How Can Personal Protective Equipment Be Best Used and Reused: A Closer Look at Donning and Doffing Procedures

Abstract

Objective: The aim of this study was to examine safety-related contamination threats and risks to health-care workers (HCWs) due to the reuse of personal protective equipment (PPE) among emergency department (ED) personnel. Methods: We used a Participatory Design (PD) approach to conduct task analysis (TA) of PPE use and reuse. TA identified the steps, risks, and protective behaviors involved in PPE reuse. We used the Centers for Disease Control and Prevention (CDC) guidance for PPE donning and doffing specifying the recommended task order. Then, we convened subject matter experts (SMEs) with relevant backgrounds in Patient Safety, Human Factors and Emergency Medicine to iteratively identify and map the tasks, risks, and protective behaviors involved in the PPE use and reuse. Results: Two emerging threats were associated with behaviors in donning, doffing, and re-using PPE: (i) direct exposure to contaminant, and (ii) transmission/spread of contaminant. Protective behaviors included: hand hygiene, not touching the patient-facing surface of PPE, and ensuring a proper fit and closure of all PPE ties and materials. Conclusions: TA was helpful revealed that the procedure for donning and doffing of re-used PPE does not protect ED personnel from contaminant spread and risk of exposure, even with protective behaviors present (e.g., hand hygiene, respirator use, etc.). Future work should make more apparent the underlying risks associated with PPE use and reuse.

Physical and stressful psychological impacts of prolonged personal protective equipment use during the COVID-19 pandemic: A cross-sectional survey study

“…Abundant data demonstrates that the COVID-19 pandemic has had significant untoward effects on health care workers (HCWs) requiring significant changes in the working routines and conditions of HCWs in health systems worldwide [1] . HCWs are required to wear personal protective equipment (PPE) kit, including a respirator mask, gown, gloves, at all times, both to protect themselves and to preserve their patients from the virus [2] . The compulsory requirements to don PPE was a necessary protective measure to prevent the spread of the COVID-19 virus, but the long hours of PPE use remains highly uncomfortable [3] , and the estimated average PPE use time is 6.8 h per shift [4] .…”

“…HCWs with repeated exposure to COVID-19 patient load reported significant physical and mental health problems [12] . Changes in the working routines of HCWs (especially the use and reuse of PPE) may have impacted their physical health [2] , [3] , [4] . HCWs reported multiple physical disorders including respiratory, nervous, musculoskeletal, and urinary related to the use of PPE, with skin problems the most frequently reported physical complaints [3] .…”