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Amos TB, Griffin C, Schaffzin JK, Ankrum A, Scaggs Huang F. Adherence to Personal Protective Equipment practices during the COVID-19 pandemic: A pilot study. Infect Prev Pract 2024; 6:100369. [PMID: 38812717 PMCID: PMC11134548 DOI: 10.1016/j.infpip.2024.100369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/17/2024] [Indexed: 05/31/2024] Open
Abstract
A direct observational pilot project of healthcare personnel (HCP) was conducted to validate a tool that measures personal protective equipment (PPE) adherence at a large pediatric institution. Overall unit PPE adherence for all moments ranged from 50-61%. Masking was the most adhered to PPE moment (100%); hand hygiene prior to donning PPE had the lowest adherence (13%). Using data from this standardized tool, researchers can evolve PPE standards to maximize their adherence, effectiveness, and ease of utilization.
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Affiliation(s)
- Taryn B. Amos
- Department of Psychology, Old Dominion University, Norfolk, USA
| | - Cameron Griffin
- Infection Prevention & Control Program, Cincinnati Children's Hospital, Cincinnati, USA
| | - Joshua K. Schaffzin
- Division of Infectious Diseases, Cincinnati Children's Hospital, Cincinnati, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA
| | - Andrea Ankrum
- Infection Prevention & Control Program, Cincinnati Children's Hospital, Cincinnati, USA
| | - Felicia Scaggs Huang
- Division of Infectious Diseases, Cincinnati Children's Hospital, Cincinnati, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA
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Abstract
Data science has the potential to greatly enhance efforts to translate evidence into practice in critical care. The intensive care unit is a data-rich environment enabling insight into both patient-level care patterns and clinician-level treatment patterns. By applying artificial intelligence to these novel data sources, implementation strategies can be tailored to individual patients, individual clinicians, and individual situations, revealing when evidence-based practices are missed and facilitating context-sensitive clinical decision support. To achieve these goals, technology developers should work closely with clinicians to create unbiased applications that are integrated into the clinical workflow.
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Affiliation(s)
- Andrew J King
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, 3500 Terrace Street, Suite 600, Pittsburgh, PA 15261, USA
| | - Jeremy M Kahn
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, 3500 Terrace Street, Suite 600, Pittsburgh, PA 15261, USA; Department of Health Policy and Management, University of Pittsburgh School of Public Health, 130 De Soto Street, Pittsburgh, PA 15261, USA.
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Kobos L, Anderson K, Kurth L, Liang X, Groth CP, England L, Laney AS, Virji MA. Characterization of Cleaning and Disinfection Product Use, Glove Use, and Skin Disorders by Healthcare Occupations in a Midwestern Healthcare Facility. BUILDINGS (BASEL, SWITZERLAND) 2022; 12:10.3390/buildings12122216. [PMID: 38650891 PMCID: PMC11034745 DOI: 10.3390/buildings12122216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Healthcare facility staff use a wide variety of cleaning and disinfecting products during their daily operations, many of which are associated with respiratory or skin irritation or sensitization with repeated exposure. The objective of this study was to characterize the prevalence of cleaning and disinfection product use, glove use during cleaning and disinfection, and skin/allergy symptoms by occupation and identify the factors influencing glove use among the healthcare facility staff. A questionnaire was administered to the current employees at a midwestern Veterans Affairs healthcare facility that elicited information on cleaning and disinfection product use, glove use during cleaning and disinfection, skin/allergy symptoms, and other demographic characteristics, which were summarized by occupation. The central supply/environmental service workers (2% of the total survey population), nurses (26%,), nurse assistants (3%), and laboratory technicians (5%) had the highest prevalence of using cleaning or disinfecting products, specifically quaternary ammonium compounds, bleach, and alcohol. Glove use while using products was common in both patient care and non-patient care occupations. The factors associated with glove use included using bleach or quaternary ammonium compounds and using cleaning products 2-3 or 4-5 days per week. A high frequency of glove use (≥75%) was reported by workers in most occupations when using quaternary ammonium compounds or bleach. The use of alcohol, bleach, and quaternary ammonium compounds was associated with skin disorders (p < 0.05). These research findings indicate that although the workers from most occupations report a high frequency of glove use when using cleaning and disinfection products, there is room for improvement, especially among administrative, maintenance, and nursing workers. These groups may represent populations which could benefit from the implementation of workplace interventions and further training regarding the use of personal protective equipment and the potential health hazards of exposure to cleaning and disinfecting chemicals.
