The effects of trained observers (dofficers) and audits during a facility-wide COVID-19 outbreak: A mixed-methods quality improvement analysis

Abstract

Background: In response to a facility-wide COVID-19 outbreak, our tertiary acute care hospital implemented an evidence-based bundle of infection control practices including the use of audits and trained observers "dofficers" to provide real-time constructive feedback. Methods: We trained furloughed staff to perform the role of dofficer. They offered support and corrective feedback on proper PPE use and completed 21-point audits during a 4-week intervention period. Audits tracked appropriate signage, placement and availability of supplies (equipment), correct PPE use, enhanced environmental cleaning, along with cohorting and social distancing rates. Audit data was used to provide weekly quality improvement reports to units. Results: Nine hundred and sixty two separate audits recorded 36,948 observations, over 7,696 observerhours. The most common errors were with environmental cleaning and PPE use; the least common were with regards to equipment availability and cohorting and social distancing. Mean error rates decreased from 9.81% to 2.88% (P < .001). The largest reduction, 22.57%, occurred in the category of PPE doffing errors. Conclusions: Dofficer led audits effectively identified areas for improvement. Feedback through weekly reports and real-time correction of PPE errors by dofficers led to statistically significant improvements; however, error rates remained high. Further research is needed establish if these relationships are causal.

Mask use among health care workers and feelings of safety at work pre- and post- COVID-19 vaccine

“…Our survey demonstrates that staff have taken it upon themselves to point out lapses in masking and have grown fatigued. Masking champions or “dofficers” 7 may be able to lift this burden from staff and provide regular and accurate feedback. Healthcare leadership may consider looking at models for hand hygiene and other infection control practices at their institution to draw inspiration for increasing mask compliance.…”

“…A study from Zehejiang, China 6 showed 73.8% correct mask use, defined as a surgical mask “worn correctly” per their Infection Prevention Department. Incorrect mask use in this study was described as “pulled downwards.” Another study from Canada 7 conducted after a facility-wide outbreak of COVID-19, showed that having an observer, or “dofficer,” monitor PPE compliance and provide intervention resulted in a reduction of errors in donning and doffing from 9.81% to 2.88%.…”

SARS-CoV-2 outbreak in a Canadian suburban tertiary hospital necessitating full facility closure: a descriptive observational study

“…However, we were able to demonstrate that the implementation of PPE coaches and auditors decreased errors related to PPE by an average of 7%, with a 23% decrease in observed PPE doffing errors. 51 …”

Building a personal protective equipment monitor team as part of a comprehensive COVID-19 prevention strategy

“… 4 , 5 , 6 , 7 , 8 Therefore, it is recommended that PPE monitors be used to promote their colleagues’ safety by guiding them through the donning and doffing processes. 6 , 9 , 10 Early in 2020, the University of North Carolina Medical Center (UNC-MC) chose to incorporate PPE monitors as part of its comprehensive prevention strategy to reduce the risk of staff self-contamination with COVID-19. This paper describes the implementation and use of PPE monitors to observe staff donning and doffing PPE in areas treating known or suspected COVID-19 patients.…”

“…4,5,6,7,8 Therefore, it is recommended that PPE monitors be used to promote their colleagues' safety by guiding them through the donning and doffing processes. 6,9,10 period, there were only two possible healthcare-associated COVID-19 transmissions on the containment units. These transmissions were determined "possible" as there were no identified PPE breaches or community sources for exposure.…”