Response to: Dos Santos WM Use of personal protective equipment reduces the risk of contamination by highly infectious diseases such as COVID-19 Evidence-Based Nursing 2021: 24:41
Nurses need accessible and thorough evidence-based guidance to support safe, effective care due to the risk of SARS-CoV-2/COVID-19 infection, sickness, and death. Selection and use of appropriate Personal Protective Equipment (PPE) is fundamental to respiratory protection programs and access to the latest evidence is vital to underpin practice and policy decisions.
The Evidence-Based Nursing commentary by Dr Dos Santos on a recent Cochrane Review of PPE use in healthcare workers offers some useful insights. However, there are other key details and findings from the original review that are also important for readers. While covering more of the body appeared to result in enhanced protection, more difficult donning, doffing, and poorer user comfort could lead to higher contamination risk. Also, more breathable PPE might result in a similar number of contamination spots on the user’s trunk compared to less permeable materials (MD 1.60, 95% CI −0.15 to 3.35) and potentially increase user satisfaction (MD −0.46, 95% CI −0.84 to −0.08).
Centers for Disease Control and Prevention guidance resulted in less contamination compared with using no guidance (small patches: MD −5.44, 95% CI −7.43 to −3.45). Other key findings include:
- One-step glove plus gown removal versus separa...
Response to: Dos Santos WM Use of personal protective equipment reduces the risk of contamination by highly infectious diseases such as COVID-19 Evidence-Based Nursing 2021: 24:41
Nurses need accessible and thorough evidence-based guidance to support safe, effective care due to the risk of SARS-CoV-2/COVID-19 infection, sickness, and death. Selection and use of appropriate Personal Protective Equipment (PPE) is fundamental to respiratory protection programs and access to the latest evidence is vital to underpin practice and policy decisions.
The Evidence-Based Nursing commentary by Dr Dos Santos on a recent Cochrane Review of PPE use in healthcare workers offers some useful insights. However, there are other key details and findings from the original review that are also important for readers. While covering more of the body appeared to result in enhanced protection, more difficult donning, doffing, and poorer user comfort could lead to higher contamination risk. Also, more breathable PPE might result in a similar number of contamination spots on the user’s trunk compared to less permeable materials (MD 1.60, 95% CI −0.15 to 3.35) and potentially increase user satisfaction (MD −0.46, 95% CI −0.84 to −0.08).
Centers for Disease Control and Prevention guidance resulted in less contamination compared with using no guidance (small patches: MD −5.44, 95% CI −7.43 to −3.45). Other key findings include:
- One-step glove plus gown removal versus separate removal resulted in less bacterial contamination (RR 0.20, 95% CI 0.05 to 0.77) but not fluorescent contamination (RR 0.98, 95% CI 0.75 to 1.28).
- Double-gloving resulted in less viral and bacterial contamination (RR 0.34, 95% CI 0.17 to 0.66) but not fluorescent contamination (RR 0.98, 95% CI 0.75 to 1.28).
- Additional spoken instructions resulted in fewer doffing errors (MD −0.9, 95% CI −1.4 to −0.4) and fewer contamination spots (MD −5, 95% CI −8.08 to −1.92).
- Extra sanitation of gloves with quaternary ammonium or bleach decreased contamination, but not alcohol‐based hand rub.
- Additional computer simulation reduced doffing errors (MD −1.2, 95% CI −1.6 to −0.7).
- Improved skill scores following PPE donning video lecture (MD 30.70, 95% CI 20.14 to 41.26).
- Face-to-face instruction reduced non-compliance with doffing guidance more than folders or videos alone (odds ratio 0.45, 95% CI 0.21 to 0.98).
References
De Castella T. WHO says ‘at least’ 115,000 health workers have now died from Covid-19. Nursing Times. 27 May 2021. Available: https://www.nursingtimes.net/news/coronavirus/who-says-at-least-115000-h... (Accessed 31 May 2021).
