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

Details

• Alternative Title:
  Infect Control Hosp Epidemiol
• Personal Author:
  Kwon, Jennie H. ; Burnham, Carey-Ann D. ; Reske, Kimberly A. ; Liang, Stephen Y. ; Hink, Tiffany ; Wallace, Meghan A. ; Shupe, Angela ; Seiler, Sondra ; Cass, Candice ; Fraser, Victoria J. ; Dubberke, Erik R.
• Corporate Authors:
  for the CDC Prevention Epicenters
• Description:
  Objective.
  
  To evaluate healthcare workers’ (HCWs) 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.
  
  36 HCWs: 18 donned/doffed contact precautions (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.
  
  27% of EVD PPE HCWs and 50% of CP PPE HCWs made ≥1 protocol deviation while donning. 100% of EVD PPE HCWs and 67% of CP PPE HCWs made ≥1 protocol deviation while doffing (p=0.02). The median number of doffing protocol deviations among EVD PPE HCWs was 4, vs. 1 among CP PPE HCWs. 15 EVD PPE protocol deviations were committed by doffing assistants and/or trained observers. Fluorescence was detected on 8 (44%) of EVD PPE HCWs and 5 (28%) CP PPE HCWs, most commonly on hands. MS2 was recovered from 2 (11%) EVD PPE HCWs and 3 (17%) CP PPE HCWs.
  
  Conclusions.
  
  Protocol deviations were common during both EVD and CP PPE doffing, and some deviations during EVD PPE doffing were committed by the HCWs’ doffing assistant and/or trained observer. Self-contamination was common. PPE donning/doffing are complex and deserve additional study.
  
  
• Subjects:
  Adult Female Gloves, Protective Guideline Adherence Health Personnel Humans Infection Control Levivirus Male Middle Aged Missouri Personal Protective Equipment Pilot Projects Protective Clothing Respiratory Protective Devices Reverse Transcriptase Polymerase Chain Reaction Tertiary Care Centers Ultraviolet Rays Video Recording

  More +
• Source:
  Infect Control Hosp Epidemiol. 38(9):1077-1083
• Pubmed ID:
  28606192
• Pubmed Central ID:
  PMC6263164
• Document Type:
  Journal Article
• Funding:
  UL1 RR024992/RR/NCRR NIH HHSUnited States/ ; U54 CK000162/CK/NCEZID CDC HHSUnited States/ ; UL1 TR002345/TR/NCATS NIH HHSUnited States/ ; KM1 CA156708/CA/NCI NIH HHSUnited States/ ; KL2 TR000450/TR/NCATS NIH HHSUnited States/ ; KL2 TR002346/TR/NCATS NIH HHSUnited States/ ; UL1 TR000448/TR/NCATS NIH HHSUnited States/
• Volume:
  38
• Issue:
  9
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:76844006bd0a42ab5de8893fe7c881036e05199ee11b9bbcc15390ab07d962af
• Download URL:
  https://stacks.cdc.gov/view/cdc/61006/cdc_61006_DS1.pdf
• File Type:
  [PDF - 80.88 KB ]