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 language | English (US) |
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Pages (from-to) | S248-S255 |
Journal | Clinical Infectious Diseases |
Volume | 69 |
DOIs | |
State | Published - Sep 13 2019 |
Keywords
- biocontainment
- inhalational exposure
- personal protective equipment doffing
- self-contamination
- viral hemorrhagic fever
ASJC Scopus subject areas
- Microbiology (medical)
- Infectious Diseases