‘VIOLET’: a fluorescence-based simulation exercise for training healthcare workers in the use of personal protective equipment

Poller, Bozena; Hall, Samantha; Bailey, Claire; Gregory, Samantha; Clark, Richard; Roberts, Paul; Tunbridge, Anne; Poran, Vin; Crook, B.; Evans, Cariad

doi:10.1016/j.jhin.2018.01.021

Cited by 39 publications

(35 citation statements)

References 35 publications

(36 reference statements)

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“…[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. A barrier identified was debate over the appropriate frequency of training, though surveyed trainees who wanted refresher training, wanted it to occur 1-2 times annually.…”

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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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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“…Further validation of the HCID assessment PPE was undertaken to provide evidence that the PPE and revised doffing procedures consistently and repeatedly prevented cross-contamination. Ten pairs of volunteer healthcare staff underwent the same 'VI-OLET' simulation exercise, 8 replicating the standard of practice of the original phase of testing. Thirteen of the seventeen participants were new to 'VIOLET' to minimise user bias as much as was possible with available resources.…”

Section: Validation Of the 'Hcid Assessment Ppe' Ensemblementioning

confidence: 99%

“…Choice of methodology is discussed further in the original VIOLET study. 8 Although the PPE elements have been carefully considered, the ensemble itself is only as good as the user's adherence to instructions in its use, alongside measures to reduce environmental contamination and potential for exposure. Training is therefore a fundamental part of its safety and must be provided and maintained.…”

Section: Limitationsmentioning

confidence: 99%

A unified personal protective equipment ensemble for clinical response to possible high consequence infectious diseases: A consensus document on behalf of the HCID programme

Poller

Tunbridge

Hall

et al. 2018

Journal of Infection

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The importance of appropriate personal protective equipment (PPE) as a component of healthcare worker (HCW) protection was highlighted during the Ebola virus disease (EVD) outbreak in West Africa. The large number of HCW deaths in Africa was in part due to lack of resources or prior training in PPE usage. As part of the Ebola legacy, the High Consequence Infectious Disease (HCID) programme was initiated by NHS England and Public Health England (PHE) to improve preparedness for Ebola and other infections that not only endanger the life of the patient, but also pose particular dangers to HCWs. A systematic review identified national standardisation of PPE protocols as a priority, but recognised that a lack of safety data limited the ability to mandate any one protocol. A simulation-based exercise was developed to assess the safety of PPE ensembles in use in the UK during first assessment of a patient with a possible HCID. A mannequin was adapted to expose volunteer HCWs to synthetic bodily fluids (vomit, sweat, diarrhoea and cough), each with a different coloured fluorescent tracer, invisible other than under ultraviolet (UV) light. After exposure, HCWs were examined under UV lights to locate fluorescent contamination, and were screened again after removing PPE (doffing) to detect any personal contamination. The exercise was videoed, allowing retrospective analysis of contamination events and user errors. The simulation testing identified significant HCW contamination events after doffing, related to protocol failure or complications in PPE doffing, providing conclusive evidence that improvements could be made. At a workshop with an expert stakeholder group, the data were examined and a unified PPE ensemble agreed. This ensemble was then tested in the same simulation exercise and no evidence of any HCW contamination was seen after doffing. Following further review by the working group, a consensus agreement has been reached and a unified 'HCID assessment PPE' ensemble, with accompanying donning and doffing protocols, is presented here.

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“…Gloved hand disinfection (for a single patient encounter) has been shown to increase compliance with hand hygiene [14]. Where glove use is appropriate, careful removal and disposal of gloves is important as environmental contamination is known to occur with doffing of PPE and gloves [15][16][17].…”

mentioning

confidence: 99%

Washing our hands of the problem

Lynch

Mahida

Oppenheim

et al. 2020

Journal of Hospital Infection

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‘VIOLET’: a fluorescence-based simulation exercise for training healthcare workers in the use of personal protective equipment

Abstract: Simulation exercises using VIOLET provide evidence-based assessment of PPE ensembles, and are a valuable resource for training of healthcare staff in wearing and safe doffing of PPE.

Cited by 39 publications

References 35 publications

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

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

A unified personal protective equipment ensemble for clinical response to possible high consequence infectious diseases: A consensus document on behalf of the HCID programme

Washing our hands of the problem

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