Hostname: page-component-848d4c4894-p2v8j Total loading time: 0 Render date: 2024-05-01T02:04:13.924Z Has data issue: false hasContentIssue false
  • English
  • Français

Contributing Risk Factors to Self-Contamination During the Process of Donning and Doffing Personal Protective Equipment

Published online by Cambridge University Press:  08 February 2024

Yunyun Liu ,
Fengling Tan ,
Qiu Yao ,
Shuqi Wang ,
Ping Zhou ,
Yihui Sun  and
Liubing Li
Yunyun Liu
Affiliation:
Department of Infection Control and Management, The Second Affiliated Hospital of Soochow University, Suzhou, PR China School of Public Health, Zhejiang University, Hangzhou, PR China
Fengling Tan
Affiliation:
Department of Infection Control and Management, The Second Affiliated Hospital of Soochow University, Suzhou, PR China
Qiu Yao
Affiliation:
Department of Infection Control and Management, The Second Affiliated Hospital of Soochow University, Suzhou, PR China
Shuqi Wang
Affiliation:
Department of Infection Control and Management, The Second Affiliated Hospital of Soochow University, Suzhou, PR China
Ping Zhou
Affiliation:
Department of Infection Control and Management, The Second Affiliated Hospital of Soochow University, Suzhou, PR China
Yihui Sun*
Affiliation:
Department of Infection Control and Management, The Second Affiliated Hospital of Soochow University, Suzhou, PR China
Liubing Li*
Affiliation:
Department of Infection Control and Management, The Second Affiliated Hospital of Soochow University, Suzhou, PR China
*
Corresponding authors: Liubing Li, Email: lbli@suda.edu.cn; Yihui Sun, Email: yihuisun@163.com
Corresponding authors: Liubing Li, Email: lbli@suda.edu.cn; Yihui Sun, Email: yihuisun@163.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

The goal of this study is to explore the risk factors associated with self-contamination points during personal protective equipment (PPE) donning and doffing among health care workers (HCWs).

Methods:

In total, 116 HCWs were randomly sampled and trained to don and doff the whole PPE set. We smeared the whole PPE set with the fluorescent powder. After each participant finished PPE doffing, the whole body was irradiated with ultraviolet light in order to detect contamination points and record the position and quantity. Sociodemographic characteristics and previous infection prevention control (IPC) training experience, among others, were collected by using electronic questionnaires. Poisson regression was used in identifying risk factors that are associated with the number of contamination points, and the relative risk (RR) and its 95% confidence interval (CI) were calculated.

Results:

About 78.5% of participants were contaminated. Ever training experience (RR = 0.37; 0.26, 0.52), clinical departments (RR = 0.67; 0.49, 0.93), body mass index (BMI) (RR = 1.09; 1.01, 1.18), and shoulder width (RR = 1.07; 1.01, 1.13) were associated with the number of contamination points.

Conclusions:

Previous IPC training experience, department types, BMI, and shoulder width were associated with self-contamination points after the PPE was removed.

Keywords

contamination pointsfluorescence simulationPPE donning and doffingrisk factors
Type
Brief Report
Information
Disaster Medicine and Public Health Preparedness , Volume 18 , 2024 , e19
Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of Society for Disaster Medicine and Public Health, Inc

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

YL and FT are co-first authors with equal contribution.

