Assessing personal protective equipment compliance in a polish healthcare setting during the COVID-19 pandemic - A pilot case study

Abstract

Objective: The purpose of this study is to identify failures in proper Personal Protective Equipment (PPE) usage in a healthcare hospital environment to enhance PPE compliance through proper donning and doffing procedures.
Methods: We used naturalistic observation (shadowing) of PPE donning and doffing by healthcare medical staff in their hospital work setting to identify non-conformities to compliant donning and doffing of PPE.
Results: We found an average of 1.84 non-conformances per healthcare worker across the donning procedures and 2.06 non-conformances in the doffing procedures per healthcare provider. Nurses experienced 1.94 average non-conformances in the donning procedures, while physicians average 1.75 non-conformances. Nurses experienced 2.29 average doffing nonconformances, while physicians averaged 1.85 average doffing non-conformances during the study. PPE compliance is critical to protect both healthcare workers and patients in the healthcare setting, as well as building a culture of safety.
Research implications: Appropriate training and compliance should be performed to ensure appropriate PPE donning and doffing protocols are adhered to, so that it reduces the transmission of disease and infections. Future studies will explore the environmental, cultural and operational factors that contribute to PPE compliance in healthcare.
Conclusions: This is the first study to quantify donning and doffing errors of personal protective compliance within the realm of environmental and cultural impacts.

Keywords

Ergonomic / Personal protective equipment / Safety in healthcare

CONFLICTS OF INTEREST DISCLOSURE

The authors declare they have no conflicts of interest.

References

[1] Polish Ministry of Health website. Access on May 16 2023. Available from: https://www.gov.pl/web/koronawirus/wykaz-zarazen-koronawirusem-sars-cov-2

[2] Carrico RM, Coty MB, Goss LK, et al. Changing health care worker behavior in relation to respiratory disease transmission with a novel training approach that uses biosimulation. American Journal of Infection Control. 2007; 35(1): 14-19. PMid: 17276786. https://doi.org/10.1016/j.ajic.2005.12.013

[3] Casanova L, Alfano-Sobsey E, Rutala WA, et al. Virus transfer from personal protective equipment to healthcare employees’ skin and clothing. Emerging Infectious Diseases. 2008; 14(8): 1291-1293. PMid: 18680659. https://doi.org/10.3201/eid1408.080085

[4] Casanova LM, Teal LJ, Sickbert-Bennett EE, et al. Assessment of Self-Contamination During Removal of Personal Protective Equipment for Ebola Patient Care. Infection Control and Hospital Epidemiology. 2016; 37(10): 1156-1161. PMid: 27477451. https://doi.org/10.1017/ice.2016.169

[5] Salehi H, Pennathur PR, Da Silva JP, et al. Examining health care personal protective equipment use through a human factors engineering and product design lens. American Journal of Infection Control. 2019; 47(5): 595-598. PMid: 30522839. https://doi.org/10.1016/j.ajic.2018.10.008

[6] Baloh J, Reisinger HS, Dukes K, et al. Healthcare Workers’ Strategies for Doffing Personal Protective Equipment. Clinical Infectious Diseases. 2019; 69(Suppl 3): 192-198. PMid: 31517970. https://doi.org/10.1093/cid/ciz613

[7] Northington WE, Mahoney GM, Hahn ME, et al. Training retention of Level C personal protective equipment use by emergency medical services personnel. Academic Emergency Medicine. 2007; 14(10): 846-849. PMid: 17898247. https://doi.org/10.1197/j.aem.2007.06.034

[8] Centers for Disease Control and Prevention (CDC). Novel Influenza A (H1N1) Virus Infections among Health-Care Personnel - United States. April-May 2009. PMid: 19480813. https://doi.org/10.2807/ese.14.21.19221-en

[9] European Centre for Disease Prevention and Control. Safe Use of Personal Protective Equipment in the Treatment of Infectious Diseases of High Consequence: A Tutorial for Trainers in Healthcare Settings. 2014.

