CJEM Articles: personal protective equipment

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  • Surgical mask versus N95 respirator for preventing influenza among health care workers: a randomized trial
    January 2012 14 1
    Andrew Worster, Damon Atrie

    Clinical Question

    Are surgical masks inferior to N95 respirators in reducing influenza infection in health care workers?

    Article Chosen

    Loeb M, Dafoe N, Mahony J, et al. Surgical mask vs N95 respirator for preventing influenza among health care workers: a randomized trial. JAMA 2009;302:1865-71.

    Objective

    To evaluate the effectiveness of N95 respirators compared to standard surgical masks in reducing influenza infection in health care workers.

  • Use of personal protective equipment in Canadian pediatric emergency departments
    March 2011 13 2
    Amy C. Plint, Kathryn N. Suh, Ken J. Farion, Nicholas J. Barrowman, Sarah M. Reid, Tobey Audcent

    Objective: Numerous barriers to maintaining infection control practices through the use of personal protective equipment (PPE) exist in the emergency department (ED). This study examined the knowledge, self-reported behaviours, and barriers to compliance with infection control practices and the use of PPE in Canadian pediatric EDs.
    Methods: A self-administered survey instrument consisting of 21 questions was developed and piloted for this study. The survey was mailed to all individuals listed in the Pediatric Emergency Research Canada database of physicians practicing pediatric emergency medicine in Canada.
    Results: A total of 186 physicians were surveyed, and 123 (66%) participated. Twenty-two percent of participants reported that they had never received PPE training and 32% had not been trained in the previous 2 years. Fifty-three percent reported being very or somewhat comfortable with their knowledge of transmission-based isolation practices. Participants were correct on a mean of 4.9 of 11 knowledge-based questions (SD 1.7). For scenarios assessing self-reported use of PPE, participants selected answers that reflected PPE use in accordance with national infection control standards in a mean of 1.0 of 6 scenarios (SD 1.0). Participants reported that they would be more likely to use PPE if patients were clearly identified prior to physician assessment, equipment was accessible, and PPE use was made a priority in their ED.
    Conclusions: Knowledge and self-reported adherence to recommended infection control practices among Canadian pediatric emergency physicians is suboptimal. Early identification of patients requiring PPE, convenient access to PPE, and improved education regarding isolation and PPE practices may improve adherence.

  • The "delay effect" of donning a gown during cardiopulmonary resuscitation in a simulation model
    July 2008 10 4
    Leah Watson, P. Richard Verbeek, Randy Gwyn, William Sault

    Objective: We sought to determine whether the use of currently issued gowns delays initiation of chest compressions and ventilations during cardiopulmonary resuscitation and whether simple gown modifications can reduce this delay.

    Methods: Firefighter defibrillation instructors were allocated into pairs and videotaped while performing standardized cardiac arrest scenarios. Three scenarios were compared: "no gown," "standard gown" and "modified gown." Key time intervals were extracted from videotaped data.

    Results: Ninety-five scenarios were analyzed. Mean time interval to chest compression was 39 seconds (95% confidence interval [CI] 34-43) for "no gown" scenarios, 71 seconds (95% CI 66-77) for "standard gown" scenarios and 59 seconds (95% CI 54-63) for "modified gown" scenarios (p < 0.001). Time to first ventilation was 146 seconds (95% CI 134-158), 238 seconds (95% CI 224-253) and 210 seconds (95% CI 198-223) in the 3 groups, respectively (p < 0.001). Post hoc testing showed that the time differences between all groups were statistically significant.

    Conclusion: Standard gowns protect front-line care providers but cause significant delays to chest compressions and ventilations, potentially increasing patient morbidity and mortality. Minor gown modifications, including pre-tied neck straps and longer waist ties that tie in front, allow for easier use and shorter delays to time-critical interventions. Future research is required to reduce care delays while maintaining adequate protection of emergency medical service providers from infectious disease.