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Affiliation(s)
- Lisa Kobos
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, WV 26505, USA
| | - Kim Anderson
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, WV 26505, USA
| | - Laura Kurth
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, WV 26505, USA
| | - Xiaoming Liang
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, WV 26505, USA
| | - Caroline P. Groth
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, WV 26505, USA
- Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, Morgantown, WV 26505, USA
| | - Lucy England
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, WV 26505, USA
| | - A. Scott Laney
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, WV 26505, USA
| | - M. Abbas Virji
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, WV 26505, USA
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Curtis SJ, Trewin A, McDermott K, Were K, Clezy K, Dempsey K, Walsh N. Electronic monitoring of doffing using video surveillance to minimise error rate and increase safety at Howard Springs International Quarantine Facility. Antimicrob Resist Infect Control 2022; 11:120. [PMID: 36175981 PMCID: PMC9522442 DOI: 10.1186/s13756-022-01155-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 08/26/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Safe donning and doffing of personal protective equipment (PPE) are critical to prevent transmission of infectious diseases. Novel strategies to improve infection prevention and control (IPC) adherence can optimise safety. We describe and quantify video surveillance of doffing at an outdoor hotel quarantine facility led by the Australian Medical Assistance Team in the Northern Territory, Australia.
Methods
Motion-activated video cameras were installed in seven areas where personnel doffed PPE upon exit from an area dedicated to quarantined residents. Video footage was reviewed daily and compliance issues were identified using a standardised checklist and risk graded to initiate feedback. We collated audit data from 1 February to 18 April 2021 to describe trends by month, staff group, doffing component and risk.
Results
In 235 h of video footage, 364 compliance issues were identified, of which none were considered high-risk compromising to PPE integrity. Compliance issues were low risk (55/364, 15%) or moderate risk (309/364, 85%) and the most common issue was missed or inadequate hand hygiene (156/364, 43%). Compliance issues per minute of video footage reviewed decreased following introduction of the activity, from 24 per 1000 in February to 7 per 1000 in March and April.
Conclusion
Video surveillance with feedback supported rapid response to improve IPC adherence in a challenging ambient environment. The activity focused on perfection to identify compliance issues that would go unreported in most healthcare settings and contributed to a suit of activities that prevented any high-risk PPE breaches or compromises to safety.
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Kumar A, Kaur M, Kaur S, Nagi M, Agnihotri M, Nagar PK, Kumar P, Das K. Attitude and Perception of Nursing Personnel Involved in Real Time Remote Audio-Visual Aided (RT-RAVA) Monitoring of Doffing for the Prevention of Covid-19 Infection among the Health Care Workers. Hosp Top 2022; 102:1-8. [PMID: 35535975 DOI: 10.1080/00185868.2022.2073303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The study was carried out to explore the attitude and perception of observers involved in monitoring of doffing through Real Time Remote Audio-Visual aided (RT-RAVA), the first well-sophisticated surveillance system. A 21-item online-survey proforma was used to collect the data amongst 150 nursing personnel. 3/4th of the participants strongly agreed that they helped in reducing the doffing errors through RT-RAVA doffing. 97.3% perceived that the system is highly effective in reducing the infection during doffing. There was significant correlation between attitude and perception of the observers. The system was perceived as highly effective and was recommended for doffing.
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Affiliation(s)
- Ashok Kumar
- National Institute of Nursing Education, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Maninderdeep Kaur
- National Institute of Nursing Education, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sukhpal Kaur
- National Institute of Nursing Education, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manisha Nagi
- National Institute of Nursing Education, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Meenakshi Agnihotri
- National Institute of Nursing Education, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pramod Kumar Nagar
- Department of Nursing, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pramod Kumar
- Department of Nursing, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Karobi Das
- National Institute of Nursing Education, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Alberto EC, McCarthy KH, Hamilton CA, Shalkevich J, Milestone ZP, Izem R, Fritzeen JL, Marsic I, Sarcevic A, O'Connell KJ, Burd RS. Personal Protective Equipment Adherence of Pediatric Resuscitation Team Members During the COVID-19 Pandemic. Ann Emerg Med 2021; 78:619-627. [PMID: 34353649 PMCID: PMC8164378 DOI: 10.1016/j.annemergmed.2021.05.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/11/2021] [Accepted: 05/21/2021] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVE During the COVID-19 pandemic, health care workers have had the highest risk of infection among essential workers. Although personal protective equipment (PPE) use is associated with lower infection rates, appropriate use of PPE has been variable among health care workers, even in settings with COVID-19 patients. We aimed to evaluate the patterns of PPE adherence during emergency department resuscitations that included aerosol-generating procedures. METHODS We conducted a retrospective, video-based review of pediatric resuscitations involving one or more aerosol-generating procedures during the first 3 months of the COVID-19 pandemic in the United States (March to June 2020). Recommended adherence (complete, inadequate, absent) with 5 PPE items (headwear, eyewear, masks, gowns, gloves) and the duration of potential exposure were evaluated for individuals in the room after aerosol-generating procedure initiation. RESULTS Among the 345 health care workers observed during 19 resuscitations, 306 (88.7%) were nonadherent (inadequate or absent adherence) with the recommended use of at least 1 PPE type at some time during the resuscitation, 23 (6.7%) of whom had no PPE. One hundred and forty health care workers (40.6%) altered or removed at least 1 type of PPE during the event. The aggregate time in the resuscitation room for health care workers across all events was 118.7 hours. During this time, providers had either absent or inadequate eyewear for 46.4 hours (39.1%) and absent or inadequate masks for 35.2 hours (29.7%). CONCLUSION Full adherence with recommended PPE use was limited in a setting at increased risk for SARS-CoV-2 virus aerosolization. In addition to ensuring appropriate donning, approaches are needed for ensuring ongoing adherence with PPE recommendations during exposure.
