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Randomized Controlled Trial
. 2019 Sep 13;69(Suppl 3):S248-S255.
doi: 10.1093/cid/ciz618.

Effect of an Intervention Package and Teamwork Training to Prevent Healthcare Personnel Self-contamination During Personal Protective Equipment Doffing

Jennifer Andonian  1 , Sadaf Kazi  2   3 , Jennifer Therkorn  4 , Lauren Benishek  2   3 , Carrie Billman  1   5 , Margaret Schiffhauer  1 , Elaine Nowakowski  1 , Patience Osei  2   3 , Ayse P Gurses  2   3 , Yea-Jen Hsu  3   5 , David Drewry  4 , Ellen R Forsyth  4 , Arjun Vignesh  2 , Ifeoluwa Oresanwo  2 , Brian T Garibaldi  6 , Kaitlin Rainwater-Lovett  4 , Polly Trexler  1 , Lisa L Maragakis  1   2   5   6   7
Affiliations
Randomized Controlled Trial

Effect of an Intervention Package and Teamwork Training to Prevent Healthcare Personnel Self-contamination During Personal Protective Equipment Doffing

Jennifer Andonian et al. Clin Infect Dis. .

Abstract

Background: More than 28 000 people were infected with Ebola virus during the 2014-2015 West African outbreak, resulting in more than 11 000 deaths. Better methods are needed to reduce the risk of self-contamination while doffing personal protective equipment (PPE) to prevent pathogen transmission.

Methods: A set of interventions based on previously identified failure modes was designed to mitigate the risk of self- contamination during PPE doffing. These interventions were tested in a randomized controlled trial of 48 participants with no prior experience doffing enhanced PPE. Contamination was simulated using a fluorescent tracer slurry and fluorescent polystyrene latex spheres (PLSs). Self-contamination of scrubs and skin was measured using ultraviolet light visualization and swabbing followed by microscopy, respectively. Doffing sessions were videotaped and reviewed to score standardized teamwork behaviors.

Results: Participants in the intervention group contaminated significantly fewer body sites than those in the control group (median [interquartile range], 6 [3-8] vs 11 [6-13], P = .002). The median contamination score was lower for the intervention group than the control group when measured by ultraviolet light visualization (23.15 vs 64.45, P = .004) and PLS swabbing (72.4 vs 144.8, P = .001). The mean teamwork score was greater in the intervention group (42.2 vs 27.5, P < .001).

Conclusions: An intervention package addressing the PPE doffing task, tools, environment, and teamwork skills significantly reduced the amount of self-contamination by study participants. These elements can be incorporated into PPE guidance and training to reduce the risk of pathogen transmission.

Keywords: biocontainment; inhalational exposure; personal protective equipment doffing; self-contamination; viral hemorrhagic fever.

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Figures

Figure 1.
Figure 1.
Components of the Johns Hopkins Prevention Epicenter studies to prevent self-contamination during enhanced personal protective equipment (PPE) doffing. The current report describes the final step of testing the efficacy of the PPE Doffing Intervention Package. Abbreviation: PPE, personal protective equipment.
See this image and copyright information in PMC

References

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