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MADISON, WI – Very few healthcare workers followed all national Centers for Disease Control and Prevention recommendations on removal and disposal of personal protective equipment (PPE), according to an observational study at a Wisconsin hospital.
The brief report, published recently in the American Journal of Infection Control, found fewer than one in six – four out of 30 – hospital staff members fully complied with protocol.
“In our study we found that the majority of HCWs did not remove PPE in the correct order,” write study authors from the William S. Middleton Veterans Hospital and the University of Wisconsin, both in Madison. “Further, many of those who did remove the PPE in the correct order failed to properly dispose of their contaminated PPE in the isolated patient's room. Deviations from protocol were common.”
For the study, a trained observer watched healthcare personnel entering and exiting patient rooms with isolation precautions on various units of the hospital from Oct. 13-31, 2014.
According to CDC recommendations, gloves should be removed first, followed by the careful removal of the gown from the back while still in the patient's isolation room.
Of the 30 healthcare workers observed removing PPE, 17 removed the gown out of order, 16 wore their PPE out into the hallway, and 15 removed their gown in a manner that was not gentle, which could cause pathogens from the gown to transfer to their clothes.
"As a result of the current Ebola outbreak, the critical issue of proper PPE removal has come front and center," the authors state. "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."
The study also found that many HCWs did not tie the back of their gowns, which could then drape over patients and increase contamination risk. Furthermore, PPE garments sometimes were removed by rolling the equipment against previously uncontaminated work clothes or bare hands before disposal.
“These breaches of PPE removal protocol may be due to a lack of awareness of the proper protocol, time constraints, or lack of realization of the importance of proper PPE removal,” suggest the authors, who call for more education.