Technique Reveals Contagion Spread from Improper Use of Protective Equipment

A physician from Florida Atlantic University’s Schmidt College of Medicine and collaborators from the University of Arizona College of Medicine-Tucson and the Indiana University School of Medicine have discovered the presence of fluorescent solution on personal protective equipment (PPE), indicating an exposure to COVID-19.

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. Courtesy of Rami A. Ahmed, D.O.

Using ultraviolet light, the researchers discovered the presence of fluorescent solution on a health care worker’s skin, which represented an exposure to the contagion and showed that they made an error while putting on or taking off their PPE.

The researchers say they conducted the training technique to reinforce the importance of using proper procedures to put on and take off PPE when caring for patients during the pandemic. The experiment demonstrated how aerosol-generating procedures can lead to exposure of the contagion with improper use of PPE.

Despite the use of PPE, reports show that many health care workers contracted COVID-19, which raises substantial concerns about the effectiveness of the PPE. The equipment is essential for the safety of those working in the health care field, but only if used properly.

To detect contamination, lead author Patrick Hughes and his and collaborators used a nontoxic fluorescent solution during a PPE training session for health care staff. They placed a highlighter refill in a warm water bath for 15 minutes to create a fluorescent solution, visible only under ultraviolet light.

For the experiment, the researchers instructed health care staff to put on PPE, which included a cap, gown, surgical gloves, eye protection, face shield, and N95 mask. In order to conserve vital PPE, supplies were wiped off and reused for multiple trainings. After health care staff in the study put on their PPE, they went to a room to care for a simulated patient sprayed down with the invisible simulated contagion. In addition, the researchers added the fluorescent solution to a simulated albuterol nebulizer treatment, which was given to the mannequins during the scenario (not in a negative pressure room).

After completing the simulated case, the health care staff remained in their PPE and were taken to another room, where the lights were turned off before removing their PPE. Turning off the lights enabled the identification of widespread simulated contagion on the PPE, both on the gloves and gowns from directly touching the simulated patient and on the face shields and masks from the aerosolized solution. The researchers used a black light flashlight to examine each health care worker and to identify the presence of any fluorescent solution.

Results from the experiment revealed that the most common error made by the health care staff was contaminating the face or forearms during PPE removal. In contrast, those who put on and took off their PPE according to guidelines had no signs of the fluorescent contagion on their skin or face.

“This training method allows educators and learners to easily visualize any contamination on themselves after they fully remove their personal protective equipment,” Hughes said. “We can make immediate corrections to each individual’s technique based on visual evidence of the exposure.”

By providing health care staff with visual evidence of protection during patient encounters with high-risk aerosol-generating procedures, this innovative training method is helping to inspire trust in their training and PPE.

“This experiment demonstrated that following PPE training improves workplace safety and decreases the risk of transmission,” Hughes said. “This simulation-based approach provides an efficient, low-cost solution that can be implemented in any hospital.”

Hughes also conducted this training technique with Florida Atlantic University’s emergency medicine resident physicians in the medical school’s Clinical Skills Simulation Center, which uses high-tech and high-fidelity patient mannequins in life-like hospital and emergency room settings. The rooms are equipped with hospital beds, gurneys or exam tables, monitors, IV poles, defibrillators, blood pressure cuffs, simulated oxygen ports, otoscopes, ophthalmoscopes, and all equipment and supplies required to respond to medical and nursing interventions, including emergencies.

The research was published in Medical Education (www.doi.org/10.1111/medu.14188).