The Grapevine

Handling PPE The Wrong Way Could Spread The Virus To Health Care Workers

Emergency resident doctors at Florida Atlantic University's Schmidt College of Medicine underwent an experimental training program to reiterate the right way for medical professionals to remove Personal Protective Equipment (PPE) after attending to COVID-19 patients. 

Patrick G. Hughes, director of FAU's emergency medicine simulation program, used high-fidelity patient mannequins for educational purposes and these mannequins were used to conduct this study that was recently published in the journal Medical Education. The research was completed with the help of University of Arizona College of Medicine-Tucson and the Indiana University School of Medicine.  

First, the researchers created a non-toxic fluorescent solution by immersing highlighter refill ink in warm water for about 15 minutes. This liquid was further added to a nebulizer to spray it on the mannequins in make-believe emergency settings used for training medical personnel at the college. As the solution is only visible under ultraviolet rays, it made it easy to expose the exchange of the spray’s aerosol particles. 

Healthcare workers were instructed to wear gowns, eye gear, face shields, caps, gloves and N95 masks before they attended to simulated patients sprayed with the solution, which in this study represents contagion. The idea behind this was to show how viruses can easily spread through aerosol particles or droplets despite being covered in PPE from head to toe. These supplies were reused several times after they were cleaned to conserve them due to being in short supply. 

231035_web Using ultraviolet light, researchers discovered the presence of fluorescent solution on the health care worker's skin, which represented an exposure to the contagion and indicated that they made an error while putting on or taking off their PPE. Rami A. Ahmed, D.O.

Once the personnel finished their duties in the staged room, they were brought to a dark room with the light switched off. This was to identify the transfer of the solution from the mannequin to the PPE and on the healthcare workers themselves under a flashlight amidst complete darkness. The fluorescent solution was visible on gloves, gowns, masks and face shields, proving that the aerosolized solution could spread if PPE was removed incorrectly. 

After the medical staff changed out of PPE, their skin was examined against the flashlight and revealed that some of the staff had exposed their face and forearms while removing PPE. Those who followed the removal guidelines did not show indication of the exchange. 

"This training method allows educators and learners to easily visualize any contamination on themselves after they fully remove their personal protective equipment. We can make immediate corrections to each individual's technique based on visual evidence of the exposure," Hughes explained. "This experiment demonstrated that following PPE training improves workplace safety and decreases the risk of transmission. This simulation-based approach provides an efficient, low-cost solution that can be implemented in any hospital."

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