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Affiliation(s)
- Emily C Alberto
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, DC
| | - Kathleen H McCarthy
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, DC
| | - Colleen A Hamilton
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, DC
| | - Jacob Shalkevich
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, DC
| | - Zachary P Milestone
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, DC
| | - Rima Izem
- Division of Biostatistics and Study Methods, Children's National Research Institute, Washington, DC; Department of Pediatrics and the Department of Epidemiology, George Washington University, Washington, DC
| | - Jennifer L Fritzeen
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, DC
| | - Ivan Marsic
- Department of Electrical and Computer Engineering, Rutgers University, Piscataway, NJ
| | | | - Karen J O'Connell
- Division of Emergency Medicine, Children's National Hospital, Washington, DC
| | - Randall S Burd
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, DC.
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Personal protective equipment training for non-healthcare workers in the Covid-19 pandemic: Effectiveness of an evidence-based skills training framework. Infect Dis Health 2021; 27:38-48. [PMID: 34688581 PMCID: PMC8495050 DOI: 10.1016/j.idh.2021.09.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/25/2021] [Accepted: 09/27/2021] [Indexed: 01/25/2023]
Abstract
Background Large-scale quarantine facilities staffed with non-healthcare workers (NHCW) were instrumental in preventing community spread of COVID-19 (coronavirus disease of 2019). The objective of this study was to determine the effectiveness of a newly developed procedural skills training framework in ensuring personal protective equipment (PPE) compliance of PPE-naïve NHCWs. Methods We developed a PPE procedural skills training framework for NHCWs using the Learn, See, Practice, Prove, Do, and Maintain (LSPPDM) framework and international guidelines on PPE for healthcare workers. The NHCWs underwent PPE training using this framework, conducted by a team of Infection Prevention nurses, prior to being stationed within the CCF. Effectiveness of the LSPPDM PPE training framework was assessed using: 1) competency assessment scores for NHCWs, 2) PPE compliance rates from daily audit findings, and, 3) healthcare-associated COVID-19 infection rates of NHCWs. Results A total of 883 NHCWs had completed the PPE training and demonstrated competency in PPE compliance, fulfilling 100% of the checklist requirements. Mean PPE compliance of all NHCWs during the 11-week study period was noted to be >96%. The post-implementation improvement was statistically significant when the compliance was expressed in 3-days blocks) and in bed management staff (P = < 0.05). None of the 883 NHCWs who underwent PPE training via the LSPPDM framework were diagnosed with healthcare-associated COVID-19 infection. Conclusion An evidence-based skills training framework is effective in PPE training of large numbers of NHCWs, resulting in high compliance of appropriate PPE use and prevention of healthcare-associated COVID-19 infection.
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What Not to Do with PPE: A Digital Application to Raise Awareness of Proper PPE Protocol. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021. [PMID: 34476745 DOI: 10.1007/978-3-030-76951-2_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
With a rise in personal protective equipment (PPE) use by all healthcare professionals (HCP) as a prime infection control strategy in the wake of the COVID-19 pandemic comes the potential increase in its misuse. Evidence suggests this failure to follow proper PPE protocol to prevent self-contamination and transmission can be attributed to both a lack of formal training and guidance and, now, atrophy of infrequently used skills, with many senior professionals demonstrating a lack of proficiency despite years of service. Previous research shows current written and illustrated instructional material depicting PPE guidelines are abundant but does not provide an answer on how best to target violations in protocol and better instruct those that are providing pre-hospital emergency healthcare.In this chapter, we aim to address the gap in paramedic-specific research into PPE protocol and provide an educational, digital tool to work alongside the current guidelines, potentially exploring the cognitive load theory as a design strategy. The use of 3D, interactive animations depicting errors in protocol and their potential contamination consequences in a device-based application could engage clinicians in a more effective way, thus increasing protection and decreasing transmission. This chapter describes the methodology behind the design and development of such an application for emergency care providers and provides the relevant materials needed to carry out user testing and evaluation once participants have been recruited.
