2015-10-01 12:00 - Messages

Contamination of Health Care Personnel During Removal of Personal Protective Equipment

Importance: Contamination of the skin and clothing of health care personnel during removal of personal protective equipment (PPE) contributes to dissemination of pathogens and places personnel at risk for infection.
Objectives: To determine the frequency and sites of contamination on the skin and clothing of personnel during PPE removal and to evaluate the effect of an intervention on the frequency of contamination.
Design, Setting, and Participants: We conducted a point-prevalence study and quasi-experimental intervention from October 28, 2014, through March 31, 2015. Data analysis began November 17, 2014, and ended April 21, 2015. Participants included a convenience sample of health care personnel from 4 Northeast Ohio hospitals who conducted simulations of contaminated PPE removal using fluorescent lotion and a cohort of health care personnel from 7 study units in 1 medical center that participated in a quasi-experimental intervention that included education and practice in removal of contaminated PPE with immediate visual feedback based on fluorescent lotion contamination of skin and clothing.
Main Outcomes and Measures: The primary outcomes were the frequency and sites of contamination on skin and clothing of personnel after removal of contaminated gloves or gowns at baseline vs after the intervention. A secondary end point focused on the correlation between contamination of skin with fluorescent lotion and bacteriophage MS2, a nonpathogenic, nonenveloped virus.
Results: Of 435 glove and gown removal simulations, contamination of skin or clothing with fluorescent lotion occurred in 200 (46.0%), with a similar frequency of contamination among the 4 hospitals (range, 42.5%-50.3%). Contamination occurred more frequently during removal of contaminated gloves than gowns (52.9% vs 37.8%, P = .002) and when lapses in technique were observed vs not observed (70.3% vs 30.0%, P < .001). The intervention resulted in a reduction in skin and clothing contamination during glove and gown removal (60.0% before the intervention vs 18.9% after, P < .001) that was sustained after 1 and 3 months (12.0% at both time points, P < .001 compared with before the intervention). During simulations of contaminated glove removal, the frequency of skin contamination was similar with fluorescent lotion and bacteriophage MS2 (58.0% vs 52.0%, P = .45).
Conclusions and Relevance: Contamination of the skin and clothing of health care personnel occurs frequently during removal of contaminated gloves or gowns. Educational interventions that include practice with immediate visual feedback on skin and clothing contamination can significantly reduce the risk of contamination during removal of PPE.

Source: Tomas, Myreen E., Kundrapu, Sirisha, Thota, Priyaleela, et al. (2015, October 12). JAMA Internal Medicine.
http://dx.doi.org/10.1001/jamainternmed.2015.4535

Évaluation de nouvelles technologies visant à réduire le stress thermophysiologique associé au port de vêtements individuels de protection pour les pompiers

Les contraintes thermiques liées au port des vêtements individuels de protection (VIP) contre la chaleur et les flammes sont un problème préoccupant pour la santé et la sécurité des pompiers. Les matériaux utilisés dans la fabrication des VIP ont souvent le désavantage d'être lourds, rigides et d'empêcher l'évacuation de la chaleur produite par l'activité physique lors d'une intervention. Deux nouvelles technologies de matériaux ont été développées par le Groupe CTT, un centre de transfert technologique spécialisé dans la recherche et la conception de matériaux textiles, et ses partenaires industriels, afin de réduire les astreintes physiologiques des travailleurs exposés au stress thermique. L'une de ces technologies consiste en un système d'absorption de la chaleur, et l'autre est un nouveau matériau qui entre dans la fabrication d'un VIP. Réalisée en deux volets, cette étude avait comme objectif d'évaluer l'efficacité de ces deux technologies par une analyse de la réponse physiologique de sujets exposés à des conditions environnementales contrôlées.

Source: http://www.irsst.qc.ca/publications-et-outils/publication/i/100842/n/technologies-thermophysiologique-vetements-protection-pompiers

Baseline evaluation with a sweating thermal manikin of personal protective ensembles recommended for use in West Africa

OBJECTIVE: Experience with the use of personal protective equipment (PPE) ensembles by health care workers responding to the Ebola outbreak in the hot, humid conditions of West Africa has prompted reports of significant issues with heat stress that has resulted in shortened work periods.
METHODS: A sweating thermal manikin was used to ascertain the time to achievement of a critical core temperature of 39°C while wearing 4 different PPE ensembles similar to those recommended by the World Health Organization and Médecins Sans Frontières (Doctors Without Borders) at 2 different ambient conditions (32°C/92% relative humidity and 26°C/80% relative humidity) compared with a control ensemble.
RESULTS: PPE ensembles that utilized coveralls with moderate to high degrees of impermeability attained the critical core temperature in significantly shorter times than did other ensembles. Encapsulation of the head and neck region resulted in higher model-predicted subjective impressions of heat sensation.
CONCLUSIONS: To maximize work capacity and to protect health care workers in the challenging ambient conditions of West Africa, consideration should be given to adjustment of work and rest schedules, improvement of PPE (e.g., using less impermeable and more breathable fabrics that provide the same protection), and the possible use of cooling devices worn simultaneously with PPE.

Source: Coca A, DiLeo T, Kim JH, Roberge R, Shaffer R. Disaster Med. Public Health Prep. 2015.
http://dx.doi.org/10.1017/dmp.2015.97

Disinfection of personal protective equipment for management of Ebola patients

Bessesen et al highlight the potential utility of reusable elastomeric face masks to bypass the risk of N95 respirator shortages during a respiratory illness pandemic and stress the importance of efficacious disinfection to reuse facial protective equipment safely.1 We would like to take the opportunity to underline the need that awareness on personal protective equipment (PPE) stocks is included in any pandemic preparedness plan. The demand for PPE must be established on the basis of the health care facility's role, defined by public health authorities to create a coordinated network approach.

Source: Vincenzo Puro, Silvia Pittalis, Pierangelo Chinello, Emanuele Nicastri, Nicola Petrosillo, Mario Antonini, Giuseppe Ippolito. American Journal of Infection Control, 2015.
http://dx.doi.org/10.1016/j.ajic.2015.07.040

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