Using the Stryker T4 Personal Protection System For High-Risk Procedures During SARS Outbreaks Randy Wax, MD, FRCPC (Critical Care) Laurie Mazurik, MD, FRCPC (Emergency Medicine) Vagia Tsiaousidis Campbell, RRCP Prepared on behalf of the Greater Toronto Area Critical Care/Emergency Medicine Advisory Group
Indications for personal protection systems during SARS outbreak Patient Known or suspected SARS Respiratory failure of unknown etiology when SARS cannot be ruled out Procedure Intubation Extubation Bronchoscopy
Stryker T4 Personal Protection System Stryker T4 was designed for orthopedic surgeons performing total joint replacements to protect patient from contamination by surgical team This system provides total body droplet protection from the patient
Stryker T4 Personal Protection System Use of this system is consistent with the “Directives to All Ontario Acute Care Hospitals for High-risk Procedures in Critical Care Areas During a SARS Outbreak” (Directive 03-06, May 1/2003)
Before putting Stryker suit on Surgical cap Secure goggles with elastic strap or tape glasses N95/N100 mask (new if time permits) One pair gloves Gown Surgical scrubs Note: don’t wear fabric shoes
Get helmet Note: these helmets should be stored and covered in plastic (not as shown here).
Put helmet on
Adjust headband
Get battery
Plug helmet cable into battery
Secure cable connection with tape
Assistant helps you gown
Lift visor towards helmet
Visor slot to helmet hook
Place slot on hook
Attach top velcro
Lift hood over helmet
Pull hood down
Attach bottom velcro
Pull zipper down
Secure ties
2nd pair of gloves (surgical)
Extend glove over cuff of toga
Tape outer gloves to toga
Enter room
Perform high risk procedure
If intubating, confirm with EtCO2 Remember, you can’t use a stethoscope!!!
Go to doorway
Present back to assistant
Assistant unfastens ties
Unzip toga
Disconnect cable from battery back
Go back inside
Pull shoulders of toga forward
Pinch cuff and outer glove
Peel down to knuckles
Repeat with other hand
Detach top velcro
Detach bottom velcro
Lift off hook and slide hood forward
Pull hood down
Rest hood on chest
Remove hand from outer glove
Repeat with other hand Use free hand under gown to pull 2nd glove off
Roll toga down arms and away
Begin turning toga inside out Remember the inside surface of the toga is clean. Wrap clean inside around contaminated exterior when removing toga. Don’t touch the outer surface of the toga once the outer gloves are removed.
Take one hand out
Only touch clean side of toga
Remove other hand
Touch only clean part of toga while rolling down
Stop rolling at ¾ length Avoid touching dirty bottom of toga
Dispose of toga
Leave room, remove remaining gloves
Alcohol wash hands
Put on new gloves
Remove battery pack off belt/scrubs
Remove helmet
Remove inserts from helmet and discard
Using accelerated hydrogen peroxide wipes…
Clean helmet
Clean cable
Clean battery
When helmet is dry, place new inserts
Wrap helmet in plastic bag