Most Healthcare Workers Improperly Remove Potentially Infectious PPE

Hospitals acquired infections (HAIs) are a major problem in the US and other counties. In the US alone, the CDC estimates that 722, search 000 people get HAIs each year and over 75,000 people die from them. There are many vectors of disease in healthcare, including door handles, contaminated work surfaces, and person to person contact.

Healthcare workers have to look after the very sick in person (doctors and nurses) and reprocess or dispose of equipment that has contacted sick patients (e.g. central service personnel). Under the OSHA Bloodborne pathogen standard all bodily fluids and anything which has or may have contacted bodily fluids is to be treated as infectious.  Whether handling patients or contaminated equipment, healthcare workers wear personal protective equipment (PPE) to both protect themselves and prevent the transmission of disease to others.

The CDC provides guidelines for how to put on (don) and far more importantly remove (doff) PPE in a way that minimizes the spread of disease and other organizations also offer guidance.* For example, if someone is wearing a contaminated gown, face shield and gloves, the gloves are removed first, then the face shield and lastly the gown (the order may vary depending on equipment used). The goal is to prevent avoid spreading contamination by only only touching non-contaminated parts, removing them slowly so as not to spray or shake contamination into the surrounding area. Lastly, after removing their PPE, healthcare workers should wash their hands.

In a study by the University of Wisconsin, healthcare personnel entering and exiting patient rooms with isolation precautions were observed. Only four out of thirty healthcare workers followed all the CDC recommendations for the removal of personal protective equipment (PPE) after patient care, according to a brief report published in the July issue of the American Journal of Infection Control, the official publication of the Association for Professionals in Infection Control and Epidemiology (APIC). Out of the other 26 people, 15 did not gently remove their gowns thus risking spreading contamination, 17 removed their PPE in the wrong order, and 16 wore their PPE out of the room (potentially contaminating wherever they went to). Obviously some people did more than one incorrect action.

This result is disappointing in view of the attention focused on the correct use of medical PPE use following the recent Ebola outbreaks, and the high priority on-going measures hospitals are taking to reduce HAIs. The authors ended with the following advice  “Healthcare facilities should use this opportunity of heightened interest to undertake practice improvement focused on PPE removal protocol, including technique, for all healthcare-associated conditions that require the donning and doffing of PPE.”

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*For example AAMI will soon offer a 1 hour training video [script was written by ChemDAQ’s Richard Warburton] on safety in sterile processing which provides training on the correct method to remove PPE.