1398. Human Factors Evaluation to Identify Systems Factors to Improve Safety during Donning and Doffing Personal Protective Equipment (PPE) in Ebola Virus Disease Management Scenarios
Session: Poster Abstract Session: All Things Ebola
Saturday, October 10, 2015
Room: Poster Hall
  • EBV posterSept 25 final.pdf (39.4 kB)
  • Background: Transmission of Ebola Virus (EV) to health care workers (HCW) has been associated with breaches of protocol during PPE use. Formal Human Factors and Ergonomics (HFE) evaluation may be a valuable tool to examine donning and doffing PPE systems factors within simulated EV patient scenarios.

     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.

    Gregory Hallihan, MASc1, Justin Baers, MSc1, Katelyn Wiley, BSc1, Jan Davies, MSc MD2, Jaime Kaufman, PhD1, John Conly, MD3 and Jeff Caird, PhD4, (1)W21C, University of Calgary, Calgary, AB, Canada, (2)Anesthesia, University of Calgary/Foothills Medical Centre,Alberta Health Services, Calgary, AB, Canada, (3)Medicine, University of Calgary/Foothills Medical Centre, Alberta Health Services, Calgary, AB, Canada, (4)Psychology, University of Calgary, Calgary, AB, Canada


    G. Hallihan, None

    J. Baers, None

    K. Wiley, None

    J. Davies, None

    J. Kaufman, None

    J. Conly, None

    J. Caird, None

    See more of: All Things Ebola
    See more of: Poster Abstract Session

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.