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Application of fluorescence method in the process of personal protective equipment removal

      To the editor,
      More than 1.2 million cases of Coronavirus disease 2019
      • Wu Y.C.
      • Chen C.S
      • Chan Y.J.
      The outbreak of COVID-19: an overview.
      had been confirmed worldwide as of April 6, 2020. With the increase in overseas returnees and visitors to China, Hangzhou sets up a working group, including health care workers and staffs from public security, transportation, foreign affairs, and other nonmedical system, responsible for quarantine work. Proper wear and removal of personal protective equipment (PPE) becomes a critical measure to ensure the safety of frontline personnel. This study intends to carry out the practice of pollutant simulation, so as to grasp the key point of PPE removal and guarantees the safety of frontline staffs.
      We trained 140 staffs from the working group for the theory of PPE in batches, followed by one-to-one field practice of wear and removal of PPE. Forty-six frontline staffs from nonmedical systems were selected to carry out the pollutant simulation test. According to the characteristics of the phosphors which can be identified by naked eyes under ultraviolet irradiation, we dissolved the phosphors in gel like ethanol as pollutant. We applied the phosphors on the outer surface of the gloves, forearms of the whole-body protective gowns, the outer surface of the gown hat, and the bare outer surface of kn95 respirator. After removing the PPE, we irradiated the clothes and the exposed skin through the ultraviolet lamp to show the risk points during the removal process.
      In the pollutant simulation test, 21 staffs polluted the upper chest, accounting for 45.7% of the total, followed by 20 and 15 staffs polluted the hands and the front chest, accounting for 43.5% and 32.6% of the total, respectively. The number of people with face and back pollution was less than 10%. See Table 1 for details.
      Table 1Analysis of contaminated sites in pollutant simulation test
      Contaminated sitesNumber of people contaminatedProportion of pollution (%)
      Upper chest2145.7
      Bare hands2043.5
      Anterior chest1532.6
      Upper limbs613.0
      Inner surface of protective gowns613.0
      Lower limbs510.9
      The face24.3
      The back12.2
      The correct use of PPE is an effective way to ensure the safety of personnel, and improper wear and removal will bring potential harm to users.
      • Ong SWX
      • Tan YK
      • Chia PY
      • et al.
      Air, surface environmental, and personal protective equipment contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from a symptomatic patient.
      In this study, 45.7% of the workers caused the upper chest pollution during the unloading process of PPE, and the main pollution source was from the lower edge of outer surface of kn95 respirator. When the user lowered his head in the removal process, the chest was contaminated. Therefore, in the wear process, it is necessary to protect the external surface of the kn95 respirator with the placket seal.
      During the removal of PPE, 43.5% users contaminated their hands. In this study, 50% of the workers' hand hygiene actions were not standardized, and 39.1% of the workers forgot to do hand hygiene at least once when they took off PPE. Hand hygiene is considered the most economical, convenient, and efficient way to control hospital infection,
      • Salmon S.
      • Pittet D
      • Sax H
      • McLaws ML
      The 'My five moments for hand hygiene' concept for the overcrowded setting in resource-limited healthcare systems.
      ,
      • Ma Q.X.
      • Shan H
      • Zhang HL
      • Li GM
      • Yang RM
      • Chen JM
      Potential utilities of maskwearing and instant hand hygiene for fighting SARS-CoV-2.
      it is of great significance to enhance the awareness of hand hygiene.
      • Wax R.S.
      • Christian M.D.
      Practical recommendations for critical care and anesthesiology teams caring for novel coronavirus (2019-nCoV) patients.
      To reduce the risk of infection, we should pay more attention to the removal of PPE without contamination as well as its supply.

      References

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        • Chen C.S
        • Chan Y.J.
        The outbreak of COVID-19: an overview.
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        • Ong SWX
        • Tan YK
        • Chia PY
        • et al.
        Air, surface environmental, and personal protective equipment contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from a symptomatic patient.
        JAMA. 2020; 323: 1610-1612
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        • McLaws ML
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        J HospInfect. 2015; 91: 95-99
        • Ma Q.X.
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        • Zhang HL
        • Li GM
        • Yang RM
        • Chen JM
        Potential utilities of maskwearing and instant hand hygiene for fighting SARS-CoV-2.
        J Med Virol. 2020; ([e-pub ahead of print])
        http://doi.org/10.1002/jmv.25805
        Date accessed: May 19, 2020
        • Wax R.S.
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