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Rodriguez-Lopez M, Parra B, Vergara E, Rey L, Salcedo M, Arturo G, Alarcon L, Holguin J, Osorio L. A case-control study of factors associated with SARS-CoV-2 infection among healthcare workers in Colombia. BMC Infect Dis 2021; 21:878. [PMID: 34452600 PMCID: PMC8391859 DOI: 10.1186/s12879-021-06581-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/17/2021] [Indexed: 02/14/2023] Open
Abstract
Background Healthcare Workers (HCW) are repeatedly exposed to SARS-CoV-2 infection. The aim of this study was to identify factors associated with SARS-CoV-2 infection among HCW in one of the largest cities in Colombia. Methods We conducted a case–control study, where cases had a positive reverse transcription-polymerase chain reaction and controls had a negative result. Participants were randomly selected and interviewed by phone. Analyses were performed using logistic regression models. Results A total of 110 cases and 113 controls were included. Men (AdjOR 4.13 95% CI 1.70–10.05), Nurses (AdjOR 11.24 95% CI 1.05–119.63), not using a high-performance filtering mask (AdjOR 2.27 95% CI 1.02–5.05) and inadequate use of personal protective equipment (AdjOR 4.82 95% CI 1.18–19.65) were identified as risk factors. Conversely, graduate (AdjOR 0.06 95% CI 0.01–0.53) and postgraduate (AdjOR 0.05 95% CI 0.005–0.7) education, feeling scared or nervous (AdjOR 0.45 95% CI 0.22–0.91), not always wearing any gloves, caps and goggles/face shields (AdjOR 0.10 95% CI 0.02–0.41), and the use of high-performance filtering or a combination of fabric plus surgical mask (AdjOR 0.27 95% CI 0.09–0.80) outside the workplace were protective factors. Conclusion This study highlights the protection provided by high-performance filtering masks or double masking among HCW. Modifiable and non-modifiable factors and the difficulty of wearing other protective equipment needs to be considered in designing, implementing and monitoring COVID-19 biosafety protocols for HCW.
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Affiliation(s)
- Merida Rodriguez-Lopez
- Pontificia Universidad Javeriana Seccional Cali, Calle 18 No.118 - 250 Edificio Raúl Posada S.J. Tercer Piso, Cali, Colombia.
| | | | - Enrique Vergara
- Pontificia Universidad Javeriana Seccional Cali, Calle 18 No.118 - 250 Edificio Raúl Posada S.J. Tercer Piso, Cali, Colombia
| | - Laura Rey
- Pontificia Universidad Javeriana Seccional Cali, Calle 18 No.118 - 250 Edificio Raúl Posada S.J. Tercer Piso, Cali, Colombia
| | | | - Gabriela Arturo
- Secretaria de Salud Pública Municipal de Cali, Cali, Colombia
| | - Liliana Alarcon
- Secretaria de Salud Pública Municipal de Cali, Cali, Colombia
| | - Jorge Holguin
- Pontificia Universidad Javeriana Seccional Cali, Calle 18 No.118 - 250 Edificio Raúl Posada S.J. Tercer Piso, Cali, Colombia.,Secretaria de Salud Pública Municipal de Cali, Cali, Colombia
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El-Sokkary RH, Khater WS, El-Kholy A, Mohy Eldin S, Gad DM, Bahgat S, Negm EEM, El Kholy JA, Mowafy S, Mahmoud E, Mortada EM. Compliance of healthcare workers to the proper use of personal protective equipment during the first wave of COVID-19 pandemic. J Infect Public Health 2021; 14:1404-1410. [PMID: 34344624 PMCID: PMC8317453 DOI: 10.1016/j.jiph.2021.07.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/25/2021] [Accepted: 07/26/2021] [Indexed: 12/20/2022] Open
Abstract
Background In limited resource settings, compliance to proper personal protective equipment (PPE) use is challenging. This study aims to characterize the pattern of PPE use among healthcare workers (HCWs) during the first wave of coronavirus diseases-2019 (COVID-19) in Egypt and to determine the factors associated with compliance to the proper use of PPE. Methods A cross-sectional study was conducted among Egyptian HCWs using an online self-administered questionnaire. Participants were classified as “Compliant” or “Non-compliant” according to their score. Results A total of 404 responses were analyzed, with a mean age of 36.6 ± 8.4 years, and 56.4% were females. Non-compliant HCWs represented 53.2% of participants. The majority reported shortage in N95 respirators (91.3%) and practiced extended PPE use (88.1%). Better compliance to proper PPE use was reported: females (51.3%, p = 0.05), Physicians (54.2 %, p = 0.005), medical specialities (34.7 %, p < 0.001), <10 years’ work experience (42.9%, p = 0.05) and working > eight hours/day (71.3%, p < 0.001). The significant predictors for compliance were; receiving prior training on the proper use of PPE (OR: 4.59, CI: 2.22–9.47, p ≤ 0.001), exposure to COVID-19 patients (OR: 2.75, CI: 1.19–6.35, p = 0.02) and performing procedures that pose HCWs at a high risk of exposure to Severe Acute Respiratory Syndrome Coronavirus 2 (OR: 2.21, CI: 1.04–4.71, p = 0.04). The high percentage of non-compliant HCWs turns on a warning signal. Increase the availability of PPE, prioritize their use, provide more focus on training of HCWs and monitor their compliance is highly recommended.