Verbeek JH, Rajamaki B, Ijaz S, et al. Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane Database Syst Rev. 2020;4: CD011621. doi:10.1002/14651858.CD011621.pub4.
As fourth-year King's College London medical students, we have read this article with great enthusiasm and felt we could identify with the concerns raised. We want to offer an additional perspective.
In terms of direct hazards, we have noticed that some of our colleagues have felt unsafe on specific placements. This is undoubtedly the case in psychiatry where patients may, unfortunately, become verbally abusive and at times physically intimidating.
Additional concerns may arise when students are placed peripherally in areas where there is a substantial crime. This can involve anything from petty theft to more serious crimes like muggings.
A clinical risk that we have been well trained to anticipate and handle are needlestick injuries. This is an example of adequate preparation making us feel more comfortable, i.e. working with sharps despite risks involved.
There are times when senior staff expectations are exceedingly high, and due to indirect risks such as stress and burnout, us students may fail to reach these standards. In some instances, lack of support and understanding perpetuate the cycle of stress. We have, however, noticed that this is less likely to occur when students have a longitudinal supervisor.
Overall we understand that certain risks are unavoidable, and we appreciate the vast number of measures in place aimed at safeguarding against risks and hazards during clinical placements. From our experience as medical stu...
As fourth-year King's College London medical students, we have read this article with great enthusiasm and felt we could identify with the concerns raised. We want to offer an additional perspective.
In terms of direct hazards, we have noticed that some of our colleagues have felt unsafe on specific placements. This is undoubtedly the case in psychiatry where patients may, unfortunately, become verbally abusive and at times physically intimidating.
Additional concerns may arise when students are placed peripherally in areas where there is a substantial crime. This can involve anything from petty theft to more serious crimes like muggings.
A clinical risk that we have been well trained to anticipate and handle are needlestick injuries. This is an example of adequate preparation making us feel more comfortable, i.e. working with sharps despite risks involved.
There are times when senior staff expectations are exceedingly high, and due to indirect risks such as stress and burnout, us students may fail to reach these standards. In some instances, lack of support and understanding perpetuate the cycle of stress. We have, however, noticed that this is less likely to occur when students have a longitudinal supervisor.
Overall we understand that certain risks are unavoidable, and we appreciate the vast number of measures in place aimed at safeguarding against risks and hazards during clinical placements. From our experience as medical students, we find that these interventions are mainly aimed at direct risks and hazards with the indirect types being overlooked.
We propose that students be made more aware of the types of indirect hazards they may encounter and better equip them to escalate concerns. This can take many forms, such as lectures, debriefing sessions, reflective practice and of course, one on one meetings with longitudinal supervisors.
We read with interest Malissa Warren's comment entitled, “Abdominal massage may decrease gastric residual volumes and abdominal circumference in critically ill patients” for our study, “The impact of abdominal massage administered to intubated and enterally fed patients on the development of ventilator-associated pneumonia: a randomized controlled study,” which was online published in the Evidence-Based Nursing Journal in April.
It is possible to criticize the fact that we did not include the protocol that we applied for enteral feeding and GRV measurement in the study methodology in detail. However, we want to say that there was no difference between the experimental and control groups in terms of both feeding rate and amount and GRV measurement. Both groups were homogeneous in these respects because this is a randomized controlled study. In the same article, there is evidence that there was no difference between the groups, for which GRV measurement is not suggested in terms of VAP development.1 However, this evidence is still disputed, and the necessity of GRV measurement is supported by some researchers.2 The writer also indicated that abdominal circumference measurement is not reliable in the case of oedema, acid, anasarca and obesity. We want to respecify that both groups body weights are similar (experimental group=69.9 16.7 and control group=69.7 16.3) and no patients with oedema, acid, anasarca were included in this study....
We read with interest Malissa Warren's comment entitled, “Abdominal massage may decrease gastric residual volumes and abdominal circumference in critically ill patients” for our study, “The impact of abdominal massage administered to intubated and enterally fed patients on the development of ventilator-associated pneumonia: a randomized controlled study,” which was online published in the Evidence-Based Nursing Journal in April.
