Elizabeth Beam, RN, MSN
UNMC College of Nursing
Special thanks to Dr. Gibbs, Kate Boulter, Marcia
Beckerdite, and Dr. Philip Smith MD
The plan
Key concepts in PPE for healthcare.
 Describe study.
 Results and discussion.
 Future directions.
 Questions?
 If time…video review simulation.

Key concepts in personal
protection for healthcare…
Proper order for donning PPE
 What PPE to wear

 Contact
 Contact & Droplet
 Contact & Airborne
How to protect yourself while in the
patient room
 Proper order for doffing PPE

A pilot study…



A study was conducted to examine the
feasibility of employing a simulated healthcare
environment to assess the technique of
healthcare workers in the use of standard
airborne and contact isolation precautions
without the potential for harm to real patients.
Powdered fluorescent marker tracking and
digital video recording were used to assess
compliance with current guidelines.
An expanded research study will be needed to
further examine these commonly noted
contamination and exposure pathways.
Simulation suite…
Faking it…
Glowing germs…
Guidelines…

Centers for Disease Control
 http://www.cdc.gov/HAI/prevent/ppe.html

World Health Organization
 http://www.who.int/csr/resources/publication
s/WHO_CDS_HSE_2008_2/en/index.html
Scenarios…
Registered Nurses hung an intravenous
(IV) medication (IV line into bag under
gown) and performed a head-to-toe
assessment on the patient.
 Respiratory Therapists assessed the
patient and administered a nebulizer
treatment (saline only).
 Nursing Technicians repositioned the
patient from bed to chair, took vital signs,
and conducted input and output
assessment.

Poster used in study…
Color copies
 Posted at donning
and doffing areas.

Summary of study design…
Simulation Room
 Cameras (in room, outside room)
 Simulated Patient (yours truly)
 Glo Germ
 Job-specific procedures (simulated)

 Nurse: IV med
 RT: Nebulizer treatment
 Patient care tech: Reposition, I & 0, VS

Randomized: Guideline poster available
Participants:
Healthcare workers (n=10)
 Convenience sample
 Good skill mix (med-surg, ICU, ER, etc.)
 Had experience with simulation
 Multiple genders, roles, etc.

Video Results…


Each of the 10 participants committed at least one
breach of standard airborne and contact isolation
precautions
Donning:
 Most common: not conducting a seal check on the
respirator, failing to tie the gown at both the neck and the
waist, and improper sequence.

Doffing:
 Most common: improper sequence, the method for
removing the respirator, and removing potentially
contaminated items from the room.

In room:
 Touching self with dirty gloves.
 Touching surfaces in room for no apparent reason.
Glo germ results…

Glo Germ noted with UV light and digital
photographs taken:
 Contamination noted in 8 of the 10
participants.
 6 hand area; 3 back of head.
 One had contamination on both their hands
and their head.
Discussion…
Our study was not large enough to
determine if poster impacted behavior,
but…
 Is it Glo Germ or is it paper towel
debris?
 Video capture: Good quality. Interesting
data. Camera position matters.
 Simulation lab vs. regular hospital room
with mounted digital cameras?

Dissemination…
Beam, E., Gibbs, S., Boulter, K., Beckerdite, M., & Smith, P. (2011).
A method for evaluating personal protective equipment technique
by healthcare workers. American Journal of Infection Control, 39, 415-420.
Future directions…

“Body of Work” creates questions:
 What are the common errors?
 Are there facility-specific errors?
 Do physical characteristics matter?
 Why are the poor behaviors seen?
 What are the beliefs among healthcare
workers about PPE?
 Could reflective practice improve
performance?
Mixed Methods Study Investigating
Infection Control Behavior
Population: Registered Nurses expected to care for patients in isolation in the hospital.
Sample Size: Minimum 30.
Pre-simulation data: Collect demographic information, occupational history,
and physical characteristics/flexibility assessment.
Simulation Experience:
Video
Record
Patient
Care
+
Review
video with
‘Think
Aloud’
Recording
Sequential Explanatory Design: Simulation will be reviewed and scored (as per
Beam, et al., 2011). Think Aloud recordings will be qualitatively analyzed (Max QDA).
Long Term Follow Up (at One Month): Interview asking about change in practice.