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Human factors–based risk analysis to improve the safety of doffing enhanced personal protective equipment

Published online by Cambridge University Press:  06 December 2018

Ayse P. Gurses Open the ORCID record for Ayse P. Gurses [Opens in a new window] ,
Aaron S. Dietz ,
Elaine Nowakowski ,
Jennifer Andonian ,
Maggie Schiffhauer ,
Carrie Billman ,
Anya M. Abashian ,
Polly Trexler ,
Patience Osei  and
Lauren E. Benishek
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Ayse P. Gurses*
Affiliation:
Armstrong Institute Center for Health Care Human Factors, The Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Aaron S. Dietz
Affiliation:
Armstrong Institute Center for Health Care Human Factors, The Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Elaine Nowakowski
Affiliation:
Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, Maryland
Jennifer Andonian
Affiliation:
Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, Maryland
Maggie Schiffhauer
Affiliation:
Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, Maryland
Carrie Billman
Affiliation:
Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, Maryland
Anya M. Abashian
Affiliation:
Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, Maryland
Polly Trexler
Affiliation:
Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, Maryland
Patience Osei
Affiliation:
Armstrong Institute Center for Health Care Human Factors, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Lauren E. Benishek
Affiliation:
Armstrong Institute Center for Health Care Human Factors, The Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Anping Xie
Affiliation:
Armstrong Institute Center for Health Care Human Factors, The Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Peter Pronovost
Affiliation:
Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Michael A. Rosen
Affiliation:
Armstrong Institute Center for Health Care Human Factors, The Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Lisa L. Maragakis
Affiliation:
Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, Maryland Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
for the CDC Prevention Epicenter Program
Affiliation:
Armstrong Institute Center for Health Care Human Factors, The Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, Maryland Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
*
Author for correspondence: Ayse P. Gurses, Armstrong Institute Center for Health Care Human Factors, Johns Hopkins University School of Medicine, 750 East Pratt Street, 15th Floor, Baltimore, MD 21202. E-mail: agurses1@jhmi.edu
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Abstract

Objective

To systematically assess enhanced personal protective equipment (PPE) doffing safety risks.

Design

We employed a 3-part approach to this study: (1) hierarchical task analysis (HTA) of the PPE doffing process; (2) human factors-informed failure modes and effects analysis (FMEA); and (3) focus group sessions with a convenience sample of infection prevention (IP) subject matter experts.

Setting

A large academic US hospital with a regional Special Pathogens Treatment Center and enhanced PPE doffing protocol experience.

Participants

Eight IP experts.

Methods

The HTA was conducted jointly by 2 human-factors experts based on the Centers for Disease Control and Prevention PPE guidelines. The findings were used as a guide in 7 focus group sessions with IP experts to assess PPE doffing safety risks. For each HTA task step, IP experts identified failure mode(s), assigned priority risk scores, identified contributing factors and potential consequences, and identified potential risk mitigation strategies. Data were recorded in a tabular format during the sessions.

Results

Of 103 identified failure modes, the highest priority scores were associated with team members moving between clean and contaminated areas, glove removal, apron removal, and self-inspection while preparing to doff. Contributing factors related to the individual (eg, technical/ teamwork competency), task (eg, undetected PPE contamination), tools/technology (eg, PPE design characteristics), environment (eg, inadequate space), and organizational aspects (eg, training) were identified. Participants identified 86 types of risk mitigation strategies targeting the failure modes.

Conclusions

Despite detailed guidelines, our study revealed 103 enhanced PPE doffing failure modes. Analysis of the failure modes suggests potential mitigation strategies to decrease self-contamination risk during enhanced PPE doffing.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 2 , February 2019 , pp. 178 - 186
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

Cite this article: Gurses AP. (2019). Human factors–based risk analysis to improve the safety of doffing enhanced personal protective equipment. Infection Control & Hospital Epidemiology 2019, 40, 178–186. doi: 10.1017/ice.2018.292

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