Oral Themed Presentation
Context: : Personal protective equipment (PPE) helps protect both patients and healthcare workers (HCW) from transmissible pathogens. HCW must therefore be able to properly don PPE while utilizing correct hand hygiene (HH) techniques. This may be challenging when HCW need to don PPE and also bring supplies and equipment into a patient room. Proper PPE cabinet configuration (CC) may help encourage adherence to HH guidelines and proper donning of PPE. The objective of this project was to utilize simulation to determine the PPE CC that works best for flow while promoting HH compliance and appropriate donning of PPE.
Description: : A multidisciplinary team of clinicians and Infectious Disease/Prevention experts met with bedside staff and performed an A3/root cause analysis of the current state. Based on this, 3 new PPE CCs were proposed: configuration 1 had 2 full shelves and a half shelf within the cabinet; configuration 2 had 3 full shelves; and configuration 3 extended the existing half shelf into a full shelf so that there were now 2 full shelves in the cabinet. These 3 new CCs were built and placed on a patient care unit alongside the existing CC that had a half-shelf and a full shelf in the cabinet. Simulations were conducted on this patient care unit utilizing all 4 CCs. Participants were given one scenario per CC and asked to carry out tasks as they would in real life. Participants then rated each of the 4 configurations on a likert scale of 1 to 5 (strongly disagree to strongly agree). Additionally, trained observers assessed each participant during each simulation and recorded contamination rates of PPE in the cabinet/shelf, on person, and hand hygiene compliance.
Observation/Evaluation: : 46 participants took part in the simulations; 13 respiratory therapists, 13 physicians/APNs, 20 registered nurses. 25/46 (54.3%) of participants felt that configuration 3 should be implemented. This configuration not only had the highest number of overall votes amongst all participants, it also had the highest number of votes for each type of participant. (Table 1) Additionally, this configuration had the highest percentages of 5/strongly agree responses when participants were asked if this configuration was easy to use, easy to place supplies, did not contaminate PPE, and liked it for their workflow. (Table 2) Participants who selected this CC were observed to have the least number of times of contaminating PPE on themselves. A coincidental finding was that there was a discrepancy between participants’ perception of HH compliance and observed HH compliance with all configurations. (Table 3)
Discussion: : Based on these simulations, CC 3 was implemented across our institution. Simulation is a valuable tool that can be used to help determine optimal PPE CC. Ongoing studies are needed to see if PPE and HH compliance is sustained when utilizing this CC. Simulation may also be used to assess compliance with HH techniques and PPE contamination rates. Further studies are needed to best determine how simulation may be utilized to provide ongoing education about PPE and HH compliance.