1387. Healthcare Worker Self-Contamination During Standard and Ebola Virus Disease Personal Protective Equipment Doffing
Session: Poster Abstract Session: HAI: Occupational Health
Friday, October 28, 2016
Room: Poster Hall

Background: Few data exist on the risk of healthcare worker (HCW) self-contamination during doffing of standard (STD) and Ebola (EBOV) personal protective equipment (PPE). The purpose of this study was to evaluate HCWs’ risk of self-contamination when donning and doffing PPE using MS2 bacteriophage and fluorescent markers as surrogates for pathogen transmission.

Methods: Enrolled HCWs were interviewed before donning PPE. A mixture of the bacteriophage MS2 (Zeptometrix; 1.0x 10^8 PFU/mL per site) and fluorescent marker (GloGerm Liquid; 100 uL per site), and dummy applications of water were applied to HCWs. HCWs doffed and discarded PPE. Donning and doffing were videotaped and errors recorded. An “error” consisted of deviations from written protocols and guidelines. HCWs were assessed for fluorescence post-doffing. HCWs’ hands, sleeves/wrist, face, and areas of fluorescence were swabbed for PCR-based MS2 detection. Univariate analyses were performed.

Results: EBOV-PPE HCWs were older than STD-PPE HCWs (p=0.02). HCWs doffing EBOV-PPE were more likely than STD-PPE HCWs to make any error (100% vs. 67%; Table 1). The unique EBOV-PPE doffing step that resulted in the most errors was boot cover removal (78% of HCWs). Fluorescence was detected on 8 (44%) of EBOV -PPE HCWs vs. 5 (28%) of STD-PPE HCWs (p=0.49). Of 124 samples, MS2 was detected on 2 EBOV-PPE HCW sites (hands, alcohol pump) and 2 STD-PPE HCWs sites (face, sleeve/wrist). Fluorescence was most common on hands (6 EBOV-PPE HCWs, 5 STD-PPE HCWs) (Figure 1).

Conclusion: 100% of HCWs made errors during EBOV-PPE removal. Boot cover removal was a common source of errors. The most common site of fluorescence was hands. Further study of the risk of contamination with PPE donning and doffing are necessary.

 

Table 1. Donning and Doffing Errors

Error Category

EBOV-PPE

N (%)

STD-PPE

N (%)

p

Donning*

 

 

 

    Any

5 (28)

9 (50)

0.31

    Gloves/hand hygiene

3 (17)

6 (33)

0.44

    Gown/apron

3 (17)

4 (22)

1.00

    PAPR/hood

2 (11)

NA

 

    Other

1 (6)

0 (0)

1.00

Doffing

 

 

 

   Any

18 (100)

12 (67)

0.02

   Boot cover removal

14 (78)

NA

 

   Gloves/hand hygiene

12 (67)

7 (39)

0.10

   Gown/apron

15 (83)

9 (50)

0.08

   PAPR/hood

7  (39)

NA

 

   Shoe disinfection       

8 (44)

NA

 

   Other

2 (11)

0 (0)

0.49

*Donning videos available for 15/18 EBOV-PPE HCWs.

 

 

 

 

 

Jennie H. Kwon, DO, MSCI1, Carey-Ann D. Burnham, PhD2, Kimberly Reske, MPH1, Stephen Liang, MD, MPHS3, Tiffany Hink, BS4, Meghan Wallace, BS5, Angela Shupe, BS6, Sondra Seiler, BA1, Candice Cass, .6, Victoria J. Fraser, MD, FIDSA, FSHEA7 and Erik R. Dubberke, MD, MSPH, FIDSA, FSHEA7, (1)Infectious Diseases, Washington University School of Medicine, St. Louis, MO, (2)Pathology & Immunology, Washington University, St. Louis, MO, (3)Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, (4)Infectious Diseases, Washington University School of Medicine, St Louis, MO, (5)Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, (6)Washington University School of Medicine, SAINT LOUIS, MO, (7)Washington University School of Medicine, St. Louis, MO

Disclosures:

J. H. Kwon, None

C. A. D. Burnham, None

K. Reske, None

S. Liang, None

T. Hink, None

M. Wallace, None

A. Shupe, None

S. Seiler, None

C. Cass, None

V. J. Fraser, NIH: Grant Investigator , Research grant
CDC: Grant Investigator , Research grant
The Foundation for Barnes-Jewish Hospital: Grant Investigator , Research grant
Doris Duke Charitable Foundation: Grant Investigator , Research grant
Express Scripts: Spouse is Senior Vice President and Chief Medical Officer at Express Scripts , Spouse employment

E. R. Dubberke, Rebiotix Inc.: Investigator and Scientific Advisor , Consulting fee and Research support
Merck: Consultant and Investigator , Consulting fee and Research support
Sanofi Pasteur: Consultant and Grant Investigator , Consulting fee and Grant recipient
Summitt: Consultant , Consulting fee

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