Developing a process for safe donning and doffing of the CleanSpace® BioHood when caring for patients with viral haemorrhagic fever: A Video-Reflexive simulation study at the NSW Biocontainment Centre
Mary Wyer1,2,3, Su-Yin Hor4, Ruth Barratt5, Patricia E Ferguson1,2,3,6, Kathy Dempsey7, Louisa Sasko8, Gwendolyn L Gilbert1,9
1Sydney Infectious Diseases Institute, Westmead, NSW, Australia
2NSW Biocontainment Centre, Westmead, NSW, Australia
3Infectious diseases, Westmead Hospital, Westmead, NSW, Australia
4University of Technology, Ultimo, NSW, Australia
5Health Quality & Safety Commission, Wellington New Zealand
6Westmead Clinical School, Westmead, NSW, Australia
7The Clinical Excellence Commission, St Leonards, NSW, Australia
8IPAC, Westmead Hospital, Westmead, NSW, Australia
9Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
Introduction
Recent outbreaks of viral haemorrhagic fevers (VHF) outside endemic regions illustrate the importance of biopreparedness in Australia. The NSW Biocontainment Centre (NBC) provides comprehensive personal protective equipment (PPE) training for staff, in ensembles that include the incorporation of the CleanSpace® HALO powered air purifying respirator (PAPR) with half-mask. When caring for a patient with ‘wet’ VHF symptoms (diarrhoea, vomiting, bleeding), the NBC is considering incorporating the CleanSpace® BioHood, to provide greater head and neck protection, as well as keeping the PAPR unit protected from pathogens. This paper reports on the world-first development in a purpose built NBC, of a safe donning/doffing process, and reprocessing of reuseable components, of the BioHood and associated PPE.
Methods
Drawing on CleanSpace® training resources, a checklist was designed for donning/doffing the BioHood with associated PPE. The process was then simulated and video-recorded. Ensembles were coated with ultraviolet fluorescent markers to identify cross-contamination after doffing. Participating NBC clinicians collaboratively analysed the recordings in researcher-facilitated reflexive discussions. Suggestions for practice optimisation were tested in subsequent video-reflexive simulations and repeated until consensus on optimal practice was achieved.
Results
Video-reflexive simulation enabled participants to identify infection transmission risks during doffing including: dexterity and process issues leading to contamination of the wearers skin and scrubs; visual impediments to doffing booties safely; and, contamination of reusable PAPR components.
Conclusion
Video-reflexive simulation enables participants to recognise, discuss and test safer approaches, and to reach consensus on the procedure for a new and complex PPE item.
Biography
Dr Mary Wyer is an APPRISE Research Fellow based at the at the Westmead Institute for Medical Research and the Sydney Infectious Diseases Institute. She is also a Nurse Educator at the NSW Biocontainment Centre; a state-wide facility for the care of patients with high consequence infectious diseases (HCID). Mary researches collaboratively with healthcare workers, patients and families, using video-reflexive ethnography, to understand and improve local infection prevention and control and biocontainment practices.