Minimizing contamination in the use of personal protective equipment: Simulation results through tracking contamination and enhanced protocols

• Published in: American journal of infection control Vol. 49; no. 6; pp. 713 - 720
• Main Authors: Kang, JaHyun, Kim, Eun Jin, Choi, Jeong Hwa, Hong, Hae Kyung, Han, Si-Hyeon, Choi, In Soon, Kim, Jinhwa, Kim, Jae Yeun, Park, Eun Suk, Choe, Pyoeng Gyun
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2021; Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc
• Subjects: Doffing; Evaluation; Fluorescent powder; Health care personnel; Major; Safety; Evaluation; Doffing; Fluorescent powder; Safety; Health care personnel
• ISSN: 0196-6553; 1527-3296
• DOI: 10.1016/j.ajic.2020.11.002

•Our enhanced protocols presented a significant reduction in doffing contaminations.•Long-sleeve apron as the broad outer layer perfectly protected major contaminations.•Tracking contamination showed every touch with outer surfaces brought contamination.•Wipes certainly decreased contamination amounts from contaminated glove surfaces.•But wipes did not fully clean glove contaminations between fingers and fingertips. Due to variations and the inadequate use of personal protective equipment (PPE), this study aimed to evaluate our enhanced PPE protocols for minimizing doffing contamination. Among 3 PPE kits (simple, Level D, and Level C), 30 participants conducted the first simulation in their adapted way and the second following enhanced protocols. After donning, participants performed a 1-minute simulation of direct care on a patient simulator covered with fluorescent powder. For tracking contamination routes between doffing processes, fluorescent powder contamination was examined with ultraviolet lamps in the darkened room. Participants were mostly registered nurses (N = 27, 90%), female (87%), and on average 31.7 years old with 8.5 years of clinical experience. Among 61 total simulations, 32 had at least 1 contamination (52.5%); “Noticeable” level (40%) at the “hands-fingers” and “shirt” body areas were most frequent. For first and second simulations with identical PPE kits, compared to the first with adapted practice, the second with enhanced protocols showed a significant reduction in doffing contamination rates (72.7% vs 22.7%, P = .0009 for both Level C and D; 77.8% vs 27.8%, P = .0027 for Level D). Our enhanced protocols could significantly reduce contaminations. More studies are necessary to provide safer PPE protocol options.