Alternative doffing strategies of personal protective equipment to prevent self-contamination in the health care setting

Osei-Bonsu, Kathryn; Masroor, Nadia; Cooper, Kaila; Doern, Christopher D.; Jefferson, Kimberly K.; Major, Yvette; Adamson, Savion; Thomas, Justin; Lovern, Ian; Albert, Heather; Stevens, Michael P.; Archer, Gordon L.; Bearman, Gonzalo; Doll, Michelle

doi:10.1016/j.ajic.2018.11.003

Cited by 49 publications

(58 citation statements)

References 11 publications

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“…The impact of gown doffing method on self-contamination, however, is uncertain. Osei-Bonsu et al, [10] in a doffing simulation study involving disposable gowns, found that use of the CDC-recommended doffing sequence that includes removing the gown by pulling from the front was associated with fewer participants with any contamination by the surrogate microorganism Staphylococcus dermidis than use of the doffing sequence that includes removing the gown from the back (2 of 15 [13%] vs. 8 of 12 [70%]), but no difference was observed in the number of participants with any contamination by the fluorescent tracer (12 of 15 [80%] vs. 11 of 12 [92%]).…”

Section: Discussionmentioning

confidence: 99%

Personal protective equipment doffing practices of healthcare workers

Phan

Maita

Mortiz

et al. 2019

Journal of Occupational and Environmental Hygiene

140

132

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Section: Discussionmentioning

confidence: 99%

Personal protective equipment doffing practices of healthcare workers

Phan

Maita

Mortiz

et al. 2019

Journal of Occupational and Environmental Hygiene

140

132

View full text Add to dashboard Cite

“…Risks of contamination during doffing can be due to an incorrect removal technique, improper handling and disposal of PPE, or by damaging PPE to expose HCWs. [1][2][3][4][5][6] HCWs endure extreme heat, long periods of standing during patient care and then remove PPE, which requires patience, attention and some unusual movements. Doffing is a physically rigorous task that demands flexibility, balance and constant vigilance.…”

Section: Introductionmentioning

confidence: 99%

“…9 However, deviations from recommended doffing protocol are common with self-contamination rates ranging from 13% to 90%. [1][2][3][4][5][6] Quantitatively, the amount of self-contamination that is clinically meaningful to transmit SARS-CoV-2 during doffing is not yet known. However, SARS-CoV-2 contamination of common objects in the intensive care unit (ICU) and wards, virus aerosolisation in a confined space or spread from asymptomatic infected persons is documented, implying a potentially high infection risk for medical staff and other close contacts even though the amount of viable virus could not be determined.…”

Section: Introductionmentioning

confidence: 99%

“…[12][13][14] Routine breaches in PPE use do not generally result in highly visible disease outbreaks but may contribute to ongoing transmission of nosocomial infection. 4 Studies describing the layout and design for doffing rooms specific to Clostridium difficile and Ebola virus have established that the space and design of built environment for donning and doffing improves HCW safety, influences compliance and has a measurable impact on HCW contamination risk while doffing PPE. [15][16][17][18] The coronavirus is not transmitted in the same way and it is not clear if these recommendations translate to Open access COVID-19.…”

Section: Introductionmentioning

confidence: 99%

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How to rapidly design and operationalise PPE donning and doffing areas for a COVID-19 care facility: quality improvement initiative

Wundavalli

Singh

et al. 2020

BMJ Open Qual

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IntroductionEffective implementation of standard precautions specific to COVID-19 is a challenge for hospitals within the existing constraints of time and resources.AimTo rapidly design and operationalise personal protective equipment (PPE) donning and doffing areas required for a COVID-19 care facility.MethodsLiterature review was done to identify all issues pertaining to donning and doffing in terms of Donabedian’s structure, process and outcome. Training on donning and doffing was given to hospital staff. Donning and doffing mock drills were held. 5S was used as a tool to set up donning and doffing areas. Instances of donning and doffing were observed for protocol deviations and errors. Plan–do–study–act cycles were conducted every alternate day for 4 weeks. The initiative was reported using Standards for QUality Improvement Reporting Excellence (SQUIRE) guidelines.ResultsBest practices in donning and doffing were described. Our study recommends a minimum area of 16 m2 each for donning and doffing rooms. Verbally assisted doffing was found most useful than visual prompts.DiscussionChallenges included sustaining the structure and process of donning and doffing, varied supplies of PPE which altered sequencing of donning and/or doffing, and training non-healthcare workers such as plumbers, electricians and drivers who were required during emergencies in the facility.ConclusionOur study used evidence-based literature and quality improvement (QI) tools to design and operationalise donning and doffing areas with focus on people, task and environment. Our QI will enable healthcare facilities to rapidly prototype donning and doffing areas in a systematic way.

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“…According to reports, the selfcontamination rate ranges from 46-90% while do ng PPE. (13,15) Therefore, in our clinical practice, when entering or leaving the contaminated area, each member of medical staff must be accompanied by another to watch for any possible contamination when removing the PPE. In Step 27, there were 11 (22.9%) participants who could potentially be contaminated when removing their gloves.…”

Section: Discussionmentioning

confidence: 99%

COVID-19: Repeated video-watching vs. combined video-watching and live demonstration as training to health care providers for donning and doffing personal protective equipment

Wang

et al. 2020

Preprint

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Background During the COVID-19 pandemic, not only was there a lack of personal protective equipment (PPE) for health care workers but a dearth in training in respect of its donning and doffing. This study compared two training methods for donning and doffing PPE in order to teach health care workers how to do so more effectively and quickly. Method A total of 48 health care workers were recruited and randomly divided into two groups. Group A watched a 10-minute demonstration (demo) video repeated four times, while Group B watched the same demo video twice followed by a 10-minute live demo twice. The learning time of both groups was the same, and an examination was performed immediately after the completion of training. The examination scores of Group A and Group B were recorded according to the checklist (Appendix 1). The time taken for the participants to don and doff PPE, their satisfaction with the training, and the confidence to don and doff PPE were analyzed. Results The average score of Group B was better than that of Group A, with a mean (SD) of 94.92 (1.72) vs. 86.63 (6.34), respectively (P < 0.001). The average time spent by Group B to do the examination was shorter than that of Group A, with a mean (SD) of 17.67 (1.01) vs. 21.75 (1.82), respectively (P < 0.001). The satisfaction and confidence of Group B were higher than those of group A (P < 0.001). Conclusions Compared with repeated video-watching learning, the video-watching plus a live demonstration teaching method is more suitable for health care workers to learn how to put on and remove personal protective equipment.

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Alternative doffing strategies of personal protective equipment to prevent self-contamination in the health care setting

Cited by 49 publications

References 11 publications

Personal protective equipment doffing practices of healthcare workers

Personal protective equipment doffing practices of healthcare workers

How to rapidly design and operationalise PPE donning and doffing areas for a COVID-19 care facility: quality improvement initiative

COVID-19: Repeated video-watching vs. combined video-watching and live demonstration as training to health care providers for donning and doffing personal protective equipment

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