Major ArticleUse of personal protective equipment among health care personnel: Results of clinical observations and simulations
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
References (17)
- et al.
Contact precautions for multidrug-resistant organisms: current recommendations and actual practice
Am J Infect Control
(2010) - et al.
A method for evaluating health care workers' personal protective equipment technique
Am J Infect Control
(2011) - et al.
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) - et al.
Personal protective equipment for the Ebola virus disease: a comparison of 2 training programs
Am J Infect Control
(2015) - et al.
Ebola virus disease: the use of fluorescents as markers of contamination for personal protective equipment
IDCases
(2015) - et al.
Hospital respiratory protection practices in 6 U.S. states: a public health evaluation study
Am J Infect Control
(2015) CDC changes Ebola care guidelines for U.S. hospitals after Dallas case
Ebola: personal protective equipment (PPE) donning and doffing procedures
Cited by (0)
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.
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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.