MedicalResearch.com Interview with:
Curtis J. Donskey, MD
Professor of Medicine
Case Western Reserve University
Staff Physician, Infectious Diseases Section,
Louis Stokes Cleveland VA Medical Center
Medical Research: What is the background for this study?
Dr. Donskey: Personal protective equipment (PPE) is intended to protect healthcare personnel by preventing them from acquiring an infection and to protect patients by preventing pathogen transmission. This study focused on gloves and gowns which are designed to reduce contamination of the skin and clothing of personnel. There are several concerns about the effectiveness of gloves and gowns.
- First, several studies have demonstrated that personnel may acquire pathogens such as Clostridium difficile and methicillin-resistant Staphylococcus aureus (MRSA) on their hands and clothing during patient care activities despite wearing gloves and gowns.
- Second, some studies involving simulations have suggested that contamination of the skin and clothing occurs frequently during removal of gloves and gowns.
- Finally, lapses in technique for PPE removal may contribute to acquisition of potentially fatal pathogens such as Ebola virus. These concerns highlight the urgent need for improved strategies to prevent contamination of personnel during PPE removal.
We had 3 goals in the study.
- First, we wanted to determine if contamination with a fluorescent lotion during glove and gown removal would correlate well with contamination with a benign virus. We did this because the fluorescent lotion method could potentially be very useful for training personnel because you can easily visualize contamination with a black light and provide immediate feedback.
- Second, we used the fluorescent lotion method to evaluate contamination of the skin and clothing of personnel from 4 hospitals during removal of contaminated gloves or gowns.
- Finally, we tested whether an intervention would reduce contamination in one of the 4 hospitals. The intervention included practice in removal of contaminated gloves and gowns with immediate visual feedback based on fluorescent lotion contamination of skin and clothing.
Medical Research: What are the main findings?
Dr. Donskey: Our first key finding was that contamination with the fluorescent lotion correlated well with contamination with the benign virus. This was an important finding because it suggests that the fluorescent lotion method is a useful surrogate method to assess pathogen contamination during Personal protective equipment removal.
Our second key finding was that contamination of the skin and clothing of personnel occurred frequently during removal of contaminated gloves or gowns. For 435 total simulations, contamination occurred 46% of the time, with similar results for each the 4 study hospitals (43%-50%). Incorrect donning or doffing technique was common and was associated with an increase in contamination (70% of the time with incorrect technique versus 30% with correct technique).
Our final key finding was that the intervention was very effective in reducing contamination during PPE removal. Immediately after the training session, the frequency of contamination decreased from 60% to 20% and then was 12% at 1 and 3 months after the intervention.
Medical Research: What should clinicians and patients take away from your report?
Dr. Donskey: It is easy for contamination of skin and clothing to occur during removal of contaminated gloves and gowns. This can place personnel at risk to acquire infections and can contribute to transmission of infection to susceptible patients. The risk can be significantly reduced by improving technique for PPE removal. Our findings suggest that simple educational interventions that include practice using fluorescent lotions to provide immediate visual feedback on skin and clothing contamination can be very effective in reducing the risk for contamination.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Donskey: We did not get to zero contamination with our intervention, so there is still room for improvement. Some approaches might include more intensive training in PPE removal, disinfection of PPE prior to removal, or new designs for PPE. We also found that contamination of clothing occurred during 2 of 29 or 7% of Ebola virus training sessions. Therefore, it may be beneficial to incorporate use of fluorescent lotion into this type of training.
Tomas ME, Kundrapu S, Thota P, et al. Contamination of Health Care Personnel During Removal of Personal Protective Equipment. JAMA Intern Med. Published online October 12, 2015. doi:10.1001/jamainternmed.2015.4535.
Curtis J. Donskey, MD (2015). Health Care Personnel Can Easily Contaminate Themselves When Removing Gowns and Gloves