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COVID-19: A systematic evaluation of personal protective equipment (PPE) performance during restraint.

Authors
  • Dix, Roland1
  • Straiton, David1
  • Metherall, Peter2
  • Laidlaw, James1
  • McLean, Lisa1
  • Hayward, Andy1
  • Ginger, Gary1
  • Forrester, Louise1
  • O'Rourke, Paul1
  • Jefferies, Rob3
  • 1 Gloucestershire Health and Care NHS Foundation Trust, Montpellier Unit, Wotton Lawn Hospital, UK.
  • 2 Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, UK.
  • 3 Avon and Wiltshire Mental Health Partnership NHS Trust, UK.
Type
Published Article
Journal
Medicine Science and the Law
Publisher
SAGE Publications
Publication Date
Oct 01, 2021
Volume
61
Issue
4
Pages
275–285
Identifiers
DOI: 10.1177/00258024211000805
PMID: 33715558
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Restraint is widely practised within inpatient mental health services and is considered a higher-risk procedure for patients and staff. There is a sparsity of evidence in respect of the efficacy of personal protective equipment (PPE) used during restraint for reducing risk of infection. A series of choreographed restraint episodes were used to simulate contact contamination in research participants playing the roles of staff members and a patient. For comparison, one episode of simulated recording of physical observations was taken. Ultraviolet (UV) fluorescent material was used to track the simulated contact contamination, with analysis undertaken using established image registration techniques of UV photographs. This was repeated for three separate sets of PPE. All three PPE sets showed similar performance in protecting against contamination transfer. For teams not utilising coveralls, this was dependent upon effective cleansing as part of doffing. There were similar patterns of contamination for restraint team members assigned to specific roles, with hands and upper torso appearing to be higher-risk areas. The restraint-related contamination was 23 times higher than that observed for physical observations. A second layer of clothing that can be removed showed efficacy in reducing contact contamination. PPE fit to individual is important. Post-restraint cleansing procedures are currently inadequate, with new procedures for face and neck cleansing required. These findings leave scope for staff to potentially improve their appearance when donning PPE and engaging with distressed patients.

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