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Affiliation(s)
- Rehab H El-Sokkary
- Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
| | - Walaa S Khater
- Medical Microbiology and Immunology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Amani El-Kholy
- Clinical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Doaa M Gad
- Chest Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Shereen Bahgat
- Family Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Essam E M Negm
- Anesthesia & Surgical Intensive Care Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Jehan A El Kholy
- Anesthesia & Surgical Intensive Care Department, Faculty of Medicine, Cairo University, Cairo, Egypt; Infection Prevention and Control Department, Dar Al Fouad Hospital, Nasr City, Cairo, Egypt
| | - Sherif Mowafy
- Anesthesia & Surgical Intensive Care Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Eman Mahmoud
- Microbiology and Immunology Department, National Liver Institute, Menoufeya University, Shibin el Kom, Egypt
| | - Eman M Mortada
- Community, Occupational and Environmental Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt; Health Sciences Department, Health Sciences & Rehabilitation College, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
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Büchler AC, Dangel M, Frei R, Jäger S, Roth JA, Seth-Smith HMB, Egli A, Widmer AF. Does high adherence to contact precautions lead to low in-hospital transmission of multi-drug-resistant micro-organisms in the endemic setting? J Hosp Infect 2021; 116:53-59. [PMID: 34252477 DOI: 10.1016/j.jhin.2021.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/29/2021] [Accepted: 07/06/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Conflicting results have been published on the impact of contact precautions (CPs) on reduction of transmission of multi-drug-resistant micro-organisms (MDROs) in the endemic setting. Ambiguous definitions coupled with low adherence partly explain these differences. AIM We prospectively monitored the level of adherence to CPs and aimed to relate it to in-hospital transmission of MDROs. METHODS Between January 2016 and March 2018, all patients under CPs underwent continuous monitoring of adherence to CPs by routine on-site visits on days 0, 3 and 7 after initiating CPs using a standardized checklist. The protocol included 10 interventions that were routinely checked such as CP sign at the door as well as wearing of gowns and gloves upon entry to the patient room. Patients requiring CPs were defined as colonized or infected with MDROs (meticillin-resistant Staphylococcus aureus (MRSA), non-Escherichia coli extended-spectrum beta lactamase (ESBL) Enterobacterales, vancomycin-resistant enterococci (VRE) and carbapenem-resistant Gram-negative micro-organisms (CRGN)) as well as patients infected with respiratory viruses, norovirus, scabies and hypervirulent strains of Clostridioides difficile. FINDINGS Overall, data from 13,756 CP records from 1378 visits of 812 patients were analysed. Adherence varied between 93% and 100% for each intervention, except for "separate space for contaminated material" with an adherence of 5.3-6.1%. The incidence of in-hospital transmission during the study period was extremely low for MRSA, VRE, non-E.coli ESBL Enterobacterales and CRGN with 0.00-0.064 cases/1000 patient days. CONCLUSION High adherence coupled with continuous monitoring of CPs correlated with a very low in-hospital transmission rate. These results indicate that CPs are highly effective if routine monitoring of adherence is implemented.
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Affiliation(s)
- A C Büchler
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - M Dangel
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - R Frei
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - S Jäger
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - J A Roth
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - H M B Seth-Smith
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland; Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - A Egli
- Division of Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland; Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - A F Widmer
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.
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Bhamra N, Gupta K, Lee J, Al-Hity S, Jolly K, Darr A. Personal protective equipment: knowledge of the guidance. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2021; 30:16-22. [PMID: 33433285 DOI: 10.12968/bjon.2021.30.1.16] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND On 11 March 2020, the World Health Organization (WHO) declared a global pandemic in the wake of the coronavirus disease 2019 (COVID-19) outbreak. The unpredictable nature of transmission of COVID-19 requires a meticulous understanding of guidance on personal protective equipment (PPE) as published by WHO and Public Health England (PHE). AIM To assess perceived confidence and knowledge of PHE guidance relating to PPE by nursing staff. METHODS A nationwide survey was disseminated between May and June 2020 through social media platforms as well as internal mail via regulatory bodies and individual hospital trusts. RESULTS Data were collated from 339 nurses. Perceived confidence as measured on a Likert scale was a mode score of 3/5, with the average score for knowledge-based questions being 5/10. Of the respondents, 47% cited insufficient training on PPE guidance, and 84% advocated further training. Conclusions: Unifying published PPE guidance and ensuring consistency in training can improve awareness, confidence, and knowledge among nursing staff.
