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ScienceDirect - Journal of Hospital Infection : Personal protective equipment in an influenza pandemic: a UK simulation exercise
Personal protective equipment in an influenza pandemic: a UK simulation exercise
N.F. Phin(a), Corresponding Author, A.J. Rylands(b), J. Allan(b), C. Edwards(b), J.E. Enstone(c) and J.S. Nguyen-Van-Tam(d)
a) Cheshire and Merseyside Health Protection Unit, Chester UK
b) Wirral University Teaching Hospital NHS Foundation Trust, Upton UK
c) Hospital Infection Society, London, UK
d) University of Nottingham, Nottingham, UK
Received 14 February 2008; accepted 4 September 2008. Available online 17 November 2008.
Summary
There is limited experience of both operational and financial impacts that adoption of UK pandemic influenza infection control guidance will have on the use of personal protective equipment (PPE), patients and staff. We attempted to assess these issues from a live exercise in a hospital in north-west England. During this 24 h exercise, all staff on an acute general medical ward wore PPE and adopted the procedures described in the UK pandemic influenza infection control guidance. Teams of infection control nurses observed and recorded staff behaviour and practice throughout the exercise, including staff attitudes towards the use of PPE.
Although World Health Organization recommendations on the likely use of high-level PPE (FFP3 respirators) proved to be excessive, more gloves and surgical masks were used than expected. Despite pre-exercise training, many staff lacked confidence in using PPE and following infection control measures.
They found PPE uncomfortable, with even basic tasks taking longer than usual.
Large quantities of clinical waste were generated: an additional 12 bags (570 L) per day.
The estimates of PPE usage within this exercise challenge assumptions that large amounts of high-level PPE are required, with significant implications for healthcare budgets. A programme of ongoing infection control education is needed.
Healthcare in a pandemic situation is not simply a case of applying pandemic influenza infection control guidance to current practice; hospitals need to consider changing the way care and services are delivered.
Keywords: Infection control; Influenza; Pandemic; Personal protective equipment; Simulation exercise
Table I.
Department of Health, England guidance for personal protective equipment for care of patients with pandemic influenza
a) Wherever possible, aerosol-generating procedures should be performed in side rooms or other closed single-patient areas with minimal staff present.
b) Gloves and apron should be worn during certain cleaning procedures.
c) Gloves should be worn in accordance with standard infection control principles. If glove supplies become limited or pressurised, this recommendation may need to be relaxed. Glove use should be prioritised for contact with blood and body fluids, invasive procedures, and contact with sterile sites.
d) Consider in place of apron if extensive soiling of clothing or contact of skin with blood and other body fluids is anticipated (for example, during intubation or caring for babies).
e) If non-fluid repellent gowns are used a plastic apron should be worn underneath.
f) Surgical masks (fluid-repellent) are recommended for use at all times in cohorted areas for practical purposes. If mask supplies become limited or pressurised, then in cohorted areas usage should be limited to close contact with a symptomatic patient (within 1 m).
Table II.
Numbers of staff working during the 24 h period of the exercise
RGNs, registered nurses; HCAs, healthcare assistants.
Table III.
Personal protective equipment (PPE) used over the 24 h period of the exercise
a) Rounded to the nearest 50.
Table IV.
Ward traffic over the 24 h period
a) Staff based on the ward are not included in these numbers.
b) No formal ward rounds were carried out during the exercise so this value is likely to underestimate the number of visits by medical staff.
Table V.
Staff concerns/comments relating to personal protective equipment (PPE) and infection control
Table VI.
Comparison of personal protective equipment estimates from the Arrowe Park Exercise and World Health Organization (WHO) guidance over seven days and based on 29 patients
Corresponding Author Contact Information
Corresponding author. Address: Health Protection Agency Centre for Infections, 61 Colindale Avenue, London NW9 5EQ, UK. Tel.: +44 2083276661; fax: +44 2082007868.
Note to users:
The section "Articles in Press" contains peer reviewed accepted articles to be published in this journal. When the final article is assigned to an issue of the journal, the "Article in Press" version will be removed from this section and will appear in the associated published journal issue. The date it was first made available online will be carried over.
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Please consult the journal's reference style for the exact appearance of these elements, abbreviation of journal names and the use of punctuation.
