Hostname: page-component-cd9895bd7-8ctnn Total loading time: 0 Render date: 2024-12-21T13:55:37.507Z Has data issue: false hasContentIssue false

Assessment of Healthcare Worker Protocol Deviations and Self-Contamination During Personal Protective Equipment Donning and Doffing

Published online by Cambridge University Press:  13 June 2017

Jennie H. Kwon*
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
Carey-Ann D. Burnham
Affiliation:
Department of Pathology and Immunology, Washington University School of Medicine, St Louis, Missouri
Kimberly A. Reske
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
Stephen Y. Liang
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
Tiffany Hink
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
Meghan A. Wallace
Affiliation:
Department of Pathology and Immunology, Washington University School of Medicine, St Louis, Missouri
Angela Shupe
Affiliation:
Department of Pathology and Immunology, Washington University School of Medicine, St Louis, Missouri
Sondra Seiler
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
Candice Cass
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
Victoria J. Fraser
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
Erik R. Dubberke
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
*
Address correspondence to Jennie H. Kwon, DO, MSCI, 4523 Clayton Ave, Campus Box 8051 St Louis, MO 63110 (j.kwon@wustl.edu).

Abstract

OBJECTIVE

To evaluate healthcare worker (HCW) risk of self-contamination when donning and doffing personal protective equipment (PPE) using fluorescence and MS2 bacteriophage.

DESIGN

Prospective pilot study.

SETTING

Tertiary-care hospital.

PARTICIPANTS

A total of 36 HCWs were included in this study: 18 donned/doffed contact precaution (CP) PPE and 18 donned/doffed Ebola virus disease (EVD) PPE.

INTERVENTIONS

HCWs donned PPE according to standard protocols. Fluorescent liquid and MS2 bacteriophage were applied to HCWs. HCWs then doffed their PPE. After doffing, HCWs were scanned for fluorescence and swabbed for MS2. MS2 detection was performed using reverse transcriptase PCR. The donning and doffing processes were videotaped, and protocol deviations were recorded.

RESULTS

Overall, 27% of EVD PPE HCWs and 50% of CP PPE HCWs made ≥1 protocol deviation while donning, and 100% of EVD PPE HCWs and 67% of CP PPE HCWs made ≥1 protocol deviation while doffing (P=.02). The median number of doffing protocol deviations among EVD PPE HCWs was 4, versus 1 among CP PPE HCWs. Also, 15 EVD PPE protocol deviations were committed by doffing assistants and/or trained observers. Fluorescence was detected on 8 EVD PPE HCWs (44%) and 5 CP PPE HCWs (28%), most commonly on hands. MS2 was recovered from 2 EVD PPE HCWs (11%) and 3 CP PPE HCWs (17%).

CONCLUSIONS

Protocol deviations were common during both EVD and CP PPE doffing, and some deviations during EVD PPE doffing were committed by the HCW doffing assistant and/or the trained observer. Self-contamination was common. PPE donning/doffing are complex and deserve additional study.

Infect Control Hosp Epidemiol 2017;38:1077–1083

Type
Original Articles
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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.)

