Methods: HCW caring for standardized EV patients donned and doffed PPE in designated environments (n=7) including Intensive Care. HF personnel recorded HCWs using video (hand-held and fixed) and still cameras (Drift HD, Nikon 810 and Canon EOS 70D). Video files were synchronized (Adobe Premiere Pro CS 6.0) and imported into Noldus Observer XT v.11.5 for synchronization. Customized coding taxonomies, developed in consultation with infection control experts, were used to identify HCW actions as high risk (touching mucous membranes/conjunctiva, potential sharps injury hazard) or low risk (contamination from people, equipment, or environment).
Results: There were 28 donning and 24 doffing sequences observed. Donning area configuration varied between environments including: physical size, proximity of the donning cart, workspace, and donning area to patient distance. Observed gaps/issues in PPE coverage included: exposed faces (n=10), exposed neck (n= 13) and fogged eyewear (n=4). Donning times (mean +/- SD) varied depending on the type of PPE, from 8.5 +/- 2.7 to 10.2 +/- 3.1 min for coveralls vs fluid-resistant gowns, respectively. Out-of-sequence Buddy instructions and doffing HCW actions (n=18) were observed. Low risk contamination actions noted included stepping from contaminated to clean area (n=10) and touching doorframes or handles (n=6). There were 6 high risk actions recorded. Doffing actions led to PPE breaches including holes in sleeves (n=7), holes in bootcovers (n=5) and ripped glove (n=1). HCW were observed losing their balance and/or slipping during doffing (n=4), typically upon shoe and leg cover removal.
Conclusion: The HFE evaluation was valuable in identifying multiple systems factors that were believed to have contributed to the observed high and low risk actions. The observations and video analysis provided a rich set of data that can be systematically integrated with quality improvement initiatives to improve HCW safety during PPE donning and doffing in the care of EV patients.
K. Wiley, None
J. Davies, None
J. Kaufman, None
J. Conly, None
J. Caird, None