ABSTRACT
BACKGROUND: Restraint is widely practised within inpatient mental health services and is considered a higher-risk procedure for patients and staff. There is a sparsity of evidence in respect of the efficacy of personal protective equipment (PPE) used during restraint for reducing risk of infection. METHODS: A series of choreographed restraint episodes were used to simulate contact contamination in research participants playing the roles of staff members and a patient. For comparison, one episode of simulated recording of physical observations was taken. Ultraviolet (UV) fluorescent material was used to track the simulated contact contamination, with analysis undertaken using established image registration techniques of UV photographs. This was repeated for three separate sets of PPE. RESULTS: All three PPE sets showed similar performance in protecting against contamination transfer. For teams not utilising coveralls, this was dependent upon effective cleansing as part of doffing. There were similar patterns of contamination for restraint team members assigned to specific roles, with hands and upper torso appearing to be higher-risk areas. The restraint-related contamination was 23 times higher than that observed for physical observations. DISCUSSION: A second layer of clothing that can be removed showed efficacy in reducing contact contamination. PPE fit to individual is important. Post-restraint cleansing procedures are currently inadequate, with new procedures for face and neck cleansing required. These findings leave scope for staff to potentially improve their appearance when donning PPE and engaging with distressed patients.
Subject(s)
COVID-19/transmission , Health Personnel/education , Infection Control/methods , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Personal Protective Equipment/standards , Restraint, Physical , Simulation Training , Behavior Control , Humans , Inpatients , SARS-CoV-2 , United Kingdom/epidemiologyABSTRACT
Mental Health inpatient units have a primary purpose of treating mental health problems, managing disturbance and promoting social contact and support networks. These factors can conflict with optimal infection prevention and control (IPC) measures. This commentary describes an IPC perspective of the challenges in managing the effects of the COVID-19 pandemic that are specific to acute mental health settings. It points out the main areas for IPC and mental health practice development. The need for a new paradigm in the relationship between IPC and mental health specialists is identified. Recent collaboration between mental health and IPC specialists in evaluating personal protective equipment (PPE) for use in restraint is outlined.