Reduction in transfer of micro-organisms between patients and staff using short-sleeved gowns and hand/arm hygiene in intensive care during the COVID-19 pandemic: A simulation-based randomised trial

  1. Laura Vincent
  2. Mudathir Ibrahim
  3. Joanne Kitchin
  4. Claire Pickering
  5. Jennie Wilson
  6. Enrico Sorrentino
  7. Claudia Salvagno
  8. Laurie Earl
  9. Louise Ma
  10. Kathryn Simpson
  11. Rose Baker
  12. Peter McCulloch

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Abstract

Current personal protective equipment (PPE) practices in UK intensive care units involve “sessional” use of long-sleeved gowns, risking nosocomial infection transmitted via gown sleeves. Data from the first wave of the COVID19 pandemic demonstrated that these changes in infection prevention and control protocols were associated with an increase in healthcare associated bloodstream infections. We therefore explored the use of a protocol using short-sleeved gowns with hand and arm hygiene to reduce this risk.

Methods

ICU staff were trained in wearing short-sleeved gowns and using a specific hand and arm washing technique between patients (experimental protocol). They then underwent simulation training, performing COVID-19 intubation and proning tasks using either experimental protocol or the standard (long-sleeved) control protocol. Fluorescent powder was used to simulate microbial contamination, detected using photographs under ultraviolet light. Teams were randomised to use control or experimental PPE first. During the simulation, staff were questioned on their feelings about personal safety, comfort and patient safety.

Results

Sixty-eight staff and 17 proning volunteers were studied. Experimental PPE completely prevented staff contamination during COVID-19 intubation, whereas this occurred in 30/67 staff wearing control PPE ( p = .003, McNemar). Proning volunteers were contaminated by staff in 15/17 control sessions and in 1/17 with experimental PPE ( p = .023 McNemar). Staff comfort was superior with experimental PPE ( p< .001, Wilcoxon). Their personal safety perception was initially higher with control PPE, but changed towards neutrality during sessions ( p < .001 start, 0.068 end). Their impressions of patient safety were initially similar ( p = .87), but finished strongly in favour of experimental PPE ( p < .001).

Conclusions

Short-sleeved gowns with hand and forearm cleansing appear superior to sessional long-sleeved gowns in preventing cross-contamination between staff and patients.

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  1. Version published to 10.1177/17511437221116472
  2. ScreenIT

    SciScore for 10.1101/2021.01.16.21249221: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: This was preceded by an uncontrolled cohort study of the development of the new PPE protocol, based on the recommendations for IDEAL Stage 2a and 2b studies Ethical approval for this trial was obtained from Oxford University Research Ethics Committee (CUREC) (Reference: R72882/RE001).
    Consent: Prior to enrolment, written informed consent was obtained, which included specific reference to the use of photography and video recording.
    RandomizationThe secondary outcomes were: Study Design: We conducted a dual-centre, non-blinded randomised cross-over trial in Oxford University Hospitals (OUH), Oxford and Whittington Hospital, London.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: We found the following clinical trial numbers in your paper:

    IdentifierStatusTitle
    NCT04712045CompletedRational Use of Personal Protective Equipment During COVID-1…

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2021.01.16.21249221v1 on medRxiv