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An experiment showed how quickly the novel coronavirus can spread. Photo by Rami A. Ahmed D.O.
  • A new study shows that some workers may not properly use PPE, which causes the cross-contamination.
  • Researchers say the training method can help healthcare workers build trust in their training and their PPE.
  • Another video from Japan showed how one person with COVID-19 in a restaurant can quickly contaminate others.

As healthcare workers struggle to get personal protective equipment (PPE), a new study shows how even the correct gear doesn’t always protect against the novel coronavirus if not used properly.

A new study shows that some workers may not properly use PPE, which causes the cross-contamination.

A team from several universities looked at how improper use leads to virus exposure. Their findings were published in the journal Medical Education.

Patrick G. Hughes, DO, director of the emergency medicine simulation program at Florida Atlantic University, had healthcare staff put on a cap, gown, surgical gloves, eye protection, N95 mask, and face shield.

Then, they went into a room and cared for a simulated patient who was sprayed down with a nontoxic fluorescent solution to simulate the virus.

They also added the fluorescent solution to a simulated albuterol nebulizer treatment, which was given to the simulated patients. They were not in a negative pressure room.

To conserve vital PPE, supplies were wiped off and reused for multiple trainings.

After completing the simulated case, the healthcare workers stayed in their PPE and went into another room. The lights were turned off prior to removing their PPE. The researchers used a black light to examine the workers and see if they had tracked any fluorescent solution on them. Then they removed their PPE.

Their skin had the fluorescent solution on it, which showed if they made an error while putting on or taking off their PPE.

The most common mistake was contaminating their faces or forearms during PPE removal.

Those who put on and took off their PPE according to proper 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 in a statement. “We can make immediate corrections to each individual’s technique based on visual evidence of the exposure.”

Researchers say the training method can help healthcare workers build trust in their training and their PPE.

“This simulation-based approach provides an efficient, low cost solution that can be implemented at any hospital,” the researchers said in the study.

This is not the first time fluorescent dye and black light were used to illustrate the spread of COVID-19.

A video from Japanese Public Broadcasting station NHK along with local health authorities used dye to show how quickly a restaurant can be contaminated. In the video posted on CNN, one person is given fluorescent dye that is only visible in black light. A total of 10 people, including the person with the dye, then go through a short simulation designed to mimic dining at a buffet. At the end of the simulation, black light was turned on, revealing that the dye was now on utensils, plates, and even the faces of two of the diners.

The pandemic has created a “perfect storm” of increasing the risk for healthcare workers to develop COVID-19. This is due to an increase in patients, a shortage of workers, and limited PPE.

All healthcare workers must be trained in the appropriate donning (putting on) and doffing (taking off) of this equipment to use it correctly, noted Dr. Krutika Kuppalli, an infectious disease physician and vice chair of the Infectious Diseases Society of America.

“I believe this simulation shows that real-time feedback is valuable for healthcare providers because it allows them to make immediate corrections to their doffing technique in a safe environment, which they can then apply to a real-time setting,” Kuppalli said.

“That study really shows the importance of doing each step the same way every time for every patient,” added Karen Hoffmann, RN, a nurse and immediate past president of the Association for Professionals in Infection Control and Epidemiology.

Hoffmann noted that simulations similar to the one mentioned in the study have been done before.

“It pretty much always has the same outcome,” she told Healthline.

“Healthcare workers, they really do have to follow the basics,” Hoffmann said.

Kuppalli had to wear full PPE, including Tyvek suits, N95 masks, boot covers, face shields, and two pairs of gloves, when she worked in Sierra Leone during the Ebola outbreak.

“I can speak from personal experience as to the various factors that can affect the safety of PPE,” Kuppalli told Healthline. “The longer amount of time someone is in PPE, the harder it is for the provider to remain safe as they become hot and tired so may not be as diligent… It takes time to get used to working in the protective equipment.”

Additionally, being able to communicate with peers can be difficult when in PPE and can affect safety.

Until the COVID-19 outbreak, Hoffmann said she hadn’t had to focus on how to extend the use of disposable PPE. The pandemic forced many workers to extend the use of N95 masks sometimes for days. Different methods to decontaminate or extend use of masks include techniques using UV lights, ethylene oxide, and hydrogen peroxide.

“We’ve never had to do this before, but we had to do it this time,” she said.

“The big challenge with COVID is that we’ve had limited supplies,” she added. “I think everyone is doing the best they can.”

A factor related to the COVID-19 outbreak that definitely affected proper PPE use was the time to respond to patients, Hoffmann added. Healthcare workers were used to being able to rush into a room to respond to a code. Because of the highly contagious virus, they had to devote more time to proper PPE use and potentially miss critical seconds helping a patient.

When wearing cloth masks, there are a few things that people need to remember, experts say.

“Although it doesn’t sound glamorous, hand hygiene is still extremely important,” Kuppalli said. The most effective thing we can do is prevent ourselves from touching our hands, nose, and mouth with dirty hands.

When you wear a mask it is important not to touch or adjust it unless you have just washed or cleaned your hands with alcohol-based hand sanitizer. Otherwise, you will contaminate your mask. Make sure it is snug but comfortable. Also, keep it clean.

While cloth masks can prevent the spread of large droplets, they are not a replacement for social or physical distancing. “They really don’t prevent all smaller aerosol transmissions,” Hoffmann said.

“People think they can be anywhere they want to be,” Hoffmann added. “But we really need to maintain social distancing,”

“Improper PPE use always increases the risk of autoinfection whether there is a pandemic or not,” Kuppalli said.

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