March 28, 2019
2 min read

39% of HCWs make doffing errors, increasing risk for MDRO contamination

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Koh Okamoto, MD, MS
Koh Okamoto

A prospective, observational study found that 39% of health care workers caring for patients on contact precautions for multidrug-resistant organisms, or MDROs, made multiple errors when doffing personal protective equipment, or PPE, and that more than one-third were contaminated with an MDRO.

The CDC established PPE recommendations after a high number of health care workers (HCWs) were exposed to infections during the West African Ebola virus epidemic. A 2018 study identified 103 ways HCWs can fail these PPE doffing procedures and potentially contaminate themselves and others.

“Health care workers' hands and clothes can become contaminated with multidrug-resistant organisms, and the risk for contamination is higher when there are errors in donning or doffing of personal protective equipment,” Koh Okamoto, MD, MS, an infectious disease fellow at Rush University Medical Center, told Infectious Disease News.

The current study followed HCWs who treated patients infected with MRSA, vancomycin-resistant Enterococci or multidrug-resistant gram-negative bacilli, in four ICUs at Rush University Medical Center from September 2015 to February 2016.

Okamoto and colleagues collected swab samples from HCWs before donning and after doffing PPE, which was cultured after donning and again before doffing, they explained. They also obtained cultures from patients 2 hours before HCWs entered their rooms and from various high-touch locations within the rooms.

The researchers developed a donning and doffing glove and gown checklist based on the CDC guidance to evaluate HCWs’ procedures.

According to the study, a total of 125 HCWs participated, including 83 (66.4%) nurses and 24 (19.2%) physicians. Among the HCWs, 64 (51.2%) received formal PPE training for Ebola virus a year before the study, and 113 (90.4%) received PPE donning and doffing training (unrelated to Ebola virus training) in the 5 years leading up to the study, according to the researchers.

Overall, 39.2% of HCWs increased their risk of contamination by making errors removing PPE, Okamoto and colleagues reported. They explained that HCWs who made multiple errors were more likely to have contaminated clothes after a patient encounter (OR, 13.23; 95% CI, 1.31-133.26) and a higher risk for contamination if they removed gloves before their gown (OR, 5.56; 95% CI, 1.07-28.80). A total of 45 (36%) of HCWs were contaminated with the target MDRO after interacting with a patient — four (3.2%) on their hands.

“An intervention as simple as reinforcing the preferred order of doffing may reduce health care worker contamination with multidrug resistant organisms,” Okamoto said. “There are other pathogens that are spread easily in healthcare settings, such as Ebola virus, for which antibiotic resistant bacteria serve as a risk surrogate in our study, which was sponsored by the CDC Epicenters Program.”– by Erin Michael

Disclosures: The authors report no relevant financial disclosures.