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Simulation reveals contamination from improper PPE use

Researchers used UV light to show solution left on the skin after treating a simulated patient


An Florida Atlantic University emergency medicine physician and collaborators discovered the presence of fluorescent solution on health care workers’ skin after a simulation training exercise, which represented exposure to a contagion and indicated they made an error while putting on or taking off their PPE.

Photo/Rami A. Ahmed, D.O., Indiana University School of Medicine

By Laura French

BOCA RATON, Fla. — Researchers have conducted a simulation showing contaminants left on the skin after improper PPE use when treating a patient.

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 conducted the simulation to show the importance of using proper procedures to put on and take off PPE, according to Florida Atlantic University news release. The team demonstrated how aerosol-generating procedures can lead to exposure of contagions using a fluorescent solution and ultraviolet light.

Lead author Patrick G. Hughes, D.O., director of FAU’s emergency medicine simulation program and his collaborators used the nontoxic solution during a PPE training session for healthcare staff. They placed a highlighter refill in a warm water bath for 15 minutes to create the solution, which is only visible under UV light.

For the experiment, which was published in the journal Medical Education, the researchers instructed healthcare staff to put on PPE, including a cap, gown, surgical gloves, eye protection, a face shield and an N95 mask. Supplies were wiped off and reused for multiple trainings to conserve supplies. After healthcare staff put on their PPE, they went into a room to care for a simulated patient sprayed down with the invisible simulated contagion. The researchers also added the fluorescent solution to a simulated albuterol nebulizer treatment, which was given to the mannikins during the scenario.

After completing the simulation, the staff remained in their PPE and were taken to another room to remove their PPE. The lights were turned off and a black-light flashlight was used to identify the 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.

Following the flashlight examination, the healthcare staff completely removed their PPE. Researchers discovered the presence of fluorescent solution on the staff members’ skin, which represented exposure to the contagion and indicated they made an error while putting on or taking off their PPE.

The results revealed the most common error made was contamination of 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 contamination 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,” said Hughes in a statement. “We can make immediate corrections to each individual’s technique based on visual evidence of the exposure.”

By providing healthcare staff with visual evidence of protection during patient encounters with high-risk aerosol-generating procedures, this training simulation aims to build trust in protective equipment and in proper donning and doffing procedures.

“This experiment demonstrated that following PPE training improves workplace safety and decreases the risk of transmission,” said Hughes.

Kate E. Hughes, D.O., of the University of Arizona College of Medicine-Tucson and Rami A. Ahmed, D.O., of the Indiana University School of Medicine in Indianapolis co-authored the study.