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

Jennifer Andonian, Sadaf Kazi, Jennifer Therkorn, Lauren Benishek, Carrie Billman, Margaret Schiffhauer, Elaine Nowakowski, Patience Osei, Ayse Gurses, Yea-Jen Hsu, David Drewry, Ellen R. Forsyth, Arjun Vignesh, Ifeoluwa Oresanwo, Brian Thomas Garibaldi, Kaitlin Rainwater-Lovett, Polly Trexler, Lisa Maragakis

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)S248-S255
JournalClinical Infectious Diseases
Volume69
DOIs
StatePublished - Sep 13 2019

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Delivery of Health Care
Infectious Disease Transmission
Ultraviolet Rays
Microspheres
Ebolavirus
Control Groups
Disease Outbreaks
Microscopy
Randomized Controlled Trials
Personal Protective Equipment
Skin
styrofoam

Keywords

  • biocontainment
  • inhalational exposure
  • personal protective equipment doffing
  • self-contamination
  • viral hemorrhagic fever

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Effect of an Intervention Package and Teamwork Training to Prevent Healthcare Personnel Self-contamination during Personal Protective Equipment Doffing. / Andonian, Jennifer; Kazi, Sadaf; Therkorn, Jennifer; Benishek, Lauren; Billman, Carrie; Schiffhauer, Margaret; Nowakowski, Elaine; Osei, Patience; Gurses, Ayse; Hsu, Yea-Jen; Drewry, David; Forsyth, Ellen R.; Vignesh, Arjun; Oresanwo, Ifeoluwa; Garibaldi, Brian Thomas; Rainwater-Lovett, Kaitlin; Trexler, Polly; Maragakis, Lisa.

In: Clinical Infectious Diseases, Vol. 69, 13.09.2019, p. S248-S255.

Research output: Contribution to journalArticle

Andonian, J, Kazi, S, Therkorn, J, Benishek, L, Billman, C, Schiffhauer, M, Nowakowski, E, Osei, P, Gurses, A, Hsu, Y-J, Drewry, D, Forsyth, ER, Vignesh, A, Oresanwo, I, Garibaldi, BT, Rainwater-Lovett, K, Trexler, P & Maragakis, L 2019, 'Effect of an Intervention Package and Teamwork Training to Prevent Healthcare Personnel Self-contamination during Personal Protective Equipment Doffing', Clinical Infectious Diseases, vol. 69, pp. S248-S255. https://doi.org/10.1093/cid/ciz618
Andonian, Jennifer ; Kazi, Sadaf ; Therkorn, Jennifer ; Benishek, Lauren ; Billman, Carrie ; Schiffhauer, Margaret ; Nowakowski, Elaine ; Osei, Patience ; Gurses, Ayse ; Hsu, Yea-Jen ; Drewry, David ; Forsyth, Ellen R. ; Vignesh, Arjun ; Oresanwo, Ifeoluwa ; Garibaldi, Brian Thomas ; Rainwater-Lovett, Kaitlin ; Trexler, Polly ; Maragakis, Lisa. / Effect of an Intervention Package and Teamwork Training to Prevent Healthcare Personnel Self-contamination during Personal Protective Equipment Doffing. In: Clinical Infectious Diseases. 2019 ; Vol. 69. pp. S248-S255.
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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.",
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AU - Benishek, Lauren

AU - Billman, Carrie

AU - Schiffhauer, Margaret

AU - Nowakowski, Elaine

AU - Osei, Patience

AU - Gurses, Ayse

AU - Hsu, Yea-Jen

AU - Drewry, David

AU - Forsyth, Ellen R.

AU - Vignesh, Arjun

AU - Oresanwo, Ifeoluwa

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N2 - 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.

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