Emergency department impaired adherence to personal protective equipment donning and doffing protocols during the COVID-19 pandemic

Tomer Lamhoot,Mansour Mhiliya,Orly Barak,Noa Ben Shoshan,Orly Bisker-Kassif,Hagit Eisenberg,Neta Cohen,Gilad Fainberg,Carolyn Weiniger,Tali Capua

doi:10.1186/s13584-021-00477-7

Abstract

ObjectivesCoronavirus Disease 2019 (COVID-19) is a highly infectious viral pandemic that has claimed the lives of millions. Personal protective equipment (PPE) may reduce the risk of transmission for health care workers (HCWs), especially in the emergency setting. This study aimed to compare the adherence to PPE donning and doffing protocols in the Emergency Department (ED) vs designated COVID-19 wards and score adherence according to the steps in our protocol.DesignPrior to managing COVID-19 patients, mandatory PPE training was undertaken for all HCWs. HCWs were observed donning or doffing COVID-19 restricted areas.SettingDonning and doffing was observed in COVID-19 designated Emergency department and compared to COVID-19 positive wards.ParticipantsAll HCWs working in the aforementioned wards during the time of observation.ResultsWe observed 107 donning and doffing procedures (30 were observed in the ED). 50% HCWs observed donned PPE correctly and 37% doffed correctly. The ED had a significantly lower mean donning score (ED: 78%, Internal: 95% ICU: 96%, p < 0.001); and a significantly lower mean doffing score (ED: 72%, Internal: 85% ICU: 91%, p = 0.02).ConclusionsAs hypothesized, HCWs assigned to the designated ED wing made more protocol deviations compared with HCWs positive COVID-19 wards. Time management, acuity, lack of personnel, stress and known COVID-19 status may explain the lesser adherence to donning and doffing protocols. Further studies to assess the correlation between protocol deviations in use of PPE and morbidity as well as improvement implementations are required. Resources should be invested to ensure PPE is properly used.

Highlights

Personal protective equipment (PPE) is defined as barrier clothing, gloves, eye protection and/or headgear designed to protect from a potential hazardous exposure
As hypothesized, health care workers (HCWs) assigned to the designated Emergency Department (ED) wing made more protocol deviations compared with HCWs positive COVID-19 wards
Further studies to assess the correlation between protocol deviations in use of PPE and morbidity as well as improvement implementations are required

Summary

Introduction

Personal protective equipment (PPE) is defined as barrier clothing, gloves, eye protection and/or headgear designed to protect from a potential hazardous exposure. In medicine, these exposures are typically either infectious diseases or toxins [1]. The transmission of the Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and its disease, COVID-19, is presumed to be primarily through droplets and fomites, viral particles have been found in feces of seropositive patients. Reports from Italy’s experience dealing with COVID-19 suggest that up to 20% of healthcare professionals dealing with COVID-19 patients became infected with the virus, with some reported deaths [6]. Adams et al reported that 3000 HCWs were infected with COVID-19 and 22 died [8]

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