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Affiliation(s)
- Navdeep Bhamra
- Doctor, Department of Otolaryngology, The Royal Wolverhampton NHS Trust
| | - Keshav Gupta
- Doctor, Department of Otolaryngology, The Royal Wolverhampton NHS Trust
| | - Jonathan Lee
- Doctor, Department of Otolaryngology, University Hospitals Birmingham NHS Trust
| | - Shams Al-Hity
- Doctor, Department of Otolaryngology, The Royal Wolverhampton NHS Trust
| | - Karan Jolly
- ENT Registrar, Department of Otolaryngology, The Royal Wolverhampton NHS Trust
| | - Adnan Darr
- ENT Registrar, Department of Otolaryngology, The Royal Wolverhampton NHS Trust
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13
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Phan LT, Maita D, Mortiz DC, Weber R, Fritzen-Pedicini C, Bleasdale SC, Jones RM. Prácticas de retiro del equipo de protección personal para personal sanitario. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2021; 18:S53-S60. [PMID: 33822695 DOI: 10.1080/15459624.2021.1877056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
RESUMENCuando se retira el equipo de protección personal (EPP), los patógenos pueden transferirse desde el EPP al cuerpo de los trabajadores de la salud, poniendo en riesgo de exposición e infección tanto a ellos mismos como a sus pacientes. Entre marzo de 2017 y abril de 2018 se observaron las prácticas de retirada del EPP del personal sanitario que atendía pacientes con infecciones respiratorias virales en un hospital de atención de enfermedades agudas. Un observador capacitado registró el desempeño del personal sanitario cuando retiraba el EPP dentro de las habitaciones de los pacientes, utilizando una lista de verificación predefinida basada en las directrices de los Centros para el Control y Prevención de Enfermedades (Centers for Disease Control and Prevention, CDC). Se observaron 162 prácticas de retirada durante el cuidado de 52 pacientes infectados con patógenos virales respiratorios. De estos 52 pacientes, 30 estaban en aislamiento por gota y contacto, 21 en aislamiento por gota y uno en aislamiento de contacto. En general, en 90% de los casos la retirada del EPP observada se realizó de manera incorrecta, ya sea en cuanto a la secuencia de retirada, la técnica de retirada o el uso del EPP apropiado. Los errores más comunes consistieron en quitarse la bata por adelante, retirar la pantalla facial de la mascarilla y tocar superficies y EPP potencialmente contaminados durante el proceso. Las desviaciones del protocolo recomendado para retirar el EPP son comunes y pueden aumentar el potencial de contaminación de la ropa o la piel del personal sanitario después de proporcionar atención. Existe una clara necesidad de cambiar el enfoque utilizado para capacitar al personal en las prácticas de retirada del EPP.
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Affiliation(s)
- Linh T Phan
- Escuela de Salud Pública, Universidad de Illinois en Chicago, Chicago, Illinois
| | - Dayana Maita
- Colegio de Medicina, Universidad de Illinois en Chicago, Chicago, Illinois
| | - Donna C Mortiz
- Colegio de Medicina, Universidad de Illinois en Chicago, Chicago, Illinois
| | - Rachel Weber
- Escuela de Salud Pública, Universidad de Illinois en Chicago, Chicago, Illinois
| | | | - Susan C Bleasdale
- Colegio de Medicina, Universidad de Illinois en Chicago, Chicago, Illinois
| | - Rachael M Jones
- Escuela de Salud Pública, Universidad de Illinois en Chicago, Chicago, Illinois
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14
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Prokopenko M, Pissaridou MK, Risk O, Khatkar H. Evaluating Healthcare Worker Competence in the Correct Use of Personal Protective Equipment in the COVID Era: A Quality Improvement Project. Cureus 2020; 12:e11954. [PMID: 33425533 PMCID: PMC7788009 DOI: 10.7759/cureus.11954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Throughout the coronavirus disease 2019 pandemic, personal protective equipment (PPE) guidance has rapidly evolved. Healthcare workers (HCWs) should use PPE correctly to reduce the risk of nosocomial transmission of the coronavirus. We predict a lack of training regarding correct PPE usage amongst HCWs and introduce a low-resource method of training. Methods: HCWs from various disciplines at a District General Hospital self-rated their ability in utilising PPE using uncontrolled pre- and post-session 16-item questionnaires following a single PPE training session. Participant responses were analysed using Student's t-test for independent (unpaired) samples. Results: Of 64 participants, 37 participants (59%) received any prior PPE training. Six participants (9%) previously received specific severe acute respiratory syndrome coronavirus 2 PPE training. Survey scores were higher in the post-test than the pre-test group. Conclusion: This study highlights the lack of formal PPE training amongst HCWs and the need for establishing PPE training as part of the mandatory training of HCWs.