[10] Beam EL, Gibbs SG, Boulter KC, et al. A method for evaluating health care workers’ personal protective equipment technique. American Journal of Infection Control. 2011; 39(5): 415-420. PMid: 21255874. https://doi.org/10.1016/j.ajic.2010.07.009

[11] Suwantarat N, Apisarnthanarak A. Risks to healthcare workers with emerging diseases: lessons from MERS-CoV, Ebola, SARS, and avian flu. Current Opinion in Infectious Diseases. 2015; 28(4): 349-361. PMid: 26098498. https://doi.org/10.1097/QCO.0000000000000183

[12] Guo YP, Li Y, Wong PL. Environment and body contamination: a comparison of two different removal methods in three types of per- sonal protective clothing. American Journal of Infection Control. 2014; 42(4): 39-45. PMid: 24679582. https://doi.org/10.1016/j.ajic.2013.12.021

[13] Kang J, O’Donnell JM, Colaianne B, et al. Use of personal protective equipment among health care personnel: Results of clinical observations and simulations. American Journal of Infection Control. 2015; 45(1): 17-23. PMid: 28065328. https://doi.org/10.1016/j.ajic.2016.08.011

[14] Tomas ME, Kundrapu S, Thota P, et al. Contamination of Health Care Personnel During Removal of Personal Protective Equipment. JAMA Internal Medicine. 2015; 175(12): 1904-1910. PMid: 26457544. https://doi.org/10.1001/jamainternmed.2015.4535

[15] Mulvey D, Mayer J, Visnovsky L, et al. Frequent and unexpected deviations from personal protective equipment guidelines increase contamination risks. American Journal of Infection Control. 2019; 47(9): 1146-1147. PMid: 31027940. https://doi.org/10.1016/j.ajic.2019.03.013

[16] Phan LT, Maita D, Mortiz DC, et al. Personal protective equipment doffing practices of healthcare workers. Journal of Occupational and Environmental Hygiene. 2019; 16(8): 575-581. PMid: 31291152. https://doi.org/10.1080/15459624.2019.1628350

[17] Boškoski I, Gallo C, Wallace MB, et al. COVID-19 pandemic and personal protective equipment shortage: protective efficacy comparing masks and scientific methods for respirator reuse. Gastrointestinal Endoscopy. 2020; 92(3): 519-523. PMid: 32353457. https://doi.org/10.1016/j.gie.2020.04.048

[18] Saran S, Gurjar M, Baronia AK, et al. Personal protective equipment during COVID-19 pandemic: a narrative review on technical aspects. Expert Review of Medical Devices. 2020; 17(12): 1265-1276. PMid: 33203245. https://doi.org/10.1080/17434440.2020.1852079

[19] Barycka K, Torlinski T, Filipiak KJ, et al. Risk of self-contamination among healthcare workers in the COVID-19 pandemic. The American Journal of Emergency Medicine. 2021; 46: 751-752. PMid: 33008700. https://doi.org/10.1016/j.ajem.2020.09.055

[20] Doos D, Barach P, Alves NJ, et al. The dangers of reused personal protective equipment: healthcare workers and workstation contamination. The Journal of hospital infection. 2022; 127: 59-68. PMid: 35688273. https://doi.org/10.1016/j.jhin.2022.05.016

[21] Graban M, Toussaint J. Lean hospitals: improving quality, patient safety, and employee engagement. Productivity Press; 2018. https://doi.org/10.4324/9781315380827

[22] Goodrich J, Ridge D, Cartwright T. A qualitative study exploring patient shadowing as a method to improve patient-centred care: 10 principles for a new gold standard. International Journal for Quality in Health Care. 2022; 34(2). PMid: 35311958. https://doi.org/10.1093/intqhc/mzac018

[23] Yi L, Seo HB. The effect of hospital unit layout on nurse walking behavior. HERD. 2012; 6(1): 66-82. PMid: 23224843. https://doi.org/10.1177/193758671200600104

[24] Teitz CC. Shadowing physicians. JAMA. 2011; 305(23): 2414; author reply 2415-6. PMid: 21673291. https://doi.org/10.1001/jama.2011.787