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. 2019 Sep 13;69(Suppl 3):S192-S198.
doi: 10.1093/cid/ciz613.

Healthcare Workers' Strategies for Doffing Personal Protective Equipment

Jure Baloh  1   2 , Heather Schacht Reisinger  1   3 , Kimberly Dukes  4 , Jaqueline Pereira da Silva  5 , Hugh P Salehi  5   6 , Melissa Ward  1 , Emily E Chasco  1   3 , Priyadarshini R Pennathur  1   5 , Loreen Herwaldt  1   7
Affiliations

Healthcare Workers' Strategies for Doffing Personal Protective Equipment

Jure Baloh et al. Clin Infect Dis. .

Abstract

Background: Personal protective equipment (PPE) helps protect healthcare workers (HCWs) from pathogens and prevents cross-contamination. PPE effectiveness is often undermined by inappropriate doffing methods. Our knowledge of how HCWs approach doffing PPE in practice is limited. In this qualitative study, we examine HCWs' perspectives about doffing PPE.

Methods: Thirty participants at a Midwestern academic hospital were recruited and assigned to 1 of 3 doffing simulation scenarios: 3 mask designs (n = 10), 2 gown designs (n = 10), or 2 glove designs (n = 10). Participants were instructed to doff PPE as they would in routine practice. Their performances were video-recorded and reviewed with participants. Semistructured interviews about their doffing approaches were conducted and audio-recorded, then transcribed and thematically analyzed.

Results: Three overarching themes were identified in interviews: doffing strategies, cognitive processes, and barriers and facilitators. Doffing strategies included doffing safely (minimizing self-contamination) and doffing expediently (eg, ripping PPE off). Cognitive processes during doffing largely pertained to tracking contaminated PPE surfaces, examining PPE design cues (eg, straps), or improvising based on prior experience from training or similar PPE designs. Doffing barriers and facilitators typically related to PPE design, such as PPE fit (or lack of it) and fastener type. Some participants also described personal barriers (eg, glasses, long hair); however, some PPE designs helped mitigate these barriers.

Conclusions: Efforts to improve HCWs' doffing performance need to address HCWs' preferences for both safety and expediency when using PPE, which has implications for PPE design, training approaches, and hospital policies and procedures.

Keywords: healthcare workers; doffing; personal protective equipment; strategies.

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References

    1. Edmond MB, Diekema DJ, Perencevich EN. Ebola virus disease and the need for new personal protective equipment. JAMA 2014; 312:2495–6. - PubMed
    1. Tomas ME, Kundrapu S, Thota P, et al. . Contamination of health care personnel during removal of personal protective equipment. JAMA Intern Med 2015; 175:1904–10. - PubMed
    1. Kang J, O’Donnell JM, Colaianne B, Bircher N, Ren D, Smith KJ. Use of personal protective equipment among health care personnel: Results of clinical observations and simulations. Am J Infect Control. 2017; 45:17-23. doi:10.1016/j.ajic.2016.08.011 - DOI - PubMed
    1. Osei-Bonsu K, Masroor N, Cooper K, et al. . Alternative doffing strategies of personal protective equipment to prevent self-contamination in the health care setting. Am J Infect Control 2019; 47:534–9. - PubMed
    1. Kwon JH, Burnham CD, Reske KA, et al. . Assessment of healthcare worker protocol deviations and self-contamination during personal protective equipment donning and doffing. Infect Control Hosp Epidemiol 2017; 38:1077–83. - PMC - PubMed

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