It is possible to criticize the fact that we did not include the protocol that we applied for enteral feeding and GRV measurement in the study methodology in detail. However, we want to say that there was no difference between the experimental and control groups in terms of both feeding rate and amount and GRV measurement. Both groups were homogeneous in these respects because this is a randomized controlled study. In the same article, there is evidence that there was no difference between the groups, for which GRV measurement is not suggested in terms of VAP development.1 However, this evidence is still disputed, and the necessity of GRV measurement is supported by some researchers.2 The writer also indicated that abdominal circumference measurement is not reliable in the case of oedema, acid, anasarca and obesity. We want to respecify that both groups body weights are similar (experimental group=69.9 16.7 and control group=69.7 16.3) and no patients with oedema, acid, anasarca were included in this study. Moreover, it is known that rather than enteral feeding, parenteral feeding is preferred in advanced cases such as abdominal acid deposition.3
Last, the limitations of our study are clear. However, it should not be forgotten that there are many criteria to ensure homogeneity between groups in this study. With these criteria, it is not impossible, but pretty difficult to increase the larger sample size, and this was suggested as a result of our study.
We know that science changes and improves every day and think that, despite the issues discussed above, our pilot study with reflections to the clinical setting leads other research in this field.
References
1. Reignier J, Mercier E, Le Gouge A, et al. Effect of not monitoring residual gastric volume on risk of ventilator-associated pneumonia in adults receiving mechanical ventilation and early enteral feeding: a randomized controlled trial. JAMA 2013;309:249–56.
2. Elke G, Heyland D. Residual Gastric Volume and Risk of Ventilator-Associated Pneumonia. JAMA 2013;309:2090.
3. Johnson TM, Overgard EB, Cohen AE, DiBaise JK. Nutrition Assessment and Management in Advanced Liver Disease. Nutrition in Clinical Practice 2013;28:15-29.
If you enjoyed this EBN Notebook you may also like to read the EBN
Research Made Simple paper looking at Qualitative data analysis: a
practical example. This is available at:
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For more information about Hypothesis testing and p values: how to
interpret results and reach the right conclusion see the EBN Research Made
Simple paper published in April 2013.
If you want to learn more about p values see EBN Research Made Simple
paper "What is a p value and what does it mean?" from April 2012.
For more information about Hypothesis testing and p values: how to
interpret results and reach the right conclusion see the EBN Research Made
Simple paper published in April 2013.
If you want to learn more about p values see EBN Research Made Simple
paper "What is a p value and what does it mean?" from April 2012.
If you enjoyed this EBN Notebook you may also like to read the EBN
Research Made Simple paper looking at Qualitative data analysis: a
practical example. This is available at:
Click here
If you would like to know more about systematic reviews why not read
the EBN Research Made Simple paper What is a systematic review? Available from:
Click here
If you enjoyed this paper and want to know more about blinding read
the EBN Research Made Simple paper Blinding: an essential component in
decreasing risk of bias in experimental designs available from:
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Response to: Dos Santos WM Use of personal protective equipment reduces the risk of contamination by highly infectious diseases such as COVID-19 Evidence-Based Nursing 2021: 24:41
Nurses need accessible and thorough evidence-based guidance to support safe, effective care due to the risk of SARS-CoV-2/COVID-19 infection, sickness, and death. Selection and use of appropriate Personal Protective Equipment (PPE) is fundamental to respiratory protection programs and access to the latest evidence is vital to underpin practice and policy decisions.
The Evidence-Based Nursing commentary by Dr Dos Santos on a recent Cochrane Review of PPE use in healthcare workers offers some useful insights. However, there are other key details and findings from the original review that are also important for readers. While covering more of the body appeared to result in enhanced protection, more difficult donning, doffing, and poorer user comfort could lead to higher contamination risk. Also, more breathable PPE might result in a similar number of contamination spots on the user’s trunk compared to less permeable materials (MD 1.60, 95% CI −0.15 to 3.35) and potentially increase user satisfaction (MD −0.46, 95% CI −0.84 to −0.08).
