Methods: We conducted a self-administered survey of HCWs in 4 intensive care units (ICUs) in an academic medical center designated for care of Ebola virus disease suspected patients. HCWs were enrolled when they cared for patients on contact precaution for MDROs. We assessed personnel characteristics (age, weight, height, job category), PPE training experience, work load, fatigue, and perception of risk of MDRO transmission and of preventive role of PPE. Research personnel observed HCW donning and doffing before and after routine patient encounter; errors were coded based on the CDC guidance.
Results: 125 HCWs completed the survey. The majority were nurses (66.4%) or physicians (19.2%) and female (77.6%). 64 (51.2%) HCWs received PPE training for prevention of Ebola virus transmission in the past year. 26 (20.6%) thought that they were unlikely or very unlikely to be contaminated with MDROs after PPE removal. 16 (12.1%), 106 (84.8%), and 49 (39.2%) of HCWs made multiple errors in donning gloves, donning gown, and doffing PPE, respectively. In univariate analysis, HCWs who felt more tired were more likely to make multiple errors in donning gloves (RR 2.21, p=.058) or gowns (RR 1.17, p=.073). HCWs who received their professional degree ≥6 years ago were less likely to make multiple errors in donning gowns (RR 0.86, p=.057). The following factors were associated with multiple errors in doffing PPE: completing degree training ≥6 years ago (RR 1.54, p=.061), PPE training ≥ 5 years ago (RR 1.83, p=.043), being overweight (RR 1.56, p=.057), and having a stressful day (RR 2.39, p=.054). HCWs who completed their degree training ≥ 6 years ago were more likely to doff gloves first (RR 2.78, p=.006), which in other analyses was associated with self-contamination.
Conclusion: We identified potentially modifiable risk factors associated with donning/ doffing errors, including time since degree training and fatigue. Interventions such as rest periods, mindfulness training to deal with stress, or regular garbing refreshers should be investigated as means of reducing errors.
M. Schoeny, None
J. Cheng, None
S. Reddy, None
E. Salazar, None
G. Warpinski, None
R. A. Weinstein, None
M. K. Hayden, None
K. Popovich, None
F. T. CDC Prevention Epicenters Program, None