PPE Champion Training

Welcome to PPE Champion Training

• Thank you for coming on board to adopt the PPE Champion role within your clinical area/s

• All of the PPE resources referred to in this training can be found on the Western Health COVID-19 Microsite https://coronavirus.wh.org.au/ppe/

• There is a dedicated section of the microsite for PPE Champions https://coronavirus.wh.org.au/ppe/ppe-champions/

Context of the PPE Champion role

Reference: Department of Health and Human Services https://www.dhhs.vic.gov.au/victorian-healthcare-worker-covid-19-data

189 Total number of Western Health staff tested positive (7/10/2020)

3Number of Western Health staff on

leave for COVID-19 (7/10/2020)

Healthcare worker cases over time

Reference: Department of Health and Human Services https://www.dhhs.vic.gov.au/victorian-healthcare-worker-covid-19-data

Healthcare worker cases by occupation

4.62% medical practitioners40.04% nurses or midwives 49.88% aged care or disability workers 3.40% other healthcare workers

Reference: Department of Health and Human Services https://www.dhhs.vic.gov.au/victorian-healthcare-worker-covid-19-data

Source of infections in healthcare workers over time

Reference: Department of Health and Human Services https://www.dhhs.vic.gov.au/victorian-healthcare-worker-covid-19-data

Acquisition of COVID-19 in healthcare settings

72.52% of cases were acquired in a healthcare setting14.52% were not acquired in a healthcare setting12.95% of cases are either still under investigation or the source of infection is unable to be determined

25 August 2020117 healthcare workers hospitalized12 were admitted to intensive care One death, a nurse from the disability sector

Reference: Department of Health and Human Services https://www.dhhs.vic.gov.au/victorian-healthcare-worker-covid-19-data

PPE Champion Pilot and Scaling

Scale PPE Champion role

to Western Health

Evaluation to refine role

Pilot role with small group of

PPE Champions on high risk and

aged care wards

- Seek to understand root cause of HCW infections- Focus on PPE - Mapping of PPE strategies to date

- Progress- Gaps- Priorities

- PPE Champion pilot and scaling

PPE Champion Role Overview

- The role will be shaped and refined over time (with your help)

- All new PPE Champions are up skilled in PPE proficiency

- Aim of the role To support staff to wear their PPE safely 100% of the time

- Key objectives of the role:

- Building staff capability to wear PPE safely

- Being a ‘go to person’ for PPE related issues & enquiries

- Building a positive PPE culture

Up skilling in PPE

To adopt the role of a PPE Champion please:

- Complete the Standard & Transmission Based Precautions Welearn online module available here: https://welearn.wh.org.au/course/view.php?id=361

- Attend PPE Champion training (this session) delivered by the COVID and Infection Prevention teams

- Complete a PPE Skill Assessment - Observation of you donning; doffing; fit checking your PPE, with a member of the

Infection Prevention CNC team or a ‘Gold Standard PPE Champion’. https://coronavirus.wh.org.au/wp-content/uploads/2020/09/Western-Health-PPE-Skill-Assessment-Tool.pdf

- Ideally your PPE skill assessment will occur within your usual clinical context and tasks, however if this is not possible a simulated environment will suffice.

- Please contact Lauren (lauren.guy@wh.org.au) to book this in.

Building Staff Capability to Wear PPE Safely

PPE spotting & coaching

- Observing staff (all disciplines) donning, doffing & fit checking their PPE and providing in the moment feedback to build PPE proficiency

1. Correct PPE items worn

2. Bare below the elbow

3. Donning order correct i.e. hand hygiene; gown; mask; eye protection; hand hygiene; gloves

4. Fit check steps correct i.e. gentle inhale; gentle exhale

5. Doffing order correct i.e. gloves; hand hygiene; gown; hand hygiene; eye protection; hand hygiene; mask; hand hygiene

6. Risk of self contamination does not occur e.g. touching front of mask

7. PPE is disposed in clinical waste bin

- PPE Champions representing wards/ clinical areas can dedicate regular time to using the ‘PPE spotting & coaching tool’ available here: https://coronavirus.wh.org.au/wp-content/uploads/2020/09/PPE-Spotting-and-Coaching-Tool-16.9.2020.xlsx

