August 31, 2019
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Longer sleeves reduce contamination during PPE removal

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Increasing the coverage of personal protective equipment, or PPE, to include the hands and wrists reduces the contamination of personnel during removal, according to findings from two nonblinded cross-over trials.

Personal protective equipment that is designed to minimize the risk for contamination of personnel is needed to protect patients and personnel,” Curtis J. Donskey, MD, professor of medicine at Case Western Reserve University and a staff physician at Louis Stokes Cleveland VA Medical Center, and colleagues wrote. “Contamination of the hands and/or wrists of personnel occurred frequently during simulations with the standard gown used in our facility, even when no lapses in technique were observed and even after education on correct technique.”

The researchers cited a previously developed gown that provided a tighter fit at the wrist and increased wrist coverage, as well as allowed the user to remove it at the neck. Simulations of PPE removal with the modified gown revealed significantly reduced contamination of personnel, and Donskey and colleagues aimed to improve upon these results further by designing and testing a gown that provided “a substantial increase in skin coverage including the entire wrist and the palms and dorsum of the hands to just above the fingers.”

In the first trial, 60 health care personnel were randomly assigned to use either the standard gown or the modified gown during simulations of PPE donning and doffing. No education on proper removal techniques was given. After a minimum 5-minute washout period, participants performed the simulation again with the alternate gown. A black light was used to assess hand and wrist contamination.

The researchers observed 53% contamination of the hands and wrists with the standard gown compared with 27% with the modified gown, and 40% of the donning and doffing simulations were considered incorrect.

In trial 2, 42 personnel were similarly randomly assigned, and the procedures were identical to trial 1. However, trial 2 differed from trial 1 in that participants were provided education on appropriate donning and doffing practices, based on CDC protocols.

There was a 5% rate of contamination for the modified gown in the second trial compared with 23% for the standard gown.

“A gown designed to increase skin coverage at the hands and wrists significantly reduced contamination of personnel during simulations of contaminated PPE removal,” Donskey and colleagues wrote. “The frequency of contamination was further reduced by education. Studies are needed to determine whether such modifications of PPE design can reduce contamination in clinical settings.” – by Marley Ghizzone

Disclosures: Donskey reports receiving research grants from Boehringer Laboratories, Clorox, GOJO, PDI and Pfizer. All other authors report no relevant financial disclosures.