References

Hui, DS, E IA, Madani, TA, et al. The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health—the latest 2019 novel coronavirus outbreak in Wuhan, China. Int J Infect Dis. 2020;91:264-266.CrossRefGoogle Scholar
What Is the JHU CRC Now? Johns Hopkins University and Medicine. Coronavirus Resource Center. Accessed January 2023. https://coronavirus.jhu.edu/ Google Scholar
Iversen, K, Bundgaard, H, Hasselbalch, RB, et al. Risk of COVID-19 in health-care workers in Denmark: an observational cohort study. Lancet Infect Dis. 2020;20(12):1401-1408.CrossRefGoogle ScholarPubMed
Piccoli, L, Ferrari, P, Piumatti, G, et al. Risk assessment and seroprevalence of SARS-CoV-2 infection in healthcare workers of COVID-19 and non-COVID-19 hospitals in Southern Switzerland. Lancet Reg Health Eur. 2021;1:100013.CrossRefGoogle ScholarPubMed
Baker, MA, Rhee, C, Tucker, R, et al. Rapid control of hospital-based severe acute respiratory syndrome coronavirus 2 omicron clusters through daily testing and universal use of N95 respirators. Clin Infect Dis. 2022;75(1):e296-e299.CrossRefGoogle ScholarPubMed
Verbeek, JH, Rajamaki, B, Ijaz, S, et al. Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane Database Syst Rev. 2020;4(4):CD011621.Google ScholarPubMed
Moore, D, Gamage, B, Bryce, E; and Group BCIRPS. Protecting health care workers from SARS and other respiratory pathogens: organizational and individual factors that affect adherence to infection control guidelines. Am J Infect Control. 2005;33(2):88-96.CrossRefGoogle ScholarPubMed
Guidance on Personal Protective Equipment (PPE) to Be Used by Healthcare Workers During Management of Patients with Confirmed Ebola or Persons Under Investigation (PUIs) for Ebola Who Are Clinically Unstable or Have Bleeding, Vomiting, Diarrhea in U.S. Hospitals, Including Procedures for Donning and Doffing PPE. Centers for Disease Control and Prevention. Accessed October 2022. https://www.cdc.gov/vhf/ebola/healthcare-us/ppe/index.html Google Scholar
Chughtai, AA, Chen, X, Macintyre, CR. Risk of self-contamination during doffing of personal protective equipment. Am J Infect Control. 2018;46(12):1329-1334.CrossRefGoogle ScholarPubMed
Kwon, JH, Burnham, CD, Reske, KA, et al. Assessment of healthcare worker protocol deviations and self-contamination during personal protective equipment donning and doffing. Infect Control Hosp Epidemiol. 2017;38(9):1077-1083.CrossRefGoogle ScholarPubMed
Baloh, J, Reisinger, HS, Dukes, K, et al. Healthcare workers’ strategies for doffing personal protective equipment. Clin Infect Dis. 2019;69(Suppl 3):S192-S198.CrossRefGoogle ScholarPubMed
Herlihey, TA, Gelmi, S, Flewwelling, CJ, et al. Personal protective equipment for infectious disease preparedness: a human factors evaluation. Infect Control Hosp Epidemiol. 2016;37(9):1022-1028.CrossRefGoogle ScholarPubMed
Technical Guidelines for the Prevention and Control of Novel Coronavirus Infection in Healthcare Settings (3rd Edition). Chinese website: www.gov.cn. Published 2021. Accessed October 2023. https://www.gov.cn/xinwen/2021-09/14/content_5637141.htm Google Scholar
Verbeek, JH, Rajamaki, B, Ijaz, S, et al. Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane Database Syst Rev. 2020;5(5):CD011621.Google ScholarPubMed
Kang, J, O’Donnell, JM, Colaianne, B, et al. Use of personal protective equipment among health care personnel: results of clinical observations and simulations. Am J Infect Control. 2017;45(1):17-23.CrossRefGoogle ScholarPubMed
Osei-Bonsu, K, Masroor, N, Cooper, K, et al. Alternative doffing strategies of personal protective equipment to prevent self-contamination in the health care setting. Am J Infect Control. 2019;47(5):534-539.CrossRefGoogle ScholarPubMed
Tomas, ME, Kundrapu, S, Thota, P, et al. Contamination of health care personnel during removal of personal protective equipment. JAMA Intern Med. 2015;175(12):1904-1910.CrossRefGoogle ScholarPubMed
Zhang, HL, Yang, S, Luo, HX, You, JP. The error-prone operational steps and key sites of self-contamination during donning and doffing of personal protective equipment by health care workers. Disaster Med Public Health Prep. 2021:1-6.Google ScholarPubMed
Kantor, J. Behavioral considerations and impact on personal protective equipment use: early lessons from the coronavirus (COVID-19) pandemic. J Am Acad Dermatol. 2020;82(5):1087-1088.CrossRefGoogle ScholarPubMed
Ojanperä, H, Kanste, OI, Syrjala, H. Hand-hygiene compliance by hospital staff and incidence of health-care-associated infections, Finland. Bull World Health Organ. 2020;98(7):475-483.CrossRefGoogle ScholarPubMed
Aiello, AE, Coulborn, RM, Perez, V, Larson, EL. Effect of hand hygiene on infectious disease risk in the community setting: a meta-analysis. Am J Public Health. 2008;98(8):1372-1381.CrossRefGoogle ScholarPubMed
Tartari, E, Fankhauser, C, Masson-Roy, S, et al. Train-the-trainers in hand hygiene: a standardized approach to guide education in infection prevention and control. Antimicrob Resist Infect Control. 2019;8(1):206.CrossRefGoogle ScholarPubMed
MacEwan, SR, Beal, EW, Gaughan, AA, et al. Perspectives of hospital leaders and staff on patient education for the prevention of healthcare-associated infections. Infect Control Hosp Epidemiol. 2022;43(9):1129-1134.CrossRefGoogle ScholarPubMed
Tsioutis, C, Birgand, G, Bathoorn, E, et al. Education and training programmes for infection prevention and control professionals: mapping the current opportunities and local needs in European countries. Antimicrob Resist Infect Control. 2020;9(1):183.CrossRefGoogle ScholarPubMed
Han, B, Zang, F, Liu, J, et al. Effect analysis of “four-step” training and assessment tool in the prevention and control of COVID-19. Infect Drug Resist. 2022;15:1247-1257.CrossRefGoogle ScholarPubMed
Xu, N, Zhang, Y, Zhang, X, et al. Knowledge, attitudes, and practices of urban residents toward COVID-19 in Shaanxi during the post-lockdown period. Front Public Health. 2021;9:659797.CrossRefGoogle ScholarPubMed
Houghton, C, Meskell, P, Delaney, H, et al. Barriers and facilitators to healthcare workers’ adherence with infection prevention and control (IPC) guidelines for respiratory infectious diseases: a rapid qualitative evidence synthesis. Cochrane Database Syst Rev. 2020;4(4):CD013582.Google ScholarPubMed
Ahmad, J, Anwar, S, Latif, A, et al. Association of PPE availability, training, and practices with COVID-19 sero-prevalence in nurses and paramedics in tertiary care hospitals of Peshawar, Pakistan. Disaster Med Public Health Prep. 2022;16(3):975-979.CrossRefGoogle ScholarPubMed
Smith, CR, Vasilopoulos, T, Frantz, AM, et al. Staying proper with your personal protective equipment: how to don and doff. J Clin Anesth. 2023;86:111057.CrossRefGoogle ScholarPubMed
Kısacık, ÖG, Ciğerci, Y, Güneş, Ü. Impact of the fluorescent concretization intervention on effectiveness of hand hygiene in nursing students: a randomized controlled study. Nurse Educ Today. 2021;97:104719.CrossRefGoogle ScholarPubMed
Supplementary material: File

Liu et al. supplementary material

Liu et al. supplementary material
Download Liu et al. supplementary material(File)
File 64.5 KB