|Ahead of print publication
An alternative to standard personal protective equipment during emergency cardiac procedures in catheterization lab
Sudhir Suryakant Shetkar
Department of Cardiovascular Sciences, Apollo Hospitals, Nashik, Maharashtra, India
|Date of Submission||22-Apr-2020|
|Date of Decision||01-May-2020|
|Date of Acceptance||01-May-2020|
|Date of Web Publication||15-May-2020|
Sudhir Suryakant Shetkar,
Department of Cardiovascular Sciences, Apollo Hospitals, Nashik - 422 001, Maharashtra
Source of Support: None, Conflict of Interest: None
Personal protective equipment (PPE) are likely to fall short as the COVID pandemic increases, and the availability will especially not be there for COVID-negative or untested patients. This brief report describes an indigenous method of improvising a PPE for use especially during emergency procedures in the cardiology catheterization lab if a full PPE is not immediately available and COVID-19 status of the patient is not known. While a proper PPE should be used for COVID-positive patients, for other patients, this kind of improvisation should provide reasonable protection from biohazards.
Keywords: Alternative, catheterization lab, improvisation, personal protective equipment
|How to cite this URL:|
Shetkar SS. An alternative to standard personal protective equipment during emergency cardiac procedures in catheterization lab. J Pract Cardiovasc Sci [Epub ahead of print] [cited 2020 Aug 13]. Available from: http://www.j-pcs.org/preprintarticle.asp?id=284442
| Introduction|| |
Personal protective equipment (PPE) consist of protective clothing and various accessories such as shields, goggles, gloves, or other equipment designed to protect the health-care provider from exposure to an infectious or bio-hazardous agent. In the fight against the current COVID-19 pandemic, a standard PPE is indispensable in our armamentarium. Health-care providers are becoming increasingly susceptible to getting infected with the infectious agent while providing care to COVID-19 infected patients, and many times, such an infection ends up with lethal consequences. Though a standard PPE is desired for each health-care provider, every time, they come in contact with the infected patient, this is hardly ever possible due to the lack of availability or financial constraints. This problem is further complicated when the patient presents with cardiac emergency and he/she needs to be urgently taken to cardiac catheterization lab without knowing his/her COVID status. Cardiac catheterization lab involves a large team of health-care professionals who come in direct contact with the patient.,,,, Recent studies suggest that the spread of COVID often occurs through asymptomatic carriers and therefore all health-care providers involved in patient contact should be wearing a basic level of PPE (gloves, gown, and respiratory protection that is at least equivalent to a N95 mask along with eye protection in the form of goggles or a face shield). Equipping each person with a Level III PPE is not feasible in a developing country like ours with restricted resources. An alternative to a standard PPE,,, which can be made with locally available resources, is highly desirable to bridge this gap. This article describes a Level III personal protection,,, which can act as a reasonable alternative to standard PPE but only in a situation where the patient's COVID status is not known. We have recently performed two emergency procedures (one permanent pacemaker implant and one primary percutaneous transluminal coronary angioplasty) in our catheterization lab using this method of personal protection due to nonavailability of standard PPE in patients who were clinically not having evidence of COVID but where the COVID status could not be tested. We request the readers to express their opinions on this concept [Figure 1] and [Table 1].
|Figure 1: Various equipment needed for donning a Stage III level personal protection.|
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|Table 1: Various equipment required for donning a Stage III level personal protection|
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| Equipment Required|| |
Various equipment required with their reusability and method of disinfection is mentioned in [Table 1] and [Figure 1].
Various steps in donning the PPE
PPE must be donned in a designated donning area before encountering the COVID-19-infected patient.
Various steps are demonstrated in [Figure 2] and [Figure 3] (the author demonstrating the equipment) and Video 1.
Medicine is all about learning and experimenting. Some ideas are borrowed from others with our modifications, I acknowledge those all. I would like to thank Mrs. Jisha John, staff nurse, and Mr. Pankaj Namdeo Bonde, catheterization lab technician, at Apollo Hospitals, Nashik, for helping in procuring the equipment and making of this presentation.
This demonstration is not a replacement for standard PPE if they are available. This technique may be used as an alternative to standard PPE when they are not available and only for emergency procedures in non-COVID patients or when the COVID status is not known. In COVID-positive patients, a proper PPE should be used.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Holland M, Zaloga DJ, Friderici CS. COVID-19 personal protective equipment (PPE) for the emergency physician. Vis J Emerg Med. 2020;19:100740. doi: 10.1016/j.visj.2020.100740. Epub 2020 Mar 18.
Sportelli MC, Izzi M, Kukushkina EA, Hossain SI, Picca RA, et al
. Can Nanotechnology and Materials Science Help the Fight against SARS-CoV-2?. Nanomaterials 2020;10:802. doi.org/10.3390/nano10040802.
Stone TE, Kunaviktikul W, Omura M, Petrini M. Editorial: Facemasks and the COVID 19 pandemic: What advice should health professionals be giving the general public about the wearing of facemasks? Nurs Health Sci 2020. doi: 10.1111/nhs.12724.
Farsi D, Mofidi M, Mahshidfar B, Hafezimoghadam P. Consider the options; can decontamination and reuse be the answer to N95 respirator shortage in COVID-19 pandemic? Advanced Journal of Emergency Medicine, 4(2s). doi.org/10.22114/ajem.v0i0.378.
Ong JJ, Bharatendu C, Goh Y, Tang JZ, Sooi KW, Tan YL, et al
. Headaches associated with personal protective equipment – A cross-sectional study among frontline healthcare workers during COVID-19. Headache 2020;60:864-77.
Verbeek JH, Rajamaki B, Ijaz S, Sauni R, Toomey E, Blackwood B, et al
. Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane Database Sys Rev 2020;4:CD011621.
Kwon JH, Burnham CD, Reske KA, Liang SY, Hink T, Wallace MA, et al
. Assessment of healthcare worker protocol deviations and self-contamination during personal protective equipment donning and doffing. Infect Control Hosp Epidemiol 2017;38:1077-83.
Kang J, O'Donnell JM, Colaianne B, Bircher N, Ren D, Smith KJ. Use of personal protective equipment among health care personnel: Results of clinical observations and simulations. Am J Infect Control 2017;45:17-23.
[Figure 1], [Figure 2], [Figure 3]