PPE Best Practices Practice Support Bundle PPE Best Practices Practice Support Resources & Strategies for Leaders Developed by Professional Practice, Infection Prevention & Control, & New Knowledge & Innovation With acknowledgement and gratitude to T 7 Leaders Flavia Mandic, Victoria Groff, & Jess Merkley for sharing their learning & examples
PPE Best Practices Practice Support Bundle Overview • What is this about? • How to implement PPE Best Practice Requirements
PPE Best Practices Practice Support Bundle Mask Use in Health Care Facilities During the COVID-19 Pandemic What is this about? Many staff & medical staff may be experiencing some or all of the following related to the COVID-19 pandemic: Information overload Confusion Differing messages for Public & Hospital settings Fatigue Fear Frustration
PPE Best Practices Practice Support Bundle Mask Use in Health Care Facilities Purpose During the COVID-19 Pandemic Continue to protect the healthand safety of all staff, medical staff, patients, families, and visitors Years of surveillance at C&W has shown no transmission of droplet + contact pathogens from a contagious patient/family, when PPE is worn appropriately.
PPE Best Practices Practice Support Bundle Mask Use in Health Care Facilities All areas. During of CWthe are. COVID-19 expected Pandemic to: • prioritize and ensure all PPE Best Practice Requirements are being met • identify and eliminate barriers to achieving best practice. olla Sup port ive gh ou Th ng rni Lea tfu l C e iv t a r bo
PPE Best Practices Practice Support Bundle Hierarchy of Controls @ C&W MOST EFFECTIVE Stay home when sick Remote work if possible Virtual health appointments Physical barriers Increased ventilation systems Use of ante-rooms for donning/doffing Active staff, patient & visitor screening/restrictions Physical distancing, hand hygiene, respiratory etiquette Point of care risk assessment LEAST EFFECTIVE Eye protection, & masks for ALL direct patient interactions, PCRA – Point of care risk assessment to determine type of mask required & whether droplet & contact or airborne precautions are required
PPE Best Practices Practice Support Bundle Know the Difference Messaging for the public is not the same for hospital environment For example: Public / Community Hospital / Acute Care 2 -3 ply cloth masks and/or double masking Medical Masks (procedure or N 95 depending on AGMP or airborne) No specific guideline calling for extended use Extended use of PPE as per PPE Allocation Framework No recommendation for eye protection Eye protection for all direct patient care Unregulated cleaning protocols Frequent medical-grade disinfection of all hospital equipment and surfaces
PPE Best Practices Practice Support Bundle PPE Best Practice Requirements All staff & medical staff supported to review current resources on e. POPS & Learning Hub Ø Resources: e. POPS – PPE Use Policy, PPE Routine Practices, Principles of Additional Precautions, PPE Donning & Doffing checklists, CW COVID-19 Learning Hub curriculum (#23617) Key Reminders: • • • Wear medical mask properly in all areas of the hospital For all direct patient care: Medical Mask & Eye Protection Droplet & Contact Precautions: Gown, Medical Mask, Eye Protection, Gloves For AGMP/Airborne Precautions: Gown, N 95 Mask, Eye Protection, Gloves Hand hygiene between each step of doffing
PPE Best Practices Practice Support Bundle Implement the PPE Peer Observation Tool for Continuous Improvement 1: 1 peer observation in clinical area for every moment of donning and doffing (nurse, nurse-porter, medical staff-medical staff, PT-Child Life, Housekeeping, etc. ) This is not a test! It’s about keeping each other safe - appropriate PPE use is imperative in preventing staff contamination Years of surveillance at C&W has shown no transmission of droplet + contact pathogens from a contagious patient/family to staff, when PPE is worn appropriately.
PPE Best Practices Education & Practice Support Bundle Peer to observe each step and indicate if step performed correctly (“yes), not performed/performed incorrectly (“no), or performed correctly with a prompt (“prompt”)
Peer to observe each step and indicate if step performed correctly (“yes), not performed/performed incorrectly (“no), or performed correctly with a prompt (“prompt”)
PPE Best Practices Practice Support Bundle Collect & Record the Findings – Donning Example ØFrom audit sheets, summarize observations for each profession and collectively Donning -All Staff How are we doing as a team? Donned Correctly with Prompts ere h a t r da u o y t r Inse Donned Incorrectly Donned Correctly with Prompts Donned Incorrectly
PPE Best Practices Practice Support Bundle Analyze the Data • • What practices are being followed consistently? What are the largest gaps in practice? What patterns emerged within specific professions or groups? What did you hear staff say in response to prompts / audit feedback?
PPE Best Practices Practice Support Bundle Share the Results BCCH T 7 Example • Make it visual (use graphs, tables, etc) • Make it accessible (post/display/send out for staff to see) • Huddles/check-ins with staff – have a conversation about the data
PPE Best Practices Practice Support Bundle Address Barriers & Challenges What themes are emerging? • • What were some common responses? Is this a knowledge gap? Is this related to PPE fatigue? Is it related to physical effects of PPE? Is this related to environmental barriers? Is it related to workflow or processes? What beliefs or assumptions may be impacting the behaviours?
PPE Best Practices Practice Support Bundle Theme Possible solutions/strategies Knowledge gap Education strategies: CW COVID-19 curriculum, Eduquick refreshers, Myth Buster Quiz PPE fatigue Normalize the experience – you are not alone; possible rotation of staff to provide break from rooms with contact & isolation precautions Physical effects of PPE Management of PPE Related Skin Damage for Health Workers for Skin Care strategies, list of ideas for foggy goggles Environmental barriers Consider placement of equipment, hand cleaning stations Workflow Review your current workflow practices, identify any barriers, use process simulation to identify steps of process & test possible improvements Team Communication Establish routine around peer-to-peer observation & feedback for donning/doffing Beliefs & Assumptions Explore beliefs about roles; identify assumptions with staff and explore evidence to support or refute
PPE Best Practices Practice Support Bundle Celebrate the Successes • What is going well? • How can you acknowledge staff and medical staff? (e. g. “caught clean handed”) • How can incentives help? (e. g. draws for prizes) • How do staff and medical staff want to be acknowledged?
PPE Best Practices Practice Support Bundle What next? Operations & Medical Dyads to: • Use this practice bundle to guide next actions in your area • Engage staff and medical staff in implementing in the audit process • Establish a plan for how your area will put this into action • Collaborate with other leaders around how to navigate challenges • Share/report data and actions via your leader structure