References

REFERENCES

1. Verbeek, JH, Ijaz, S, Mischke, C, et al. Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane Database Syst Rev 2016;4:Cd011621.Google ScholarPubMed
2. Fischer, WA 2d, Uyeki, TM, Tauxe, RV. Ebola virus disease: what clinicians in the United States need to know. Am J Infect Control 2015;43:788793.CrossRefGoogle ScholarPubMed
3. Fischer, WA 2d, Weber, DJ, Wohl, DA. Personal protective equipment: protecting health care providers in an Ebola outbreak. Clin Ther 2015;37:24022410.CrossRefGoogle Scholar
4. Sprecher, AG, Caluwaerts, A, Draper, M, et al. Personal protective equipment for filovirus epidemics: a call for better evidence. J Infect Dis 2015;212:S98S100.CrossRefGoogle Scholar
5. Weber, DJ, Fischer, WA, Wohl, DA, Rutala, WA. Protecting healthcare personnel from acquiring Ebola virus disease. Infect Control Hosp Epidemiol 2015;36:12291232.CrossRefGoogle ScholarPubMed
6. Sequence for putting on personal protective equipment (PPE). Centers for Disease Control and Prevention website. http://www.cdc.gov/hai/pdfs/ppe/ppeposter8511.pdf. Published 2014. Accessed September 8, 2016.Google Scholar
7. Tomas, ME, Kundrapu, S, Thota, P, et al. Contamination of health care personnel during removal of personal protective equipment. JAMA Intern Med 2015;175:19041910.CrossRefGoogle ScholarPubMed
8. Beam, EL, Gibbs, SG, Boulter, KC, Beckerdite, ME, Smith, PW. A method for evaluating health care workers’ personal protective equipment technique. Am J Infect Control 2011;39:415420.CrossRefGoogle ScholarPubMed
9. Bell, T, Smoot, J, Patterson, J, Smalligan, R, Jordan, R. Ebola virus disease: the use of fluorescents as markers of contamination for personal protective equipment. IDCases 2015;2:2730.CrossRefGoogle ScholarPubMed
10. Casanova, L, Alfano-Sobsey, E, Rutala, WA, Weber, DJ, Sobsey, M. Virus transfer from personal protective equipment to healthcare employees’ skin and clothing. Emerging Infect Dis 2008;14:12911293.CrossRefGoogle ScholarPubMed
11. Casanova, L, Rutala, WA, Weber, DJ, Sobsey, MD. Methods for the recovery of a model virus from healthcare personal protective equipment. J Appl Microbiol 2009;106:12441251.CrossRefGoogle Scholar
12. Guo, YP, Li, Y, Wong, PL. Environment and body contamination: a comparison of two different removal methods in three types of personal protective clothing. Am J Infect Control 2014;42:e39e45.CrossRefGoogle ScholarPubMed
13. Wong, TK, Chung, JW, Li, Y, et al. Effective personal protective clothing for health care workers attending patients with severe acute respiratory syndrome. Am J Infect Control 2004;32:9096.CrossRefGoogle ScholarPubMed
14. Zamora, JE, Murdoch, J, Simchison, B, Day, AG. Contamination: a comparison of 2 personal protective systems. CMAJ 2006;175:249254.CrossRefGoogle ScholarPubMed
15. Casanova, LM, Rutala, WA, Weber, DJ, Sobsey, MD. Effect of single- versus double-gloving on virus transfer to health care workers’ skin and clothing during removal of personal protective equipment. Am J Infect Control 2012;40:369374.CrossRefGoogle ScholarPubMed
16. Tomas, ME, Cadnum, JL, Jencson, A, Donskey, CJ. The Ebola disinfection booth: evaluation of an enclosed ultraviolet light booth for disinfection of contaminated personal protective equipment prior to removal. Infect Control Hosp Epidemiol 2015;36:12261228.CrossRefGoogle ScholarPubMed
17. Sassi, HP, Sifuentes, LY, Koenig, DW, et al. Control of the spread of viruses in a long-term care facility using hygiene protocols. Am J Infect Control 2015;43:702706.CrossRefGoogle Scholar
18. Sifuentes, LY, Koenig, DW, Phillips, RL, Reynolds, KA, Gerba, CP. Use of hygiene protocols to control the spread of viruses in a hotel. Food Environ Virol 2014;6:175181.CrossRefGoogle ScholarPubMed
19. Beamer, PI, Plotkin, KR, Gerba, CP, Sifuentes, LY, Koenig, DW, Reynolds, KA. Modeling of human viruses on hands and risk of infection in an office workplace using micro-activity data. J Occupat Environ Hygiene 2015;12:266275.CrossRefGoogle Scholar
20. 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, or diarrhea in U.S. hospitals, including procedures for donning and doffing PPE. Centers for Disease Control and Prevention website. http://www.cdc.gov/vhf/ebola/healthcare-us/ppe/guidance.html. Published 2015. Accessed September 8, 2016.Google Scholar
21. Ninove, L, Nougairede, A, Gazin, C, et al. RNA and DNA bacteriophages as molecular diagnosis controls in clinical virology: a comprehensive study of more than 45,000 routine PCR tests. PloS One 2011;6:e16142.CrossRefGoogle Scholar
22. Casalino, E, Astocondor, E, Sanchez, JC, Diaz-Santana, DE, Del Aguila, C, Carrillo, JP. Personal protective equipment for the Ebola virus disease: a comparison of 2 training programs. Am J Infect Control 2015;43:12811287.CrossRefGoogle ScholarPubMed
23. Herlihey, TA, Gelmi, S, Flewwelling, CJ, et al. Personal protective equipment for infectious disease preparedness: a human factors evaluation. Infect Control Hosp Epidemiol 2016;37:10221028.CrossRefGoogle ScholarPubMed
24. Hon, CY, Gamage, B, Bryce, EA, et al. Personal protective equipment in health care: can online infection control courses transfer knowledge and improve proper selection and use? Am J Infect Control 2008;36:e33e37.CrossRefGoogle ScholarPubMed
25. Weber, DJ, Rutala, WA, Fischer, WA, Kanamori, H, Sickbert-Bennett, EE. Emerging infectious diseases: focus on infection control issues for novel coronaviruses (Severe Acute Respiratory Syndrome-CoV and Middle East Respiratory Syndrome-CoV), hemorrhagic fever viruses (Lassa and Ebola), and highly pathogenic avian influenza viruses, A(H5N1) and A(H7N9). Am J Infect Control 2016;44(Suppl 5):e91e100.CrossRefGoogle Scholar
26. Turnberg, W, Daniell, W, Seixas, N, et al. Appraisal of recommended respiratory infection control practices in primary care and emergency department settings. Am J Infect Control 2008;36:268275.CrossRefGoogle ScholarPubMed
27. John, A, Tomas, ME, Cadnum, JL, et al. Are health care personnel trained in correct use of personal protective equipment? Am J Infect Control 2016;44:840842.CrossRefGoogle ScholarPubMed