- Be strategic about when you complete the tool – break time; start/ end of a shift

- Aim to collect at least 15 (smaller teams) – 25 (larger teams/ wards) observations (different people) each week (the more data the more meaning we can deduct)

- At the end of each week submit completed tools to Lauren (lauren.guy@wh.org.au) for data entry. We will return run charts to you so that you can start to track trends

Building Staff Capability to Wear PPE Safely

Run chart examples from FH Trends toward improvement!↙

↙ Opportunity to target improvement!

6859

7176

93100

67 7178

64

0

20

40

60

80

100

2. Bare below the elbow (%)

100

20

0

80

100 100

67

100 100 100

0102030405060708090

100

5. Doffing order correct (%)

100 100 100 100 100 100 100 100 100 100 100

0102030405060708090

100

7. PPE is disposed in clinical waste

Goal achieved!↙

Building Staff Capability to Wear PPE Safely

Using data to drive improvement

Building Staff Capability to Wear PPE Safely

PPE Skill Assessments

- Offer staff a PPE Skill Assessment, as an opportunity to review and build skill. The PPE Skill Assessment tool template is available here: https://coronavirus.wh.org.au/wp-content/uploads/2020/09/Western-Health-PPE-Skill-Assessment-Tool.pdf

- To administer the PPE Skill Assessment - 1:1 within usual practice. You may need to administer the tool over a few occasions to

observe all relevant items. Be strategic about when you administer the tool

- Alternatively you can set up a simulated environment. There are sufficient supplies of PPE to use for the purpose of practice – except N95 masks. Expired N95 masks are available to use for training - contact the nursing education team to access

- If using a simulated environment consider using a buddy approach to assessment and training (approach used by PPE Champions in Williamstown)

- Provide targeted education to the staff member to build their capability and obtain PPE proficiency.

- Submit completed tools to Lauren (lauren.guy@wh.org.au) for data entry

Building Staff Capability to Wear PPE Safely

Setting up the environment to optimise PPE skill

- Putting up laminated PPE related posters (e.g. how to don; doff; fit check)

- Participating in the scaling of mirrors at donning/ doffing stations

- Look for gaps and opportunities for improvement e.g. where to clean face shields

- Facilitate improvements in the environment

Nameeta with the new signage put up at the PPE doffing station

Nameeta from WACU & Lower GEM

New donning & doffing stations on FH 3B & Level 3 Acute Allied Health office

Building a Positive PPE Culture

You may build a positive PPE Culture through:

- Best practice role modeling - Eliciting and modeling best practice PPE technique and infection control

- Delivering training & promotional activities - Encourage staff to complete the ‘Standard & Transmission Based Precautions’

Welearn module https://welearn.wh.org.au/course/view.php?id=361

- Offer training & promotional activities to create the conditions for cultural and behavioural change (e.g. information sessions, emails, posters). Consider being strategic

- Building a buddy culture - Building a buddy culture where staff are empowered to speak up, act proactively and

offer to be a buddy or seek a buddy to support safe PPE donning, doffing and fit checking e.g. role model, promote during PPE Skill Assessments where staff are buddied up, set up donning & doffing stations as ‘buddy checkpoints’ (posters, mirror, supply)

- Communicating in a way that builds skill & growth- Rather than staff feeling like they have made a mistake, rather building a culture where it

is ok not to know all of the answers and we are all learning and improving.

