Donning and doffing of personal protective equipment for health care workers in a tertiary hospital in China: A simulation study

Abstract

The application and removal of personal protective equipment (PPE) by health care workers (HCWs) is pivotal to their health and safety and the comprehensive efficacy of hospital infection control measures. This investigation was orchestrated to elucidate the challenges that HCWs may encounter during the donning and doffing of PPE. A total of 110 participants from a tertiary hospital in China were engaged. The study employed fluorescent markers to mimic the exposure of HCWs to tainted body fluids, quantified the contamination outcomes, and evaluated adherence to procedures for donning and doffing. Factors including gender, educational background, and the timing of the most recent instruction on PPE donning and doffing were found to influence the occurrence of contamination points (p < 0.05). No significant differences were identified in contamination frequency when assessing age, body mass index (BMI), occupation, educational background, positional title, working tenure, and experience in managing respiratory infectious diseases (p > 0.05). Predominant contamination sites for fluorescent marker residue included the shoulder (32.73%), neck (21.82%), forearm (16.36%), chest (12.73%), and abdomen (11.82%), with the shoulder being the most contaminated body part. A majority of HCWs exhibited susceptibility to errors during the removal of protective clothing, boot covers, and gloves. The contamination frequency was observed to be correlated with the timing of the last PPE training, educational background, and gender. In acknowledging the intricacy of PPE removal and the deficiencies in HCWs’ removal techniques, there emerges a perpetual necessity to refine training methodologies and perpetuate regular PPE instruction.

Keywords:

• Contamination
• exposure prevention
• infection control
• infection prevention
• fluorescent marking
• PPE

Acknowledgments

The authors are grateful to all staff of infection control units in hospitals where data were collected.

Conflicts of interest

The authors declare no conflict of interest.

Data availability statement

Due to the nature of this research, participants of this study did not agree for their data to be shared publicly, so supporting data is not available.

Informed consent

All subjects gave their informed consent for inclusion before they participated in the study. The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Ethics Committee of the Affiliated Hospital of Xuzhou Medical University (ethical approval number: XYFY2022-KL310-01).

Additional information

Funding

This work was supported by the Scientific Research and Innovation Program for Postgraduate Students of School of Nursing, Xuzhou Medical University [grant number HLYC202204].