The association between self-perceived proficiency of personal protective equipment and objective performance: An observational study during a bioterrorism simulation drill

Fogel, Itay; David, Osant; Balik, Chaya; Eisenkraft, Arik; Poles, Lion; Shental, Omri; Kassirer, Michael; Brosh‐Nissimov, Tal

doi:10.1016/j.ajic.2017.05.018

Cited by 24 publications

(23 citation statements)

References 19 publications

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“…Simulation studies have shown a high incidence of HCW contamination during the doffing process. 11 Regular dedicated simulation training has been shown to be effective in minimizing contamination and also improves HCW confidence. 11 …”

Section: Discussionmentioning

confidence: 99%

State of Personal Protective Equipment Practice in Indian Intensive Care Units amidst COVID-19 Pandemic: A Nationwide Survey

Haji¹,

Subramaniam

Kumar³

et al. 2020

Indian Journal of Critical Care Medicine

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A bstract Background Optimal personal protective equipment (PPE) preparedness is key to minimize healthcare workers (HCW) infection with COVID-19. This two-phase survey evaluated PPE preparedness (adherence to Ministry of Health India (MoH) PPE-recommendations; HCW-training; PPE-inventory; PPE-breach management) in Indian intensive care units (ICU). Materials and methods The phase 1 survey was distributed electronically to intensivists from 481 Indian hospitals between March 25, 2020, and April 06, 2020, as part of a multinational survey. Phase 2 was repeated in 320 Indian hospitals between April 20, 2020, and April 30, 2020. Results Response rate was 25% from 22 states. PPE practice varied between states and between private, government, and medical colleges. Between phase 1 and phase 2, all aspects of PPE training improved: donning/doffing 43% vs 66%, respectively; p value <0.01); safe waste disposal practices (38% vs 52%; p value = 0.09); intubation training (18% vs 31%; p value = 0.05); and transport (18% vs 31%; p value = 0.05). Perception of confidence for adequate PPE-training improved from 39 to 53% ( p value = 0.26). In all, 47 to 60% ICUs adhered to MoH recommendations. Wearing N95-masks at all times increased from 47 to 60% ( p value = 0.89). Very few ICUs provided quantitative/qualitative N95 masks fit testing (12% vs 29%; p value <0.01). Low-cost practices like “buddy-system” for donning-doffing (27% vs 44%; p value = 0.02) and showering after PPE breach (10% vs 8%; p value = 0.63) were underutilized. There was reluctance to PPE reuse. In all, 71% were unaware/diffident about PPE inventory. Conclusion Despite interstate variability, most ICUs conformed to MoH recommendations. This survey conducted during initial pandemic phase demonstrated improved PPE preparedness uniformly across India with scope for further improvement. We suggest implementation of quality improvement measures to improve pandemic preparedness and minimize HCW infection rates, focused on regular PPE training, buddy system, and PPE-breach management. How to cite this article Haji JY, Subramaniam A, Kumar P, Ramanathan K, Rajamani A. State of Personal Protective Equipment Practice in Indian Intensive Care Units amidst COVID-19 Pandemic: A Nationwide Survey. Indian J Crit Care Med 2020;24(9):809–816.

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Section: Discussionmentioning

confidence: 99%

State of Personal Protective Equipment Practice in Indian Intensive Care Units amidst COVID-19 Pandemic: A Nationwide Survey

Haji¹,

Subramaniam

Kumar³

et al. 2020

Indian Journal of Critical Care Medicine

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“…[32][33][34] Hands-on training also offers opportunity for evaluation, which is particularly important when self-perceived proficiency is not correlated with performance, such as has been observed for doffing of PPE ensembles. [35] Hands-on training can provide real-time feedback to correct behaviors in the moment with observer interventions or surrogates for contamination. [36,37] In this sample, skills maintenance training was limited and primarily occurred at ETCs.…”

Section: Discussionmentioning

confidence: 99%

Experience of Chicagoland acute care hospitals in preparing for Ebola virus disease, 2014–2015