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N.F. Phin(a), Corresponding Author, A.J. Rylands(b), J. Allan(b), C. Edwards(b), J.E. Enstone(c) and J.S. Nguyen-Van-Tam(d)
a) Cheshire and Merseyside Health Protection Unit, Chester UK
b) Wirral University Teaching Hospital NHS Foundation Trust, Upton UK
c) Hospital Infection Society, London, UK
d) University of Nottingham, Nottingham, UK
Received 14 February 2008; accepted 4 September 2008. Available online 17 November 2008.
Summary
There is limited experience of both operational and financial impacts that adoption of UK pandemic influenza infection control guidance will have on the use of personal protective equipment (PPE), patients and staff. We attempted to assess these issues from a live exercise in a hospital in north-west England. During this 24 h exercise, all staff on an acute general medical ward wore PPE and adopted the procedures described in the UK pandemic influenza infection control guidance. Teams of infection control nurses observed and recorded staff behaviour and practice throughout the exercise, including staff attitudes towards the use of PPE.
Although World Health Organization recommendations on the likely use of high-level PPE (FFP3 respirators) proved to be excessive, more gloves and surgical masks were used than expected. Despite pre-exercise training, many staff lacked confidence in using PPE and following infection control measures.
They found PPE uncomfortable, with even basic tasks taking longer than usual.
Large quantities of clinical waste were generated: an additional 12 bags (570 L) per day.
The estimates of PPE usage within this exercise challenge assumptions that large amounts of high-level PPE are required, with significant implications for healthcare budgets. A programme of ongoing infection control education is needed.
Healthcare in a pandemic situation is not simply a case of applying pandemic influenza infection control guidance to current practice; hospitals need to consider changing the way care and services are delivered.
Keywords: Infection control; Influenza; Pandemic; Personal protective equipment; Simulation exercise
Table I.
Department of Health, England guidance for personal protective equipment for care of patients with pandemic influenza
a) Wherever possible, aerosol-generating procedures should be performed in side rooms or other closed single-patient areas with minimal staff present.
b) Gloves and apron should be worn during certain cleaning procedures.
c) Gloves should be worn in accordance with standard infection control principles. If glove supplies become limited or pressurised, this recommendation may need to be relaxed. Glove use should be prioritised for contact with blood and body fluids, invasive procedures, and contact with sterile sites.
d) Consider in place of apron if extensive soiling of clothing or contact of skin with blood and other body fluids is anticipated (for example, during intubation or caring for babies).
e) If non-fluid repellent gowns are used a plastic apron should be worn underneath.
f) Surgical masks (fluid-repellent) are recommended for use at all times in cohorted areas for practical purposes. If mask supplies become limited or pressurised, then in cohorted areas usage should be limited to close contact with a symptomatic patient (within 1 m).
Table II.
Numbers of staff working during the 24 h period of the exercise
RGNs, registered nurses; HCAs, healthcare assistants.
Table III.
Personal protective equipment (PPE) used over the 24 h period of the exercise
a) Rounded to the nearest 50.
Table IV.
Ward traffic over the 24 h period
a) Staff based on the ward are not included in these numbers.
b) No formal ward rounds were carried out during the exercise so this value is likely to underestimate the number of visits by medical staff.
Table V.
Staff concerns/comments relating to personal protective equipment (PPE) and infection control
Table VI.
Comparison of personal protective equipment estimates from the Arrowe Park Exercise and World Health Organization (WHO) guidance over seven days and based on 29 patients
Corresponding Author Contact Information
Corresponding author. Address: Health Protection Agency Centre for Infections, 61 Colindale Avenue, London NW9 5EQ, UK. Tel.: +44 2083276661; fax: +44 2082007868.
Note to users:
The section "Articles in Press" contains peer reviewed accepted articles to be published in this journal. When the final article is assigned to an issue of the journal, the "Article in Press" version will be removed from this section and will appear in the associated published journal issue. The date it was first made available online will be carried over.
Please be aware that although "Articles in Press" do not have all bibliographic details available yet, they can already be cited using the year of online publication and the DOI as follows: Author(s), Article Title, Journal (Year), DOI.
Please consult the journal's reference style for the exact appearance of these elements, abbreviation of journal names and the use of punctuation.
There are three types of "Articles in Press":
* Accepted manuscripts: these are articles that have been peer reviewed and accepted for publication by the Editorial Board. The articles have not yet been copy edited and/or formatted in the journal house style.
* Uncorrected proofs: these are copy edited and formatted articles that are not yet finalized and that will be corrected by the authors. Therefore the text could change before final publication.
* Corrected proofs: these are articles containing the authors' corrections and may, or may not yet have specific issue and page numbers assigned.
-