Surgery crisis simulation during the COVID-19 pandemic

Abstract

Surgery crisis simulation during the COVID-19 pandemic The COVID-19 pandemic puts health care workers at risk for infection with SARS-CoV-2 because of direct and prolonged exposure to patients with COVID-19. Personal protective equipment (PPE) can be used to reduce viral transmission. However, proper PPE protocols must be followed in order to successfully reduce viral transmission. Various problems with PPE adherence and ease of use can limit its effectiveness.Our goal was to explore the use of an in situ intraoperative crisis simulation involving an infectious outbreak as a tool for assessment of PPE adherence, confidence in PPE use, and latent safety threats. SimulationThree simulations were conducted in July 2020 involving 12 participants: 3 senior thoracic surgery trainees, 3 anesthesia residents, and 6 registered nurses. The simulation involved a tracheo-innominate fistula in a mannequin representing a patient with COVID-19; PPE was available. Simulations were video-recorded and reviewed by 2 thoracic surgery consultants to assess adherence to the London Health Sciences Centre (LHSC) Donning and Doffing Sequence for Protected Droplet and Contact With Enhanced PPE (unpublished; Appendix 1, available at www.canjsurg.ca/lookup/doi/10.1503/ cjs.025420/tab-related-content). After simulation, all participants completed forms to assess confidence in PPE use and simulation fidelity. The Simulation PPE Confidence form was based on a 5-point Likert scale, ranging from 1 (not at all confident) to 5 (extremely confident), and asked participants to recall perceived presimulation and actual post-simulation confidence in the following areas: managing a surgical emergency with a COVID-19-positive patient, performing operating room skills while wearing PPE, donning PPE, and doffing PPE. Simulation fidelity was assessed using the Method Material Member Overall (MMMO) Questionnaire, asking participants to rate simulation experience on a scale of 1 (disagree) to 5 (agree)" (Appendix 1). 1-3 adherence All participants responded "yes" to "Are you aware of the current London Health Sciences Centre (LHSC) guidelines for PPE use?" Video review showed deviations from the LHSC PPE Checklist for all participants during both donning and doffing. Two thoracic surgery consultants