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Impact of Personal Protective Equipment on the Performance of Emergency Pediatric Tasks
Mark D Adler, Steven Krug1, Carmel Eiger2
1From the Departments of Pediatrics.
Insights
Personal protective equipment (PPE) did not significantly impact most emergency procedure times for pediatric health care providers (HCPs) on a simulator. However, IV placement was slower with PPE, though HCPs reported less interference after use.
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Simulation
- Infection Control
Background:
- Health care providers (HCPs) use personal protective equipment (PPE) to prevent hazardous exposures.
- Previous studies on PPE's impact on critical resuscitation tasks have shown mixed results and have not focused on pediatric care.
- The effect of PPE on procedures in pediatric emergency settings remains under-evaluated.
Purpose of the Study:
- To assess the impact of full-shroud personal protective equipment (PPE) on the timeliness and success of emergency procedures performed by pediatric health care providers (HCPs).
- To evaluate performance differences in critical tasks such as intubation, ventilation, IV placement, and defibrillation when HCPs wear normal attire versus PPE.
Main Methods:
- A prospective study was conducted at two tertiary children's hospitals involving medical doctors and registered nurses.
- HCPs performed simulated pediatric emergency tasks in normal attire and then in full-shroud PPE (Ebola or chemical level).
- Procedure completion times for intubation, bag-valve mask ventilation, IV placement, fluid bolus, and defibrillation were compared between the two conditions.
Main Results:
- Medical doctors showed no significant differences in task completion times between wearing normal attire and PPE.
- Registered nurses demonstrated significant differences in defibrillation and IV placement times when wearing PPE.
- Registered nurses were faster at defibrillation with Ebola PPE but slower with chemical PPE; IV placement was slower in both types of PPE.
Conclusions:
- Personal protective equipment (PPE) did not generally affect the timeliness or success of simulated emergency procedures for pediatric HCPs, except for IV placement.
- Despite some observed differences in task completion times, participants reported less perceived interference and claustrophobia after wearing PPE.
- Further research is recommended to explore the real-world clinical impact of PPE on procedures in pediatric care settings.
Objectives:
Personal protective equipment (PPE) is worn by health care providers (HCPs) to protect against hazardous exposures. Studies of HCPs performing critical resuscitation tasks in PPE have yielded mixed results and have not evaluated performance in care of children. We evaluated the impacts of PPE on timeliness or success of emergency procedures performed by pediatric HCPs.
Methods:
This prospective study was conducted at 2 tertiary children's hospitals. For session 1, HCPs (medical doctors and registered nurses) wore normal attire; for session 2, they wore full-shroud PPE garb with 2 glove types: Ebola level or chemical. During each session, they performed clinical tasks on a patient simulator: intubation, bag-valve mask ventilation, venous catheter (IV) placement, push-pull fluid bolus, and defibrillation. Differences in completion time per task were compared.
Results:
There were no significant differences in medical doctor completion time across sessions. For registered nurses, there was a significant difference between baseline and PPE sessions for both defibrillation and IV placement tasks. Registered nurses were faster to defibrillate in Ebola PPE and slower when wearing chemical PPE (median difference, -3.5 vs 2 seconds, respectively; P < 0.01). Registered nurse IV placement took longer in Ebola and chemical PPE (5.5 vs 42 seconds, respectively; P < 0.01). After the PPE session, participants were significantly less likely to indicate that full-body PPE interfered with procedures, was claustrophobic, or slowed them down.
Conclusions:
Personal protective equipment did not affect procedure timeliness or success on a simulated child, with the exception of IV placement. Further study is needed to investigate PPE's impact on procedures performed in a clinical care context.
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