In reply: Personal protective equipment during the COVID-19 pandemic (Letters #1 and #2)
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CORRESPONDENCE
In reply: Personal protective equipment during the COVID-19 pandemic (Letters #1 and #2) Laura V. Duggan, MD, FRCPC
. Shannon L. Lockhart, MD, FRCPC . Hilary P. Grocott, MD, FRCPC
Received: 30 July 2020 / Accepted: 30 July 2020 Ó Canadian Anesthesiologists’ Society 2020
To the Editor, We would like to thank Dr. Shorten1 and Dr. Hung et al.2 for their interest in our article.3 Both authors have focused (and rightly so) on the donning and doffing processes of personal protective equipment (PPE). We agree with both commentaries that those PPE procedural skills should be acquired during simulation sessions prior to their use during patient care. We also agree that, in our climate of current and potential future PPE shortages, sharing PPE in simulation to preserve supply presents a potential nidus for transmission. Given this, achieving donning and doffing proficiency during the pandemic certainly presents challenges. Its simulation does not have to be performed with the specific PPE items and in fact, this is likely impossible to achieve as supply chains mandate substitutions of various PPE items at various times (e.g., impervious gowns or N95 masks). In addition, the cognitive rehearsal and emphasis of the key concepts of PPE donning and doffing using well-made cognitive aids
It is related to letter #1 20-00445 and letter #2 20-00439. L. V. Duggan, MD, FRCPC (&) Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada e-mail: [email protected] S. L. Lockhart, MD, FRCPC Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada H. P. Grocott, MD, FRCPC Department of Anesthesiology, Perioperative Medicine, University of Manitoba, Winnipeg, MB, Canada
and visual demonstrations (e.g., videos, posters, etc.) in the presence of a trained observer may offer a stopgap until PPE substitutes are re-supplied. The most important lesson to be learned during simulation sessions relates to the key concepts and proficiency of the donning and doffing procedures. This depends on direct observation and real-time feedback from a trained observer (i.e., a ‘‘PPE coach’’). Compulsory steps in donning and doffing should include the presence of a PPE coach every time PPE is used in a clinical situation. Airway management is a high-risk procedure that can expose multiple healthcare workers (HCWs) to droplets and aerosols. Given the potential for HCW contamination and infection, both donning and doffing are often performed in a high-stress cognitive state; the HCW cannot rely upon recall or self-monitoring to perform these procedures correctly. Indeed, doing so has been shown to be ineffective and places others at risk of contamination. Donning and doffing takes time, and a PPE coach who reads aloud the donning and doffing steps every time the procedures are performed has been shown to decrease PPE protocol breaches.4 Dr. Hung offers a controversial suggestion that a procedural gown may not need to be used during airway management for COVI
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