Centers for Disease Control and Prevention guidance resulted in less contamination compared with using no guidance (small patches: MD −5.44, 95% CI −7.43 to −3.45). Other key findings include:
- One-step glove plus gown removal versus separa...
Show MoreAs fourth-year King's College London medical students, we have read this article with great enthusiasm and felt we could identify with the concerns raised. We want to offer an additional perspective.
In terms of direct hazards, we have noticed that some of our colleagues have felt unsafe on specific placements. This is undoubtedly the case in psychiatry where patients may, unfortunately, become verbally abusive and at times physically intimidating.
Additional concerns may arise when students are placed peripherally in areas where there is a substantial crime. This can involve anything from petty theft to more serious crimes like muggings.
A clinical risk that we have been well trained to anticipate and handle are needlestick injuries. This is an example of adequate preparation making us feel more comfortable, i.e. working with sharps despite risks involved.
There are times when senior staff expectations are exceedingly high, and due to indirect risks such as stress and burnout, us students may fail to reach these standards. In some instances, lack of support and understanding perpetuate the cycle of stress. We have, however, noticed that this is less likely to occur when students have a longitudinal supervisor.
Overall we understand that certain risks are unavoidable, and we appreciate the vast number of measures in place aimed at safeguarding against risks and hazards during clinical placements. From our experience as medical stu...
Show MoreDear Editor,
We read with interest Malissa Warren's comment entitled, “Abdominal massage may decrease gastric residual volumes and abdominal circumference in critically ill patients” for our study, “The impact of abdominal massage administered to intubated and enterally fed patients on the development of ventilator-associated pneumonia: a randomized controlled study,” which was online published in the Evidence-Based Nursing Journal in April.
Show MoreIt is possible to criticize the fact that we did not include the protocol that we applied for enteral feeding and GRV measurement in the study methodology in detail. However, we want to say that there was no difference between the experimental and control groups in terms of both feeding rate and amount and GRV measurement. Both groups were homogeneous in these respects because this is a randomized controlled study. In the same article, there is evidence that there was no difference between the groups, for which GRV measurement is not suggested in terms of VAP development.1 However, this evidence is still disputed, and the necessity of GRV measurement is supported by some researchers.2 The writer also indicated that abdominal circumference measurement is not reliable in the case of oedema, acid, anasarca and obesity. We want to respecify that both groups body weights are similar (experimental group=69.9 16.7 and control group=69.7 16.3) and no patients with oedema, acid, anasarca were included in this study....
If you enjoyed this EBN Notebook you may also like to read the EBN Research Made Simple paper looking at Qualitative data analysis: a practical example. This is available at: Click here
Conflict of Interest:
None declared
Readers of this EBN Notebook might like the EBN Research Made Simple paper looking at What is qualitative synthesis? This is available at: Click here
Conflict of Interest:
None declared
Readers of this EBN Notebook might like the EBN Research Made Simple paper entitled: Selecting the sample. This is available at: Click here
Conflict of Interest:
None declared
For more information about Hypothesis testing and p values: how to interpret results and reach the right conclusion see the EBN Research Made Simple paper published in April 2013.
If you want to learn more about p values see EBN Research Made Simple paper "What is a p value and what does it mean?" from April 2012.
These are both available at:
Cli...
If you enjoyed this EBN Notebook you may also like to read the EBN Research Made Simple paper looking at Qualitative data analysis: a practical example. This is available at: Click here
Conflict of Interest:
None declared
If you would like to know more about systematic reviews why not read the EBN Research Made Simple paper What is a systematic review? Available from: Click here
Conflict of Interest:
None declared
If you enjoyed this paper and want to know more about blinding read the EBN Research Made Simple paper Blinding: an essential component in decreasing risk of bias in experimental designs available from: Click here
Conflict of Interest:
None declared
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