Using an iterative, participatory, video-feedback approach to rapidly develop safe and user-acceptable powered air-purifying respirator (PAPR) protocols

Dr Mary Wyer1,2,5, Ms Ruth Barratt2,4,5, Dr Su-Yin Hor3, Dr Patricia Ferguson1,4,5, Professor Lyn Gilbert1,5

1Western Sydney Local Health District, Westmead, Australia
2Westmead Institute for Medical Reserach, Westmead, Australia
3University of Technology, Sydney, Australia
4Faculty of Medicine and Health Sciences, University of Sydney, Sydney, Australia
5Marie Bashir Institute for Infectious Diseases & Biosecurity, Sydney, Australia

Introduction: Prior to the COVID-19 pandemic, the use of powered air-purifying respirators (PAPR) in NSW was limited to appropriately trained staff in high-level biocontainment facilities. However, in the context of COVID-19, clinicians who perform or assist in aerosol-generating procedures, some surgical specialties, or who work in high-risk areas such as intensive care (ICU), requested them.  At our facility, the urgency of these requests, and a lack of guidelines for use in healthcare, presented challenges for rapidly developing protocols for safe PAPR use, while also responding to the expectations of staff. We discuss how we deployed video-feedback to develop and evaluate processes for the safe donning/doffing of personal protective equipment (PPE) with the CleanSpace HALO PAPR in the ICU.

Methods: Checklists for donning/doffing PAPR with associated PPE were developed in discussions with local stakeholders using generic CleanSpace guidelines. We videoed simulated donning/doffing procedures in clinical settings, sent stakeholders electronic links to the footage, and made amendments to the checklists according to their feedback. This process was repeated, and checklists refined, until all stakeholders were satisfied.

Findings: Access to the video-link was useful for wide dissemination and prompt feedback from stakeholders. They were able to repeatedly review PAPR use in real time and pay close attention to areas of perceived contamination risk. Over a 4-week period the donning and doffing checklists were substantially amended six and four times respectively.

Conclusion: An iterative, participatory, video-feedback approach can assist in rapidly developing safe and user-acceptable protocols.


Mary Wyer is a Nurse Educator for biopreparedness at Westmead Hospital and a Postdoctoral Researcher located at the Westmead Institute for Medical Research, Sydney. Her research is funded through the National Health and Medical Research Council Centre of Research Excellence (NHMRC CRE), the Australian Partnership for Preparedness Research on Infectious Disease Emergencies (APPRISE). She researches collaboratively with healthcare-workers, patients and families, using video-reflexive ethnography, to understand and improve infection prevention and control practices.

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