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Affiliation(s)
- Max Prokopenko
- Trauma and Orthopaedics, Oxford University Hospitals NHS Foundation Trust, Oxford, GBR
| | | | - Omar Risk
- Research, Aceso Global Health Consultants Ltd, London, GBR.,Emergency Medicine, Milton Keynes University Hospital NHS Foundation Trust, Oxford, GBR
| | - Harman Khatkar
- Trauma and Orthopaedics, Royal Berkshire Hospital, Reading, GBR.,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, GBR
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15
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Fan J, Jiang Y, Hu K, Chen X, Xu Q, Qi Y, Yin H, Gou X, Liang S. Barriers to using personal protective equipment by healthcare staff during the COVID-19 outbreak in China. Medicine (Baltimore) 2020; 99:e23310. [PMID: 33235088 PMCID: PMC7710226 DOI: 10.1097/md.0000000000023310] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The spread of coronavirus disease 2019 (COVID-19) around the world has put a heavy burden on human society and is also a great challenge facing medical staff. This study aimed to assess the difficulties faced by health care personnel (HCP) in using personal protective equipment (PPE) in clinical practice during the COVID-19 outbreak in Wuhan, China. One hundred twenty medical staff from the First Affiliated Hospital of Chongqing Medical University presented to the Wuhan First Hospital to provide medical assistance, from whom 20 HCP volunteered to participate in a focus group discussion attended by infection control nurse leaders. Participants' responses and discussions were recorded, and the content was analyzed for themes. Observed difficulties included inappropriate PPE sizes, the design of the PPE and its complexity of use, doubts related to the quality and effectiveness of PPE, potential risks during doffing, space layout between clean and contaminated area, and poor comfort with PPE use. Other factors, such as the support environment, management, processes, preparedness, HCP, and equipment can also have a positive or negative impact on the use of PPE. Future efforts to optimize PPE use should focus on strengthening training for HCP using real items for increasing compliance with standardized protocols, improving PPE design, and performing further research on the risks, benefits, and best practices of PPE use.
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Affiliation(s)
| | - Ying Jiang
- Department of Gynecology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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16
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Effectiveness of a multisite personal protective equipment (PPE)-free zone intervention in acute care. Infect Control Hosp Epidemiol 2020; 40:761-766. [PMID: 31172904 DOI: 10.1017/ice.2019.111] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Determine the effectiveness of a personal protective equipment (PPE)-free zone intervention on healthcare personnel (HCP) entry hand hygiene (HH) and PPE donning compliance in rooms of patients in contact precautions. DESIGN Quasi-experimental, multicenter intervention, before-and-after study with concurrent controls. SETTING All patient rooms on contact precautions on 16 units (5 medical-surgical, 6 intensive care, 5 specialty care units) at 3 acute-care facilities (2 academic medical centers, 1 Veterans Affairs hospital). Observations of PPE donning and entry HH compliance by HCP were conducted during both study phases. Surveys of HCP perceptions of the PPE-free zone were distributed in both study phases. INTERVENTION A PPE-free zone, where a low-risk area inside door thresholds of contact precautions rooms was demarcated by red tape on the floor. Inside this area, HCP were not required to wear PPE. RESULTS We observed 3,970 room entries. HH compliance did not change between study phases among intervention units (relative risk [RR], 0.92; P = .29) and declined in control units (RR, 0.70; P = .005); however, the PPE-free zone did not significantly affect compliance (P = .07). The PPE-free zone effect on HH was significant only for rooms on enteric precautions (P = .008). PPE use was not significantly different before versus after the intervention (P = .15). HCP perceived the zone positively; 65% agreed that it facilitated communication and 66.8% agreed that it permitted checking on patients more frequently. CONCLUSIONS HCP viewed the PPE-free zone favorably and it did not adversely affect PPE or HH compliance. Future infection prevention interventions should consider the complex sociotechnical system factors influencing behavior change.
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Patel PK, Popovich KJ, Collier S, Lassiter S, Mody L, Ameling JM, Meddings J. Foundational Elements of Infection Prevention in the STRIVE Curriculum. Ann Intern Med 2019; 171:S10-S15. [PMID: 31569229 DOI: 10.7326/m18-3531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Payal K Patel
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (P.K.P., L.M., J.M.)
| | | | - Sue Collier
- Health Research & Educational Trust, American Hospital Association, Chicago, Illinois (S.C., S.L.)
| | - Shelby Lassiter
- Health Research & Educational Trust, American Hospital Association, Chicago, Illinois (S.C., S.L.)
| | - Lona Mody
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (P.K.P., L.M., J.M.)
| | | | - Jennifer Meddings
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (P.K.P., L.M., J.M.)
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18
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Reddy SC, Valderrama AL, Kuhar DT. Improving the Use of Personal Protective Equipment: Applying Lessons Learned. Clin Infect Dis 2019; 69:S165-S170. [DOI: 10.1093/cid/ciz619] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Abstract
Unrecognized transmission of pathogens in healthcare settings can lead to colonization and infection of both patients and healthcare personnel. The use of personal protective equipment (PPE) is an important strategy to protect healthcare personnel from contamination and to prevent the spread of pathogens to subsequent patients. However, optimal PPE use is difficult, and healthcare personnel may alter delivery of care because of the PPE. Here, we summarize recent research from the Prevention Epicenters Program on healthcare personnel contamination and improvement of the routine use of PPE as well as Ebola-specific PPE. Future efforts to optimize the use of PPE should include increasing adherence to protocols for PPE use, improving PPE design, and further research into the risks, benefits, and best practices of PPE use.
