Experiences of wearing Personal Protective Equipment (PPE) when examining patients

Site: ISRRT e-Learning
Course: International Covid-19 support for Radiographers and Radiological Technologists
Book: Experiences of wearing Personal Protective Equipment (PPE) when examining patients
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Date: Tuesday, 5 July 2022, 3:27 PM


Author: Kelly Judith

1. Background

The routine working life of a radiographer has changed dramatically in a few short weeks due to the current Coronavirus pandemic. One of the main aspects of this change is the mandatory requirement to wear various levels of PPE, in order to minimise the potential for transmission of the virus from a patient to staff; staff to patient and staff to staff etc, thereby facilitating the (uncontrolled) spread of disease.  The specific type of PPE donned by the radiographer is determined by the perceived level of risk, for example, maximum protection is provided for imaging examinations on Covid19 positive/suspected patients and a lesser degree of protection is provided for the imaging of all other patients on the assumption that they may be carrying the virus, even if they are completely asymptomatic. (Obviously the same applies to staff members too.)

Radiographers will need to don and doff PPE multiple times (in addition to adhering to the guidance on handwashing) during a shift because of the requirement to image multiple patients. If done properly these activities prove time consuming and add to the overall time spent on each examination and this has to be factored in. Undoubtedly these processes will become quicker as staff get more familiar with the routine.  It does however mean that they are not necessarily wearing it constantly, therefore providing short, welcome breaks which many nurses wearing full PPE when caring 1:1 for patients will not get in a shift.

2. Examinations involving asymptomatic patients

It is important for all staff to remind themselves constantly of the imperative to do no harm to their patients and be mindful that the PPE being donned is also to protect the patient, as well as themselves, since the staff member may be a virus carrier.  This starts at the outset of the day’s work in the imaging department by the donning of clean clothes in the workplace, usually employer provided clothes, commonly named ‘scrubs’ or possibly the staff member’s own, clean clothes.

Off to do a mobile

The (previously) normal daily preparation routine has now been revolutionised and checking the stock of available PPE within the particular area of work has become the first burning task of the day. This takes place prior to commencing any imaging list and bringing the patient into the room.  In fact, it has almost become the main focus, such has this crisis come to dominate working life within the NHS and one has to be careful not to forget to include all the other routine checks that are crucial in ensuring the professional care and safety of the patient undergoing imaging.

Careful donning of the standard PPE supplied (for examining asymptomatic patients) then takes place which immediately draws attention to the fact there are more distinct ‘barriers’ between staff and patient than in the pre Coronavirus days. Most hospital visits are anxious times for patients and none more so than now and staff will be aware that the manner in which patients are treated has a major impact on anxiety and stress. The sight of staff wearing multiple pieces of PPE will only serve to increase such emotions.  The face mask particularly prevents the patient seeing normal facial expressions which are so important in conveying unspoken messages and inhibits the instant rapport and relationship building that usually commences from the moment the patient is greeted. These are at least as important as the words that are spoken and under normal circumstances set the scene for the episode of care being provided. Wearing a mask also renders it more challenging to communicate verbally with patients, particularly those with hearing difficulties. The more substantial perspex whole face shield encases the voice sound waves which then rebound back to the speaker,  making it more difficult to gauge how loudly to project the voice and avoid the impression of shouting. Speaking itself also causes the perspex to steam up, resulting in problems with clear visualisation. Of particular note too, wearing any facial covering makes it harder to breathe normally and feels quite claustrophobic, at least for a good while, until its use becomes more familiar to the wearer.

A further, immediate (unwelcome) effect of wearing any type of PPE is the generation of substantial body heat and that, if coupled with heat generating equipment such as an ultrasound machine can make it very uncomfortable and sometimes unbearably hot.

PPE for ultrasound
This is especially true with any examination lasting 15 minutes or more and requiring considerable concentration such as an ultrasound guided interventional procedure. Plastic eye protective glasses easily become slippery when the face perspires and can fall off which is a distracting inconvenience. Overall, this can lead to the desire to speed up the examination but it is important to keep focussed on the task in hand.   Liberal use of air conditioning if available is very beneficial in such conditions to try and mitigate the heat build-up, provided this doesn’t make the patient cold.

A useful tip after completing each examination if time permits (or after every 2 or 3 patients if not) after all the hand washing procedure is carried out is to remove the facial PPE and plastic apron to allow time for the body to breathe again before re-donning once more for the next case.  

Of course it is not just the interactions with patients that is affected by wearing PPE – it  presents a barrier between colleagues too, creating more of a distance, though there is also a feeling of being much less exposed and therefore safer when ‘hiding’ behind the PPE.  

There is no doubt that, with time, this continuous donning and doffing of PPE will become much more of a familiar everyday activity.

3. Examinations involving Covid19 positive patients

Ready to X-ray COVID positive patient

These examinations obviously require the maximum PPE to be worn and staff report similar experiences to those felt with the lesser PPE but with a particular emphasis on how incredibly hot they become. Communications to patients and between colleagues again is very challenging. The most extreme physical impact has been significant facial bruising and skin reactions caused by the rigid protectors when these are worn for quite long periods of time, for example in operating theatres or on the ward when caring for very sick patients in Intensive Care.

Staff are fearful of causing contamination during the doffing of PPE after dealing with such patients and therefore it is important to perform this systematically, according to the guidance and without rushing.

A final point – the incessant hand washing often causes very dry irritated skin and consequently an effective hand cream is essential!