Donning and Doffing of Personal Protective Equipment (PPE): Is Training Necessary?

Abstract

The use of personal protective equipment (PPE) to provide care to patients on “contact” isolation precautions is a standard infection prevention practice. This is despite the fact that limited data exists to show such practices are effective in preventing transmission of organisms from patient to patient (Lopez-Alcalde J, Mateos-Mazon M, Guevara M et al, Cochrane Database Syst Rev (7):CD007087, 2015; Cohen CC, Cohen B, Shang J, J Hosp Infect 90:275–284, 2015; De Angelis G, Cataldo MA, De Waure C et al, J Antimicrob Chemother 69:1185–1192, 2014). Yet contamination of healthcare providers after interaction with the patient care environment has been well documented in the ICU setting, where multidrug-resistant organisms similar to those colonizing patients can be found on the gloves and gowns of healthcare workers after providing care (Morgan DJ, Liang SY, Smith CL et al, Infect Control Hosp Epidemiol 31:716–721, 2010; Snyder GM, Thom KA, Furuno JP et al, Infect Control Hosp Epidemiol 29:583–589, 2008). Several human factors presumably limit effectiveness of contact precautions as they are currently practiced including poor adherence (Dhar S, Marchaim D, Tansek R et al, Infect Control Hosp Epidemiol 35:213–221, 2014). More recently, technique in PPE donning and doffing has become recognized as a widespread opportunity for improvement among healthcare providers (Doll M, Bearman GB, JAMA Intern Med 175(12), 2015).