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Impact of doffing errors on healthcare worker self-contamination when caring for patients on contact precautions

Published online by Cambridge University Press:  20 March 2019

Koh Okamoto*
Affiliation:
Department of Medicine, Rush University Medical Center, Chicago, Illinois Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
Yoona Rhee
Affiliation:
Department of Medicine, Rush University Medical Center, Chicago, Illinois
Michael Schoeny
Affiliation:
College of Nursing, Rush University Medical Center, Chicago, Illinois
Karen Lolans
Affiliation:
Department of Pathology, Rush University Medical Center, Chicago, Illinois
Jennifer Cheng
Affiliation:
Department of Medicine, Rush University Medical Center, Chicago, Illinois
Shivani Reddy
Affiliation:
Department of Medicine, Rush University Medical Center, Chicago, Illinois
Robert A. Weinstein
Affiliation:
Department of Medicine, Rush University Medical Center, Chicago, Illinois Department of Medicine, Cook County Health and Hospitals System, Chicago, Illinois
Mary K. Hayden
Affiliation:
Department of Medicine, Rush University Medical Center, Chicago, Illinois Department of Pathology, Rush University Medical Center, Chicago, Illinois
Kyle J. Popovich*
Affiliation:
Department of Medicine, Rush University Medical Center, Chicago, Illinois Department of Medicine, Cook County Health and Hospitals System, Chicago, Illinois
for the Centers for Disease Control and Prevention Epicenters Program
Affiliation:
Department of Medicine, Rush University Medical Center, Chicago, Illinois Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan College of Nursing, Rush University Medical Center, Chicago, Illinois Department of Pathology, Rush University Medical Center, Chicago, Illinois Department of Medicine, Cook County Health and Hospitals System, Chicago, Illinois
*
Author for correspondence: Koh Okamoto, Email: kokamoto-tky@umin.ac.jp; Kyle J. Popovich, Email: kyle_popovich@rush.edu
Author for correspondence: Koh Okamoto, Email: kokamoto-tky@umin.ac.jp; Kyle J. Popovich, Email: kyle_popovich@rush.edu

Abstract

Objective:

We assessed the impact of personal protective equipment (PPE) doffing errors on healthcare worker (HCW) contamination with multidrug-resistant organisms (MDROs).

Design:

Prospective, observational study.

Setting:

The study was conducted at 4 adult ICUs at 1 tertiary-care teaching hospital.

Participants:

HCWs who cared for patients on contact precautions for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococci, or multidrug-resistant gram-negative bacilli were enrolled. Samples were collected from standardized areas of patient body, garb sites, and high-touch environmental surfaces in patient rooms. HCW hands, gloves, PPE, and equipment were sampled before and after patient interaction. Research personnel observed PPE doffing and coded errors based on CDC guidelines.

Results:

We enrolled 125 HCWs; most were nurses (66.4%) or physicians (19.2%). During the study, 95 patients were on contact precautions for MRSA. Among 5,093 cultured sites (HCW, patient, environment), 652 (14.7%) yielded the target MDRO. Moreover, 45 HCWs (36%) were contaminated with the target MDRO after patient interactions, including 4 (3.2%) on hands and 38 (30.4%) on PPE. Overall, 49 HCWs (39.2%) made multiple doffing errors and were more likely to have contaminated clothes following a patient interaction (risk ratio [RR], 4.69; P = .04). All 4 HCWs with hand contamination made doffing errors. The risk of hand contamination was higher when gloves were removed before gowns during PPE doffing (RR, 11.76; P = .025).

Conclusion:

When caring for patients on CP for MDROs, HCWs appear to have differential risk for hand contamination based on their method of doffing PPE. An intervention as simple as reinforcing the preferred order of doffing may reduce HCW contamination with MDROs.

Type
Original Article
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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