How to rapidly design and operationalise PPE donning and doffing areas for a COVID-19 care facility: quality improvement initiative

Abstract

IntroductionEffective implementation of standard precautions specific to COVID-19 is a challenge for hospitals within the existing constraints of time and resources.AimTo rapidly design and operationalise personal protective equipment (PPE) donning and doffing areas required for a COVID-19 care facility.MethodsLiterature review was done to identify all issues pertaining to donning and doffing in terms of Donabedian’s structure, process and outcome. Training on donning and doffing was given to hospital staff. Donning and doffing mock drills were held. 5S was used as a tool to set up donning and doffing areas. Instances of donning and doffing were observed for protocol deviations and errors. Plan–do–study–act cycles were conducted every alternate day for 4 weeks. The initiative was reported using Standards for QUality Improvement Reporting Excellence (SQUIRE) guidelines.ResultsBest practices in donning and doffing were described. Our study recommends a minimum area of 16 m2 each for donning and doffing rooms. Verbally assisted doffing was found most useful than visual prompts.DiscussionChallenges included sustaining the structure and process of donning and doffing, varied supplies of PPE which altered sequencing of donning and/or doffing, and training non-healthcare workers such as plumbers, electricians and drivers who were required during emergencies in the facility.ConclusionOur study used evidence-based literature and quality improvement (QI) tools to design and operationalise donning and doffing areas with focus on people, task and environment. Our QI will enable healthcare facilities to rapidly prototype donning and doffing areas in a systematic way.

Management of a Hospital-Wide COVID-19 Outbreak Affecting Patients and Healthcare Workers

“…Both routes of transmission, HCW to patients and HCW to HCW, were successfully addressed in infection control training sessions in which HCW were instructed in the correct handling of personal protective equipment and in social distancing measures. Several reports point out the importance of verbal training sessions demonstrating that HCW education does not only improve the handling of PPE but also reduces anxiety and increases the sense of preparedness [ 6 , 7 ].…”

The effects of trained observers (dofficers) and audits during a facility-wide COVID-19 outbreak: A mixed-methods quality improvement analysis

“…This is critical given previous published data highlighting self-perceived proficiency is a poor predictor of proper PPE use 24 and use of dofficers providing verbal directions in COVID-19 settings is important to help support safety and quality of care. 10,25 Previous research has found that a bundled approach to addressing COVID-19 transmission on a respiratory medicine unit at a Singaporean hospital can be successful. 3 The study implemented a bundle including infrastructure enhancements, PPE audits, social distancing requirements, masking of patients when not eating, and enhanced environmental cleaning protocols.…”

Impact of Face-to-Face Teaching in Addition to Electronic Learning on Personal Protective Equipment Doffing Proficiency in Student Paramedics: Protocol for a Randomized Controlled Trial

“…Although the donning phase is associated with a low risk of contamination, doffing is a critical phase and greatly increases the risk of contamination of caregivers [5][6][7][8][9]. One of the strategies that effectively contributes to reducing staff self-contamination is doffing in structured areas dedicated to the removal of PPE [10,11]. However, this strategy is difficult to apply in the prehospital field, where health care workers must often doff PPE on site.…”