问工作人员对个人安全、舒适度和患者安全的感受。
研究了68名工作人员和17名俯卧位志愿者。实验性个人防护装备在新冠气管插管期间完全防止了工作人员受到污染，而在67名穿戴对照个人防护装备的工作人员中有30人受到污染（P = 0.003，McNemar检验）。在17次对照操作中有15次俯卧位志愿者被工作人员污染，而在使用实验性个人防护装备的17次操作中有1次被污染（P = 0.023，McNemar检验）。使用实验性个人防护装备时工作人员的舒适度更高（P < 0.001，Wilcoxon检验）。他们最初对对照个人防护装备的个人安全感知更高，但在操作过程中转变为中立（开始时P < 0.001，结束时P = 0.068）。他们对患者安全的印象最初相似（P = 0.87），但最后强烈倾向于实验性个人防护装备（P < 0.001）。
配备洗手和前臂清洁措施的短袖隔离衣在预防工作人员与患者之间的交叉污染方面似乎优于阶段性使用的长袖隔离衣。
