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