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Affiliation(s)
- Sujan C Reddy
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amy L Valderrama
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - David T Kuhar
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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19
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Harrod M, Petersen L, Weston LE, Gregory L, Mayer J, Samore MH, Drews FA, Krein SL. Understanding Workflow and Personal Protective Equipment Challenges Across Different Healthcare Personnel Roles. Clin Infect Dis 2019; 69:S185-S191. [DOI: 10.1093/cid/ciz527] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Abstract
Background
Hospitals use standard and transmission-based precautions, including personal protective equipment (PPE), to prevent the spread of infectious organisms. However, little attention has been paid to the potentially unique challenges of various healthcare personnel (HCP) in following precaution practices.
Methods
From September through December 2016, 5 physicians, 5 nurses, and 4 physical therapists were shadowed for 1 hour 30 minutes to 3 hours 15 minutes at an academic medical center. Observers documented activities using unstructured field notes. Focus groups were conducted to better understand HCP perspectives about precautions and PPE-related challenges. Data were analyzed by comparing workflow and challenges (observed and stated) in precaution practices across HCP roles.
Results
Precaution patients were interspersed throughout physician rounds, which covered a broad geographic range throughout the hospital. Patient encounters were generally brief, and appropriate use of gowns and cleaning of personal stethoscopes varied among observed physicians. Nurses were unit based and frequently entered/exited rooms. Frustration with donning/doffing was especially apparent when needing supplies while in a precaution room, which nurses acknowledged was a time when practice lapses could occur. The observed physical therapists worked in one geographic location, spent extended periods of time with patients, and noted that given their close physical contact with patients, gowns do not fully protect them.
Conclusions
Movement patterns, time with patients, care activities, and equipment use varied across HCP, leading to a diverse set of challenges in following precaution practices and PPE use. Attention to these differences among HCP is important for understanding and developing effective strategies to prevent the potential spread of infectious organisms.
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Affiliation(s)
- Molly Harrod
- Veterans Affairs Ann Arbor Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor
| | - Laura Petersen
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Lauren E Weston
- Veterans Affairs Ann Arbor Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor
| | - Lynn Gregory
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Jeanmarie Mayer
- Department of Internal Medicine, University of Utah, Salt Lake City
- Department of Veterans Affairs Medical Center, Salt Lake City
| | - Matthew H Samore
- Department of Veterans Affairs Medical Center, Salt Lake City
- Department of Psychology, University of Utah, Salt Lake City
| | - Frank A Drews
- Department of Internal Medicine, University of Utah, Salt Lake City
- Department of Veterans Affairs Medical Center, Salt Lake City
- Department of Psychology, University of Utah, Salt Lake City
| | - Sarah L Krein
- Veterans Affairs Ann Arbor Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
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20
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Phan LT, Maita D, Mortiz DC, Weber R, Fritzen-Pedicini C, Bleasdale SC, Jones RM. Personal protective equipment doffing practices of healthcare workers. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2019; 16:575-581. [PMID: 31291152 PMCID: PMC7157959 DOI: 10.1080/15459624.2019.1628350] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
During the doffing of personal protective equipment (PPE), pathogens can be transferred from the PPE to the bodies of healthcare workers (HCWs), putting HCWs and patients at risk of exposure and infection. PPE doffing practices of HCWs who cared for patients with viral respiratory infections were observed at an acute care hospital from March 2017 to April 2018. A trained observer recorded doffing performance of HCWs inside the patient rooms using a pre-defined checklist based on the Centers for Disease Control and Prevention (CDC) guideline. Doffing practices were observed 162 times during care of 52 patients infected with respiratory viral pathogens. Out of the 52 patients, 30 were in droplet and contact isolation, 21 were in droplet isolation, and 1 was in contact isolation. Overall, 90% of observed doffing was incorrect, with respect to the doffing sequence, doffing technique, or use of appropriate PPE. Common errors were doffing gown from the front, removing face shield of the mask, and touching potentially contaminated surfaces and PPE during doffing. Deviations from the recommended PPE doffing protocol are common and can increase potential for contamination of the HCW's clothing or skin after providing care. There is a clear need to change the approach used to training HCWs in PPE doffing practices.
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Affiliation(s)
- Linh T. Phan
- School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - Dayana Maita
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Donna C. Mortiz
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Rachel Weber
- School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | | | - Susan C. Bleasdale
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Rachael M. Jones
- School of Public Health, University of Illinois at Chicago, Chicago, Illinois
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