Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Toronto anaesthesiologists Muñoz-Leyva & Niazi share observations from PPE training simulations, identifying the 'high risk' moments where frequent exposures and PPE failures are seen.
Why is this important?
For all the understandable concern over adequate access to PPE and discussion of appropriate levels of protection, HCW safety is entirely dependent on the effective use of this protective equipment.
Identifying common areas of 'biosafety breach' allows both clinicians and PPE supervisors to apply added attention to these steps. These areas can be conceptualised as offering a disproportionate safety benefit for the time and resources deployed in ensuring compliance at these moments.
Which areas did they identify as most important?
Donning
- N95 mask fit-testing and fit-checking; notably shaving facial hair to ensure a face-mask interface seal.
- Use of extended-cuff gloves with gown cuff tucked securely into glove.
- Time management: PPE donning should never be rushed, even in critical medical emergencies.
Doffing
- Glove removal is a high-risk step. When removing the second, inner glove, ensure as little contact as possible with the glove sleeve by the ungloved hand.
- Gown removal is the next highest risk step. Do not touch the front of the gown, especially with ungloved hands.
- Mask removal avoid touching front of mask; avoid any snapping of straps.
- Perform alcohol-based hand-hygiene after each article is removed.
summary -
Videolaryngoscopy is widely believed to give a superior view to that obtained by direct laryngoscopy. Published literature suggests this benefit extends to both hyper-angulated and Macintosh-style videolaryngoscopes. Notwithstanding, our clinical experience shows that the videoscopic view with a Macintosh-style videolaryngoscope is often no different or only marginally better than the directly sighted peroral view. ⋯ This study failed to corroborate previously published findings of a clinically significantly improved videoscopic view compared with direct peroral sighting using Macintosh-style videolaryngoscopes. Further study of this class of device is warranted in human subjects.