Simulated pediatric resuscitation use for personal protective equipment adherence measurement and training during the 2009 influenza (H1N1) pandemic

Christopher M. Watson, Jordan M. Duval-Arnould, Michael C. McCrory, Stephan Froz, Cheryl Connors, Trish M. Perl, Elizabeth A. Hunt

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Background: Previous experience with simulated pediatric cardiac arrests (that is, mock codes) suggests frequent deviation f om American Heart Association (AHA) basic and advanced life support algorithms. During highly infectious outbreaks, acute resuscitation scenarios may also increase the risk of insufficient personal protective equipment (PPE) use by health care workers (HCWs). Simulation was used as an educational tool to measure adherence with PPE use and pediatric resuscitation guidelines during simulated cardiopulmonary arrests of 2009 influenza A patients. Methods: A retrospective, observational study was performed of 84 HCWs participating in 11 in situ simulations in June 2009. Assessment included (1) PPE adherence, (2) confidence in PPE use, (3) elapsed time to specific resuscitation maneuvers, and (4) deviation from AHA guidelines. Results: Observed adherence with PPE use was 61% for eye shields, 81% for filtering facepiece respirators or powered air-purifying respirators, and 87% for gown/gloves. Use of a "gatekeeper" to control access and facilitate donning of PPE was associated with 100% adherence with gown and respirator precautions and improved respirator adherence. All simulations showed deviation from pediatric basic life support protocols. The median time to bag-valve-mask ventilation improved from 4.3 to 2.7 minutes with a gatekeeper present. Rapid isolation carts appeared to improve access to necessary PPE. Confidence in PPE use improved from 64% to 85% after the mock code and structured debriefing. Conclusions: Large gaps exist in the use of PPE and selfprotective behaviors, as well as adherence to resuscitation guidelines, during simulated resuscitation events. Intervention opportunities include use of rapid isolation measures, use of gatekeepers, reinforcement of first responder roles, and further simulation training with PPE. Copyright 2011

Original languageEnglish (US)
Pages (from-to)515-523
Number of pages9
JournalJoint Commission Journal on Quality and Patient Safety
Issue number11
StatePublished - Nov 2011

ASJC Scopus subject areas

  • Leadership and Management


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