Major Article
Use of personal protective equipment among health care personnel: Results of clinical observations and simulations

https://doi.org/10.1016/j.ajic.2016.08.011Get rights and content

Highlights

  • Among 130 simulations, contamination occurred in 79.2% during the doffing process.

  • Despite feedback, contaminations still occurred in 82% of 22 follow-up simulations.

  • Devising better personal protective equipment education and protocols is necessary to ensure health care personnel safety.

Background

Very little is known about how health care personnel (HCP) actually use personal protective equipment (PPE).

Methods

The clinical PPE practices of 50 HCP from selected units at the University of Pittsburgh Medical Center (UPMC) Presbyterian Hospital were videotaped with HCP consent. For 2 PPE simulation sessions (simple and full-body sets), 82 HCP were recruited throughout the UPMC system. Simulation practices were videotaped and examined using fluorescent powder with ultraviolet lighting. All participants completed an electronic survey. For a follow-up evaluation simulation, 12 HCP were recruited among simulation participants.

Results

Among 130 total sessions from 65 participants, contamination occurred in 79.2% of simulations during the doffing process with various PPE items: simple set (92.3%) and full-body set (66.2%). Among 11 follow-up evaluation participants, contaminations still occurred in 82% after receiving individual feedback, but the overall contamination level was reduced. Using the contamination information gained during the simulation analysis, 66% of potential contamination was estimated for the clinical observation. Concerns and barriers in PPE use from HCP survey responses were as follows: time-consuming, cumbersomeness, and PPE effectiveness.

Conclusions

Although HCP knew they were being videotaped, contamination occurred in 79.2% of the PPE simulations. Devising better standardized PPE protocols and implementing innovative PPE education are necessary to ensure HCP safety.

Section snippets

Background

The 2014 U.S. Ebola cases in nurses that resulted from occupational exposure underscored that health care personnel (HCP) are at risk for contracting infectious diseases during patient care. Despite the Ebola transmission route (ie, contact with body fluids) being relatively clear, 2 U.S. nurses were infected with Ebola during patient care despite their wearing of full-body personal protective equipment (PPE). Cable News Network reported inconsistencies in the type of PPE worn and the

Methods

This study was designed as an observational, descriptive study in 4 parts: a clinical observation, a simulation observation, a survey (for both clinical and simulation participants), and a follow-up evaluation simulation. Simulations required HCP to don and doff diverse PPE types for each item (eg, N95 respirator—pouch vs flat-fold vs cup style) in 2 levels of sets (ie, simple set [basic PPE items, such as daily use PPE in clinical setting], full-body set [enhanced protection PPE items, such as

Simulation

Among 82 HCP who made a participation appointment, 65 HCP (72.9%; including 3 HCP who participated in the clinical observation) completed their 1-hour simulations. Participants' characteristics are summarized in Table 1. Their average PPE use experience was 5.16 years (Table 2). Among the 65 simulation participants, 63 HCP (97%) had at least 1 instance of contamination during the PPE doffing process in 2 simulation sessions with both a simple set and a full-body set (Table 3). Only 2

Discussion

Our study demonstrated substantial contamination rates measured after the doffing process regardless of differences in PPE sets and styles. This aligns with other recent small-scale pilot study results that have reported PPE doffing contamination rates ranging from 25%-100%.7, 8, 9 To our knowledge, this study is the first to examine HCP PPE donning and doffing practices through a comprehensive approach using videotaped observations, fluorescent powder on full-body simulation mannequins, both

Conclusions

Regardless of the different levels of PPE sets or various style combinations, this study demonstrated frequent contaminations after PPE use and doffing. These contamination breaches appear to be associated with poor HCP PPE techniques, knowledge deficits, and behavioral flaws. Although it may be impossible to achieve zero breaches in HCP PPE doffing, this study emphasizes the need for refining PPE protocols based on further scientific evidence, reinforcing PPE training using innovative methods,

Acknowledgments

We thank the 114 health care personnel for their participation in either clinical videotaped observations, simulations, or both study parts; the Peter M. Winter Institution for Simulation, Education, and Research (WISER) center for their professional support and their in kind donations of approximately a total of $22,000 for study simulations; Debra A. Novak, Senior Service Fellow of National Personal Protective Technology Laboratory/National Institute for Occupational Safety, for her expert

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Funding/support: Supported by the APIC Heroes Implementation Research Scholar Award 2015-16 program and the Peter M. Winter Institution for Simulation, Education, and Research Center.

Conflicts of interest: None to report.

1

Current affiliations: College of Nursing, Seoul National University, Seoul, Republic of Korea and Research Institute of Nursing Science, Seoul National University, Seoul, Republic of Korea.

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