Being a ‘Go To Person’ for PPE Related Issues & Enquiries

To be a ‘go to person’ you can:

- Disseminate PPE related updates (e.g. updates received from the PPE Core Group, COVID-19 team, Infection Prevention team)

- Be a point of contact within your clinical area for staff to ask questions or raise issues relating to PPE

- Actively seeking to problem solve PPE related issues or find the answer to PPE related enquiries through the microsite

- Collaborate with others – consider linking with others to support resolution of issues/ to overcome barriers, such as Infection Prevention, COVID-19 team, OH&S and the PPE Access Team

Time Allocation to the Objectives of the Role

Building staff capability to wear PPE safely

- Dedicated time dependent on the needs of your clinical area

- Time needed will vary between clinical areas and will change over time

- May need to ramp up in context of outbreak within your clinical area

Being a ‘go to person’ for PPE related issues & enquiries

- Always, ongoing

Building a positive PPE culture

- Always, ongoing

PPE Champion Sticker/ Badge

Infection Prevention and Control

How Infections Spread in the Healthcare Setting

Infectious Agent

Contact Airborne

Indirect

Droplet

DirectDroplet nuclei

(Suspended in air)

Equipment &

EnvironmentHands

Injection

Ingestion

Route of Transmission

Route of transmission is likely to

be droplet spread through close

contact with infected individuals

R0 2.5-3, similar to (1918

Pandemic was 2.8), compare with

Chickenpox (3.7-5) and Measles

(12-18)

Demonstrating transmission

https://youtu.be/VK2vpOh5wws

https://youtu.be/GSPv04IJvpI

What are the Symptoms of COVID-19?

• Incubation period is 2-7 days after exposure (maximum 14, peak 5-7)

• This is similar to flu

• Majority have a fever and dry cough (rapid onset)

• Symptoms last 5-6 days

• Severe illness starts day 7

• Shortness of breath

• Lung inflammation

• Pneumonia

Symptom Proportion of cases

Fever > 37.5oC 88%

Dry Cough 68%

Fatigue 38%

Sputum 33%

Shortness of breath

19%

Muscle/joint pain

15%

Sore throat 14%

Headache 14%

PPE Up Skilling

• Selecting the right Personal Protective Equipment- Western Health COVID-19 PPE Guideline V9

- PPE during Covid Tier system

• Safely donning, doffing and fit checking PPE in the right order (https://coronavirus.wh.org.au/ppe/)

- Donning & doffing

- Surgical Mask

- Cupped P2/ N95 mask

- Duckbill P2/ N95 masks

- Facial Hairstyles and Filtering Face piece Respirators

- Standard precautions donning & doffing video

- N95 donning and doffing video

• Maintaining good habits while wearing PPE - Lighting up the virus

- Every day things we need to do differently in a COVID-19 world https://coronavirus.wh.org.au/wp-content/uploads/2020/08/PPE-Everyday-things-that-we-need-to-do-differently-in-a-COVID-19-world-6.8.2020.pdf

- Facial pressure injuries and skin issues from PPE

- Safety with patient personal hygiene care during COVID-19

Facial Pressure Injuries

P2/N95 Respirator Masks

• Protective dressings are NOTto be used on the face under P2/N95 respirator masks as they may impair the seal and not provide protection

Plastic aprons for Standard Precautions

Plastic aprons are recommended to be worn by all healthcare workers when:

• Close contact with the patient, materials or equipment that may lead to contamination of skin, uniforms, or other clothing with infectious organisms (known and unknown)

• There is a risk of contamination with blood and body substances, secretions, and excretions (excluding sweat).

Bare Below the Elbows

• What is Bare Below the Elbows (BBE)? It is an initiative aiming to improve the effectiveness of hand hygiene performed by health care workers

• Who should be BBE? – all staff undertaking direct patient contact or patient environment

• When should I be BBE?

• With direct patient care

• When in contact with the patient environment (patient zone)

• When working in the clinical area (healthcare zone)

Contacts:

Infection Prevention• Maureen Canning

Maureen.Canning@wh.org.au• Richard Bartolo

Richard.Bartolo@wh.org.au• Anie Edward

anie.edward@wh.org.au• Infection Control (WH)

whsinfectioncontrol@mh.org.au

PPE Champion role• Lauren Guy

lauren.guy@wh.org.au

For further information

CORONAVIRUS.WH.ORG.AU/PPE