Bleasdale

Sikka

Moritz

et al. 2019

Journal of Occupational and Environmental Hygiene

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During the 2014-2015 Ebola virus disease (EVD) outbreak, hospitals in the United States selected personal protective equipment (PPE) and trained healthcare personnel (HCP) in anticipation of receiving EVD patients. To improve future preparations for high-consequence infectious diseases, it was important to understand factors that affected PPE selection and training in the context of the EVD outbreak. Semistructured interviews were conducted with HCP involved with decision-making during EVD preparations at acute care hospitals in the Chicago, IL area to gather information about the PPE selection and training process. HCP who received training were surveyed about elements of training and their perceived impact and overall experience by email invitation. A total of 28 HCP from 15 hospitals were interviewed, and 55 HCP completed the survey. Factors affecting PPE selection included: changing guidance, vendor supply, performance evaluations, and perceived risk and comfort for HCP. Cost did not affect selection. PPE acquisition challenges were mitigated by: sharing within hospital networks, reusing PPE during training, and improvising with existing PPE stock. Selected PPE ensembles were similar across sites. Training included hands-on activities with trained observers, instructional videos, and simulations/drills, which were felt to increase HCP confidence. Many felt refresher training would be helpful. Hands-on training was perceived to be effective, but there is a need to establish the appropriate frequency of refresher training frequency to maintain competence. Lacking confidence in the CDC guidance, interviewed trainers described turning to other sources of information and developing independent PPE evaluation and selection. Response to emerging and/or high consequence infectious diseases would be enhanced by transparent, risk-based guidance for PPE selection and training that addresses protection level, ease of use, ensembles, and availability. KEYWORDSEbola virus disease; healthcare personnel training; high-consequence infections; occupational health; personal protective equipment; qualitative research; standard precautions

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“…However, perceptions of risk do not always match objective measures of performance. 13 Further studies are needed to evaluate whether the risk of contamination is truly lower using PPE B. We are in the process of optimizing a protocol that uses fluorescent microbeads to track simulated infectious particles through a clinical space during HCW activities.…”

Section: Discussionmentioning

confidence: 99%

A novel personal protective equipment coverall was rated higher than standard Ebola virus personal protective equipment in terms of comfort, mobility and perception of safety when tested by health care workers in Liberia and in a United States biocontainment unit

Garibaldi

Ruparelia

Shaw-Saliba

et al. 2019

American Journal of Infection Control

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Background: During the 2014-2016 Ebola virus epidemic, more than 500 health care workers (HCWs) died in spite of the use of personal protective equipment (PPE). The Johns Hopkins University Center for Bioengineering Innovation and Design (CBID) and Jhpiego, an international nongovernmental organization affiliate of Johns Hopkins, collaborated to create new PPE to improve the ease of the doffing process. Methods: HCWs in Liberia and a US biocontainment unit compared standard M edecins Sans Fronti ere PPE (PPE A) with the new PPE (PPE B). Participants wore each PPE ensemble while performing simulated patient care activities. Range of motion, time to doff, comfort, and perceived risk were measured. Results: Overall, 100% of participants preferred PPE B over PPE A (P < .0001); 98.1% of respondents would recommend PPE B for their home clinical unit (P < .0001). There was a trend towards greater comfort in PPE B. HCWs at both sites felt more at risk in PPE A than PPE B (71.9% vs 25% in Liberia, P < .0001; 100% vs 40% in the US biocontainment unit, P < .0001). Conclusions: HCWs preferred a new PPE ensemble to M edecins Sans Fronti ere PPE for high-consequence pathogens. Further studies on the safety of this new PPE need to be conducted.

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The association between self-perceived proficiency of personal protective equipment and objective performance: An observational study during a bioterrorism simulation drill

Abstract: Self-perceived proficiency is a poor predictor of appropriate PPE use. The results suggest poor awareness of the possibility of PPE misuse.

Cited by 24 publications

References 19 publications

State of Personal Protective Equipment Practice in Indian Intensive Care Units amidst COVID-19 Pandemic: A Nationwide Survey

State of Personal Protective Equipment Practice in Indian Intensive Care Units amidst COVID-19 Pandemic: A Nationwide Survey

Experience of Chicagoland acute care hospitals in preparing for Ebola virus disease, 2014–2015

A novel personal protective equipment coverall was rated higher than standard Ebola virus personal protective equipment in terms of comfort, mobility and perception of safety when tested by health care workers in Liberia and in a United States biocontainment unit

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