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. 2021 Nov;65(11):820-829.
doi: 10.4103/ija.ija_768_21. Epub 2021 Nov 23.

Simulation with a colour indicator to help reduce contamination during airway management in COVID-19 times: An experience from a tertiary centre in India

Leah R George  1 , Smitha E George  1 , Ira Dhawan  1 , Malavika Babu  2 , Raj Sahajanandan  1 , Anita S Joselyn  1
Affiliations

Simulation with a colour indicator to help reduce contamination during airway management in COVID-19 times: An experience from a tertiary centre in India

Leah R George et al. Indian J Anaesth. 2021 Nov.

Abstract

Background and aims: The coronavirus disease 2019 (COVID-19) pandemic has initiated modified protocols for aerosol-generating procedures. A simulation study using dye was conducted to highlight contamination at intubation and extubation and to encourage adherence to the new COVID-19 protocol among anaesthesia personnel in our institution.

Methods: A video demonstrating the new COVID-19 protocols was circulated in the Department of Anaesthesiology a week prior to the study. Thirty teams, each comprising an anaesthesia resident and a staff technician, were enroled. Each team was asked to demonstrate the steps of preparation, intubation and extubation on a mannequin in a COVID-19 scenario. Checklists were used to assess points of contamination and adherence to the protocols. Following debriefing, a repeat simulation was conducted. The use of a dye highlighted the points of contamination. The study subjects provided feedback on the usefulness of the session and practical difficulties encountered in adapting to the new protocols.

Results: The average contamination scores decreased by 3.4 (95% confidence interval (CI): 2.4-4.4, P < 0.001) in the post-debrief session. Adherence to the steps of the modified protocol improved by a score of 2.7 (CI: 3.6-1.83) among anaesthesiologists and by 4.3 (CI: 5.3-3.3) among technicians. Further, 93% felt that the use of the colour indicator reinforced awareness of the possible points of contamination.

Conclusion: Simulation with a low-fidelity mannequin by using colour indicator for secretions is an effective teaching tool to reduce health hazards during airway management in COVID-19 times.

Keywords: Anaesthesia; COVID-19; equipment contamination; simulation training.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
(a) Colour indicator used to stain the oral cavity; (b) Areas of contamination indicated by red arrows
Figure 2
Figure 2
CONSORT diagram showing enrolment of study participants
Figure 3
Figure 3
Steps of protocol by residents and technicians, baseline and post debrief
Figure 4
Figure 4
Points of contamination in baseline and post debrief
See this image and copyright information in PMC

References

    1. Director-General's opening remarks at the World Health Assembly - 24 May 2021. [Last accessed on 2021 Aug 10]. Available from: https://www.who.int/director-general/speeches/detail/director-general-s-... .
    1. COVID-19 and Risks Posed to Personnel During Endotracheal Intubation. Anesthesiology. JAMA. JAMA Network. [Last accessed on 2021 Nov 2]. Available from: https://jamanetwork.com/journals/jama/fullarticle/2765376 . - PMC - PubMed
    1. Bajwa SJS, Kurdi M, Stroumpoulis K. Difficult airway management in COVID times. Indian J Anaesth. 2020;64((Suppl 2)):S116–9. - PMC - PubMed
    1. Cook TM, El-Boghdadly K, McGuire B, McNarry AF, Patel A, Higgs A. Consensus guidelines for managing the airway in patients with COVID-19: Guidelines from the difficult airway society, the association of anaesthetists the intensive care society, the faculty of intensive care medicine and the Royal college of anaesthetists. Anaesthesia. 2020;75:785–99. - PMC - PubMed
    1. Malhotra N, Joshi M, Datta R, Bajwa SJS, Mehdiratta L. Indian society of anaesthesiologists (ISA national) advisory and position statement regarding COVID-19. Indian J Anaesth. 2020;64:259–63. - PMC - PubMed