Funded by ASPR & CDC

Personal Protective Equipment: Developing a Train-the Trainer

ProgramAngie Vasa BSN, RN, CCRN

Sharon Vanairsdale, MS, APRN, ACNS-BC, NP-C, CEN

Objectives

• Reviewkeyconceptsofpersonalprotectiveequipment(PPE).• Clarifycompetency:Theory,PracticeandUse.• DiscussstrategiesfordevelopingPPEcourses.• DiscusswaysofmaintainingongoingPPEcompetency.

WhatisPersonalProtectiveEquipment?

• Equipmentworntominimizeexposuretoworkplaceinjuriesandillnesses…”• OSHAmandatestrainingofworkplacePPE

• WhenPPEisnecessary.• WhattypeofPPEisnecessary.• Howtoproperlyputitonandtakeitoff.• LimitationsofthePPE.• Propercare,maintenanceanddisposalofPPE.

(OccupationalSafetyandHealthAdministration-OSHA)

Isn’tPPEsomethingHCWsuseeveryday?

• Yes!• Except:• NOTPAPRlevel• NOTconsistently• NOTcorrectly• NOTwithconfidence

ConsiderationsWhenSelectingPPE

• Diseasetransmissioncharacteristics• Expertguidance• Staffsafetyandcomfort• Supplychainanditemavailability• StandardizationofPPEforallstaff• Layoutofpatientcarearea

WetandDryPPEExamples

FacilitiesmayanddodifferinthetypesandbrandsofPPEused.

PPEMultipleCombinations

PPEImplementation

• DonninganddoffingPPEsafelyrequires:• Education• Training• Demonstratedcompetency• Observationbyaskilledobserver

WhoNeedsTraining?

• Nurses• EmergencyDepartment• ClinicStaff• IntensiveCareNurses• L&DNurses• NICUNurses• PediatricNurses

• LabPersonnel• LabTransportPersonnel• EnvironmentServices

• Physicians• InternalMedicine• EmergencyMedicine• CriticalCare• InfectiousDiseases• Obstetricians• Pediatricians• Anesthesiology

• RadiologyStaff• Maintenance

LevelofPPEandscopeofworkGUIDE trainingcontent!

Whohasbeentrainedatyourfacility?Anyonenotlistedhere?

TrainingandCompetencyRequirements

• RegionalETC– Rosteredstaffreceivequarterlytrainingininfectioncontrol,

safety,andpatientcare.– RosteredstaffreceiveJITrefreshertrainingwithin72hours

whenactivated.

• State-DesignatedETC– RosteredstafftrainedinsafelydonninganddoffingPPE.

• Assessmenthospitals– EDstafftrainedatleastannuallyininfectioncontrolandsafety.– ICUstafftrainedatleastannuallyininfectioncontroland

safety.

• FrontlineFacilities

StrategiesforTraining

• Competencybasedassessment• Drills/exercises

• Theseexercisesincorporateskillstraininginadditiontostandarddonninganddoffingpractices.

• TraintheTrainerprograms• Considertheneedfortrainedtrainersinbiocontainmentunits,emergencydepartments,clinicsandfrontlinehospitals.

• JIT:JustinTimeTraining

HowDoesYourOrganization:

1. Assesscompetency?2. Maintainteamcompetency?3. Sustainorganizationalreadiness?

WhatisCompetence?

• “Aclusterofrelatedabilities,commitments,knowledge,andskillsthatenableaperson(oranorganization)toacteffectivelyinajoborsituation.”(http://www.businessdictionary.com/definition/competence.html#ixzz4ElfRJJjn)

• “Whateverisrequiredtososomethingadequately.”(Pollock,1981)

• Theabilitytoperformataskwithdesirableoutcomesunderthevariedcircumstancesoftherealworld.”(Benner,1982)

• “Theeffectiveapplicationofknowledgeandskillintheworksetting.”(delBueno,1990)

AssessingSkillDomains

InterpersonalCriticalThinking

Technical

Clinical/TechnicalSkills CriticalThinkingSkills InterpersonalSkills

Cognitiveskills Problemsolving Communication

Knowledge Prioritysetting Collaboration

Psychomotorskills Ethics Delegation

Technicalunderstanding Clinicalreasoning Directingothers

Examples

DelBueno,D.(1980)

MatchingMethodtoDomain

11VerificationMethods

Test/Exams

ReturnDemonstrations

EvidenceofDailyWork

CaseStudies

Exemplars

PeerReview

SelfAssessment

Discussion/ReflectionGroups

Presentations

MockEvents/Surveys

QIMonitors

CompetencyDomain(s)Measured

Technical:Knowledge&Cognition

Technical:PsychomotorSkillsTechnical

CriticalthinkingCriticalthinking&Interpersonal

Criticalthinking&Interpersonal

Criticalthinking

Criticalthinking;LinkedwithMockEvent:All3DomainsTechnical:Knowledge&understanding

