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

Keywords

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

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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    Andonian, J., Kazi, S., Therkorn, J., Benishek, L., Billman, C., Schiffhauer, M., Nowakowski, E., Osei, P., Gurses, A., Hsu, Y-J., Drewry, D., Forsyth, E. R., Vignesh, A., Oresanwo, I., Garibaldi, B. T., 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, 69, S248-S255. https://doi.org/10.1093/cid/ciz618