Abstract

BackgroundVery little has been reported about health care workers' (HCWs) adherence to the Centers for Disease Control and Prevention (CDC) guidelines of doffing personal protective equipment (PPE) amid the COVID-19 pandemic. Real-time remote audio-visual doffing surveillance (RADS) system for assisting doffing might reduce the risk of self-contamination. We used this system to determine the incidence of the breach in biosafety during doffing of PPE among HCWs involved in the care of Covid-19 patients.MethodsA total of 100 HCWs were enrolled in this observational study who performed duties in the COVID intensive care unit (ICU) of our tertiary care centre. With a real-time RADS system, trained observers from remote locations assisted HCWs during doffing of PPE and noted breach at any step using the CDC doffing checklist. The breach was considered major if committed during removal of gloves/gown/N-95 or if ≥3 errors occurred in any other steps.ResultsOverall, 40% of the HCWs committed a breach during doffing at least one step. The majority of the errors were observed during hand hygiene (34%), followed by glove removal (12%) and N-95 removal (8%). Nineteen percent of HCWs committed the major breach, out of which 37.5% were done by house-keeping sanitation staff (p = 0.008 and RR 2.85; 95% CI of 1.313-6.19), followed by technicians (22.5%), nursing staff (16.7%) and resident doctors (6.5%).ConclusionsPerforming doffing using a real-time RADS system is associated with a relatively low incidence of a breach in biosafety compared with earlier studies using an onsite standard observer. Overall adherence of HCWs to the CDC guidelines of doffing PPE was satisfactory. This study highlights the importance of the RADS system during doffing of PPE in a health care setting amid the COVID-19 pandemic.

Highlights

  • Prompted by the menace of Coronavirus disease 2019 (COVID-19) and its implications all over the world, the Centers for Disease Control and Prevention (CDC) augmented efforts to provide safe care for patients with suspected or confirmed COVID-19 [1]

  • Nineteen percent of health care workers' (HCWs) committed the major breach, out of which 37.5% were done by house-keeping sanitation staff (p = 0.008 and RR 2.85; 95% CI of 1.313-6.19), followed by technicians (22.5%), nursing staff (16.7%) and resident doctors (6.5%)

  • Performing doffing using a real-time remote audio-visual doffing surveillance (RADS) system is associated with a relatively low incidence of a breach in biosafety compared with earlier studies using an onsite standard observer

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Summary

Introduction

Prompted by the menace of Coronavirus disease 2019 (COVID-19) and its implications all over the world, the Centers for Disease Control and Prevention (CDC) augmented efforts to provide safe care for patients with suspected or confirmed COVID-19 [1]. Personal protective equipment (PPE) protects HCW from the risk of exposure to COVID-19 and enables them to deliver safe and effective patient care [2]. Incorrect doffing of PPE by HCWs could potentially cause a breach in bio-safety and lead to self-contamination [4]. Very little has been reported about health care workers' (HCWs) adherence to the Centers for Disease Control and Prevention (CDC) guidelines of doffing personal protective equipment (PPE) amid the COVID-19 pandemic. Real-time remote audio-visual doffing surveillance (RADS) system for assisting doffing might reduce the risk of self-contamination. We used this system to determine the incidence of the breach in biosafety during doffing of PPE among HCWs involved in the care of Covid-19 patients

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