Technical+Criticalthinking+Interpersonal

Technical+Criticalthinking+Interpersonal

• Howdoyoudefineteamcompetency?• Whatareteamcompetencies?• Howdoyoumeasureteamcompetencies?

http://pda.rnao.ca/content/teamwork-competency-and-defining-behaviours

TeamCompetencies

TeamCompetencies

• Workscollaborativelytogetherwithotherstoachievegroupgoalsandobjectives.§ Collaboration§ Relationships/Partnerships

• Noamountofteamworkcancompensateforclinical/technicalproficiency.

• Thefoundationofteamworkbuildsontechnicalproficiencyandprotocolcompliance.

http://pda.rnao.ca/content/teamwork-competency-and-defining-behaviours

OutcomesofTeamCompetencies:TeamSTEPPS

• Knowledge§ SharedMentalModel

• Attitudes§ MutualTrust§ TeamOrientation

• Performance§ Adaptability§ Accuracy§ Productivity§ Efficiency§ Safety

WhyDoErrorsOccur–SomeObstacles

• Workloadfluctuations• Interruptions• Fatigue• Multitasking• Failuretofollowup• Poorhandoffs• Ineffectivecommunication• Notfollowingprotocol

• Excessiveprofessionalcourtesy

• Haloeffect• Passengersyndrome• Hiddenagenda• Complacency• High-riskphase• Strengthofanidea• Task(target)fixation

http://www.ahrq.gov/professionals/education/curriculumtools/teamstepps/longtermcare/module1/igltcintro.html#s18

InteractiveQuestions

Whattypeoftrainingmodelshavebeenimplementedinyourfacilities?

• TraintheTrainer• JustinTime• CompetencyBasedAssessment• DrillsandExercises

DrillsandExercises

• Utilizeannualtrainingcalendar—Includemultifacetedtrainingmodalities.• Progressinexercisecomplexityeg:tabletop,functional,fullscale.• AlwaysincludedonninganddoffingPPE.• Considerinclusionofskillspecificactivities.

BenefitofTrainingTrainers

• Train-the-trainermodelislesscostlythanthetraditionalmethods.

• Allowsforcoursestobetailoredtospecificissues.• Canbeaneffectivemethodforbroadlydisseminatingevidence-basedpublichealthprinciples.

TraintheTrainerModel

• Identifywhoyourtrainerswillbe:• ClinicalNurseSpecialists• Educators• InfectionPrevention• StaffNurses• Biosafety

• Determinehowyouwillassesscompetence.• Determinehowoftenwillyouproviderefreshertrainingandsupport.

TrainingtheTrainers

• Createtrainingmaterials.• Includerationalesforallsteps.• Includeinstructionalgraphics.• Includegeneralprinciplesandunitspecificprocesses.

• SupporttheTrainers.• Followuptrainingtokeeptrainerscurrent.• Updateonanypolicychanges.• Validatetrainerscompetencyineducatingandperformingthetask.

ExcerptfromNBUTrainingManual

JustInTime

• Videos:specifictoyourprotocols.• Distributionandaccessibilityofstandardoperatingprocedures(SOP)• Hands-onsessions.

• Schedulesmallgrouplearningforstaffwhoqualify.• Considerconsultingteams,staffreturningfromleaveofabsenceorstaffwhoexpressdesire.

InteractiveActivity

• ApatientwithafeverandcoughpresentstoyourED.YoulearnhejustreturnedfromtheMiddleEastoneweekago.WhatPPEwouldyoudon?• Apatientwithalertedmentalstatuspresentswithvomitinganddiarrhea.HerdaughterstatessherecentlyreturnedfromWestAfricaafterassistingwithEbolasurvivorcare.WhatPPEwouldyoudon?

CDCPPECoachingApp

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ContactBob@33sparks.com withadditionalQuestionsorInformationRequests

WhatResourcesareAvailablethroughNETEC?

• In-persondidacticandcollaborativetrainingcourses.• In-personskillscourses.• Availableresourcesonthewww.netec.org websiteforfacilitiesandcoalitionstouseandenhancetheirowntrainingandeducationmaterials.• RobustLearningManagementSystem,allowingfacilitiesandhealthcareworkersfreeaccesstocoursesspecificallytailoredtotheirneeds.• Exercisetemplatesforcoalitions,facilitiesandfrontlinehealthcareworkerstoutilize.

Resources

• NETEC:www.netec.org• RegionalETC:10RegionalCenters• CDC:www.cdc.gov• LocalPublicHealth• LocalMedicalResponseServicei.e:OMMRS