A pilot study to assess use of fluorescent lotion in patient care simulations to illustrate pathogen dissemination and train personnel in correct use of personal protective equipment

Abstract

BackgroundSimulations using fluorescent tracers can be useful in understanding the spread of pathogens and in devising effective infection control strategies.MethodsDuring simulated patient care interactions in which providers wore gloves and gowns, we evaluated environmental and personnel dissemination of fluorescent lotion and bacteriophage MS2 from a contaminated mannequin. The frequency of skin and clothing contamination after removal of personal protective equipment (PPE) was compared before versus after an intervention that included education and practice in PPE donning and doffing.ResultsTen healthcare personnel participated in 30 pre-intervention and 30 post-intervention patient care simulations. Fluorescent lotion and bacteriophage MS2 were rapidly disseminated to touched surfaces throughout the room; there was no difference in the frequency of contamination before versus after the PPE training intervention. After the intervention, there was a decrease in skin and/or clothing contamination with fluorescent lotion (9/30, 30 % versus 1/30, 3 %; P = 0.01) and bacteriophage MS2 (8/30, 27 % versus 2/30, 7 %; P = 0.08) and there was a significant reduction in the concentration of bacteriophage MS2 recovered from hands (0.31 versus 0.07 log10plaque-forming units; P < 0.01).ConclusionsOur findings suggest that simulations with fluorescent lotion can be a useful teaching tool to illustrate the spread of pathogens and provide further evidence that simple PPE training interventions can be effective in reducing contamination of personnel.

Silica nanoparticles with encapsulated DNA (SPED) – a novel surrogate tracer for microbial transmission in healthcare

“…Previous studies have evaluated the use of harmless surrogate tracers to simulate contact transmission pathways of potential pathogens in healthcare settings [11][12][13][14][15][16][17][18][19][20][21][22]. These studies employed four surrogate markers, namely DNA sequences of the cauliflower mosaic virus DNA, [11,[17][18][19][20][21] bacteriophage MS2, a non-pathogenic non-enveloped RNA virus, [11][12][13][14][15][16] and fluorescent agents [13,14,16,19,22]. Some of these studies compared fluorescent agents against MS2 bacteriophages [13,14,16] or against cauliflower virus DNA [19]; or used the two viral DNA markers in parallel [11].…”

“…Surrogate tracers may therefore provide a safer and easier means to increase our understanding of transmission pathways. Prior studies have attempted to trace transmission events using microbial surrogates, [11][12][13][14][15][16] and/ or DNA [11,[17][18][19][20][21]. Use of microbial surrogates is limited to benign organisms, like MS2 phage, and therefore limits their widespread use in transmission studies.…”

‘VIOLET’: a fluorescence-based simulation exercise for training healthcare workers in the use of personal protective equipment

“…Reassuringly, work using both methods showed no difference in rates of contamination events on healthcare workers, suggesting that both are suitable for PPE assessment. Furthermore, in the absence of minimum infecting dose of HCID pathogens through cross-contamination, presence or absence of contamination is the valid basis of safety assessment [6,20,38]. Using qualitative fluorescent markers therefore provides an evidence base for real-time training.…”

Silica nanoparticles with encapsulated DNA (SPED) – a novel surrogate tracer for microbial transmission in healthcare

“…(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) These studies employed three surrogate markers, namely DNA sequences of the cauli ower mosaic virus DNA, (11,(17)(18)(19)(20)(21) bacteriophage MS2, a non-pathogenic non-enveloped RNA virus, (11)(12)(13)(14)(15)(16) and uorescent agents. (13, 14, 16, 19, 22) Some of these studies compared uorescent agents against MS2 bacteriophages (13,14,16) or against cauli ower virus DNA (19); or used the two viral DNA markers in parallel. (11) Only one of these studies compared the behaviour of cauli ower virus DNA and MS2 bacteriophage against Clostridioides di cile spores and found a similar environmental transmission behaviour,(11) as did we in our comparison between SPED and E. coli.…”