Proper Use of Personal Protective Equipment Study Reveals Gaps

Knowing that seeing is believing, researchers at the University of Pittsburgh Medical Center (UPMC) Presbyterian Hospital secured the consent of healthcare personnel to videotape how they gowned and gloved, and other related clinical practices. Kang, et al. (2017) discovered that healthcare personnel contaminated themselves in almost 80 percent of the PPE simulations

Various styles of each PPE item were randomly combined by taking one sample among each different PPE available from each category in order: disposable gown, surgical mask, N95 respirator, gloves, cap, full-body gown, hood, face shield, eye protection, and shoe cover. In addition, a powered air purifying respirator (PAPR) was used as part of some randomly assigned full-body PPE sets. Simulation practices were videotaped and examined using fluorescent powder with ultraviolet lighting. After donning an assigned PPE set, each participant was asked to demonstrate their usual patient care (physical assessment which was intensive enough to contaminate the surface of PPE; touching-involved practices varied by occupation and were chosen by participants) at bedside to a SimMan that was covered with fluorescent powder. After doffing the PPE set, contamination with fluorescent powder was examined using an ultraviolet light in the darkened simulation room. Any contaminated areas were photographed using a tablet computer and/or a high-resolution camera. All contamination with fluorescent powder was thoroughly cleaned using soap and water before the healthcare personnel left the simulation room.


Among 130 total sessions from 65 participants, contamination occurred in 79.2 percent of simulations during the doffing process with various PPE items: simple set (92.3 percent) and full-body set (66.2 percent). Among 11 follow-up evaluation participants, contaminations still occurred in 82 percent after receiving individual feedback, but the overall contamination level was reduced. Using the contamination information gained during the simulation analysis, 66 percent of potential contamination was estimated for the clinical observation. Concerns and barriers in PPE use from HCP survey responses were as follows: time-consuming, cumbersomeness, and PPE effectiveness. As Kang, et al. (2017) explain, "Although participants believed in the effectiveness of PPE use in minimizing exposure to infectious pathogens, they also reported that PPE use during their practice was cumbersome. Participants showed relatively high confidence in their PPE use in general and with a simple PPE set. However, they were less confident in the use of full-body protection PPE sets, as in Ebola preparedness. Barriers or concerns in PPE use expressed by the simulation participants were time consumption (e.g., slowed down team rounding), cumbersomeness (e.g., tough to move with a PAPR), lack of training (e.g., not sure in what order to don or doff PPE), worry about PPE effectiveness (e.g., thin yellow disposable gown), PPE issues (e.g., throwing PPE away), and others. Suggestions from participating HCP for better PPE use were more training (e.g., yearly continuing education, orientation training), the need to develop better PPE (e.g., something more efficient), and the hope to resolve unexamined issues (e.g., trash container, stethoscope)."

Read the study in it's entirety on Infection Control Today.