1. 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

2. 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

3. 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

4. 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)

5. 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

6. Get helmet
Note: these helmets should be stored and covered in plastic (not as shown here).

7. Put helmet on

8. Adjust headband

9. Get battery

10. Plug helmet cable into battery

11. Secure cable connection with tape

12. Assistant helps you gown

13. Lift visor towards helmet

14. Visor slot to helmet hook

15. Place slot on hook

16. Attach top velcro

17. Lift hood over helmet

18. Pull hood down

19. Attach bottom velcro

20. Pull zipper down

21. Secure ties

22. 2nd pair of gloves (surgical)

23. Extend glove over cuff of toga

24. Tape outer gloves to toga

25. Enter room

26. Perform high risk procedure

27. If intubating, confirm with EtCO2
Remember, you can’t use a stethoscope!!!

28. Go to doorway

29. Present back to assistant

30. Assistant unfastens ties

31. Unzip toga

32. Disconnect cable from battery back

33. Go back inside

34. Pull shoulders of toga forward

35. Pinch cuff and outer glove

36. Peel down to knuckles

37. Repeat with other hand

38. Detach top velcro

39. Detach bottom velcro

40. Lift off hook and slide hood forward

41. Pull hood down

42. Rest hood on chest

43. Remove hand from outer glove

44. Repeat with other hand
Use free hand under gown to pull 2nd glove off

45. Roll toga down arms and away

46. 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.

47. Take one hand out

48. Only touch clean side of toga

49. Remove other hand

50. Touch only clean part of toga while rolling down

51. Stop rolling at ¾ length
Avoid touching dirty bottom of toga

52. Dispose of toga

53. Leave room, remove remaining gloves

54. Alcohol wash hands

55. Put on new gloves

56. Remove battery pack off belt/scrubs

57. Remove helmet

58. Remove inserts from helmet and discard

59. Using accelerated hydrogen peroxide wipes…

60. Clean helmet

61. Clean cable

62. Clean battery

63. When helmet is dry, place new inserts

64. Wrap helmet in plastic bag