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