It is important for surgery center staff to learn and practice the correct way to wear personal protective equipment (PPE). One helpful technique is to use medical simulation.

“You want to be confident in your personal protective equipment when you go to work, enter a room, and intubate a patient,” says Patrick Hughes, DO, MEHP, FACEP, FACOEP, emergency medicine residency assistant program director, assistant professor of integrated medical science, and director of the emergency simulation program at Florida Atlantic University’s Schmidt College of Medicine.

Hughes led a team that developed a simulation that is inexpensive, easy to create, and effective. “We developed a solution with the inside of a highlighter. You put the highlighter refills into warm water,” Hughes explains. “It leaks into the warm water, and then we spray the water on a mannequin.”

The highlighter creates a fluorescent solution, which can be put in a spray bottle. After soaking, the solution can sit for a few minutes. Hughes’ simulation lab typically sprays a mannequin within five minutes of starting the simulation. It does not matter whether the spray is wet or dry when the simulation starts, he notes.

The staff don their PPE and perform a simulation of a common operating room task or nebulizing treatment. Then, the surgery center’s infectious disease leader can turn on a black light to show how the simulated contagion spread.

“We have them go out and see if there is any contagion on them after they took off their PPE, and 25% of participants might have some fluorescents on their forehead or face that they touched while contaminated,” Hughes reports.

For a hospital environment, the simulation scenario goes like this: A member of the staff roleplays a patient in respiratory distress. “They do a history and physical exam, and then the patient needs an airway intervention,” Hughes says. “They do a nebulizer treatment on the patient.”

This shows how using the nebulizer can put viruses like the SARS-CoV-2 into the air. “The person finished the procedure, and we have them care for the patient. At the end, we turn off the light in the room and shine the UV light on participants to show them all of the contagion,” Hughes explains. “Then, we turn the light back on and have them take off their PPE in the manner they were taught. We reuse the UV light to see if anything was left on them.”

Seeing the visual impact of their PPE mistakes allows managers and staff to correct their use of PPE in real time. “For instance, one person had some left on their cheek,” Hughes recalls. “When they had taken off their outer gloves, they had touched the under glove with the contaminated outer glove. Then, they touched the side of their face with their contaminated glove and left some of the solution on their face.”

Surgery centers can create a simulation that more closely reflects an operating room, presurgery procedure. The materials cost less than $25, and the mannequin can be anything that might work with the equipment used in the simulation. “This is something that can be done in any hospital or surgery center. You don’t necessarily need a high-fidelity simulator,” Hughes says. “We found that people liked the extra training and refresher course on using personal protective equipment. They liked the fact that we showed them how contaminated they were at the end of the scenario.”