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Impact of doffing errors on healthcare worker self-contamination when caring for patients on contact precautions

Koh Okamoto1, Yoona Rhee1, Michael Schoeny2

  • 1Department of Medicine,Rush University Medical Center,Chicago, Illinois.

Infection Control and Hospital Epidemiology
|March 21, 2019
PubMed
Abstract

Insights

Improper removal of personal protective equipment (PPE) increases healthcare worker (HCW) contamination with multidrug-resistant organisms (MDROs). Correcting doffing techniques can reduce HCW contamination risks.

Area of Science:

  • Infection Control
  • Healthcare Epidemiology
  • Occupational Health

Background:

  • Multidrug-resistant organisms (MDROs) pose a significant threat in healthcare settings.
  • Healthcare worker (HCW) contamination is a key transmission route for MDROs.
  • Personal protective equipment (PPE) doffing is a critical step where contamination can occur.

Purpose of the Study:

  • To assess the impact of personal protective equipment (PPE) doffing errors on healthcare worker (HCW) contamination with multidrug-resistant organisms (MDROs).

Main Methods:

  • A prospective, observational study was conducted in four adult ICUs.
  • Samples were collected from HCWs, patients, and environmental surfaces.
  • PPE doffing procedures were observed and errors coded based on CDC guidelines.

Main Results:

  • 14.7% of cultured sites yielded MDROs, and 36% of HCWs were contaminated post-interaction.
  • HCWs making multiple doffing errors had a higher risk of contaminated clothing (RR, 4.69).
  • Hand contamination risk increased significantly when gloves were removed before gowns (RR, 11.76).

Conclusions:

  • HCW contamination risk with MDROs is influenced by PPE doffing methods.
  • Reinforcing correct PPE doffing order may reduce HCW contamination.
  • Simple interventions in PPE doffing can enhance patient and HCW safety.

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