Self-contamination during doffing of personal protective equipment by healthcare workers to prevent Ebola transmission

Abstract

BackgroundHealthcare workers (HCWs) use personal protective equipment (PPE) in Ebola virus disease (EVD) situations. However, preventing the contamination of HCWs and the environment during PPE removal crucially requires improved strategies. This study aimed to compare the efficacy of three PPE ensembles, namely, Hospital Authority (HA) Standard Ebola PPE set (PPE1), Dupont Tyvek Model, style 1422A (PPE2), and HA isolation gown for routine patient care and performing aerosol-generating procedures (PPE3) to prevent EVD transmission by measuring the degree of contamination of HCWs and the environment.MethodsA total of 59 participants randomly performed PPE donning and doffing. The trial consisted of PPE donning, applying fluorescent solution on the PPE surface, PPE doffing of participants, and estimation of the degree of contamination as indicated by the number of fluorescent stains on the working clothes and environment. Protocol deviations during PPE donning and doffing were monitored.ResultsPPE2 and PPE3 presented higher contamination risks than PPE1. Environmental contaminations such as those originating from rubbish bin covers, chairs, faucets, and sinks were detected. Procedure deviations were observed during PPE donning and doffing, with PPE1 presenting the lowest overall deviation rate (%) among the three PPE ensembles (p < 0.05).ConclusionContamination of the subjects’ working clothes and surrounding environment occurred frequently during PPE doffing. Procedure deviations were observed during PPE donning and doffing. Although PPE1 presented a lower contamination risk than PPE2 and PPE3 during doffing and protocol deviations, the design of PPE1 can still be further improved. Future directions should focus on designing a high-coverage-area PPE with simple ergonomic features and on evaluating the doffing procedure to minimise the risk of recontamination. Regular training for users should be emphasised to minimise protocol deviations, and in turn, guarantee the best protection to HCWs.Electronic supplementary materialThe online version of this article (10.1186/s13756-018-0433-y) contains supplementary material, which is available to authorized users.

Overview of guidance for endoscopy during the coronavirus disease 2019 pandemic

“…All endoscopy staff must receive adequate education and enhanced training relating to the use of PPE to minimize protocol deviations as self‐contamination during doffing is frequently encountered 58 . Many resources are readily available from various institutions and the web.…”

Aerosol-generating otolaryngology procedures and the need for enhanced PPE during the COVID-19 pandemic: A literature review

“…No studies exist that directly compare the different respirators' abilities to prevent transmission of viral illness in the health care setting. Such studies would need to incorporate doffing and reprocessing procedures in the experimental design, since there is high risk of transmission if doffing is performed incorrectly, and the risk may be modified by the type of PPE used [71]. .Experimental studies in the occupational health literature have been performed that compare how well different respirators filter aerosols (typically sodium chloride aerosols) in simulated industrial environments.…”

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“…However, at a minimum, otolaryngologists should don a respirator, gown, cap, eye protection, and gloves [17]. Moreover, studies from the Ebola outbreak reported that in some circumstances, up to 79.2% of providers self- contaminated while removing PPE [18]; therefore, careful consideration must be applied to doffing PPE during the COVID-19 pandemic. Even after exercising adequate precautions, it is sensible to recommend that vulnerable demographics limit their exposure to possible COVID-19 infection as much as possible [19].…”