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Original Investigation |

Contamination of Health Care Personnel During Removal of Personal Protective Equipment

Myreen E. Tomas, MD1; Sirisha Kundrapu, MD2; Priyaleela Thota, MD2; Venkata C. K. Sunkesula, MD2; Jennifer L. Cadnum, BS2; Thriveen Sankar Chittoor Mana, MS2; Annette Jencson, BS, CIC2; Marguerite O’Donnell, RN3; Trina F. Zabarsky, RN3; Michelle T. Hecker, MD4,5; Amy J. Ray, MD5; Brigid M. Wilson, PhD1; Curtis J. Donskey, MD1,5
[+] Author Affiliations
1Geriatric Research, Education, and Clinical Center, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
2Research Service, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
3Infection Prevention and Control Department, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
4Division of Infectious Diseases, Department of Medicine, MetroHealth Medical Center, Cleveland, Ohio
5Department of Medicine, Infectious Diseases Division, Case Western Reserve University School of Medicine, Cleveland, Ohio
JAMA Intern Med. 2015;175(12):1904-1910. doi:10.1001/jamainternmed.2015.4535.
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Importance  Contamination of the skin and clothing of health care personnel during removal of personal protective equipment (PPE) contributes to dissemination of pathogens and places personnel at risk for infection.

Objectives  To determine the frequency and sites of contamination on the skin and clothing of personnel during PPE removal and to evaluate the effect of an intervention on the frequency of contamination.

Design, Setting, and Participants  We conducted a point-prevalence study and quasi-experimental intervention from October 28, 2014, through March 31, 2015. Data analysis began November 17, 2014, and ended April 21, 2015. Participants included a convenience sample of health care personnel from 4 Northeast Ohio hospitals who conducted simulations of contaminated PPE removal using fluorescent lotion and a cohort of health care personnel from 7 study units in 1 medical center that participated in a quasi-experimental intervention that included education and practice in removal of contaminated PPE with immediate visual feedback based on fluorescent lotion contamination of skin and clothing.

Main Outcomes and Measures  The primary outcomes were the frequency and sites of contamination on skin and clothing of personnel after removal of contaminated gloves or gowns at baseline vs after the intervention. A secondary end point focused on the correlation between contamination of skin with fluorescent lotion and bacteriophage MS2, a nonpathogenic, nonenveloped virus.

Results  Of 435 glove and gown removal simulations, contamination of skin or clothing with fluorescent lotion occurred in 200 (46.0%), with a similar frequency of contamination among the 4 hospitals (range, 42.5%-50.3%). Contamination occurred more frequently during removal of contaminated gloves than gowns (52.9% vs 37.8%, P = .002) and when lapses in technique were observed vs not observed (70.3% vs 30.0%, P < .001). The intervention resulted in a reduction in skin and clothing contamination during glove and gown removal (60.0% before the intervention vs 18.9% after, P < .001) that was sustained after 1 and 3 months (12.0% at both time points, P < .001 compared with before the intervention). During simulations of contaminated glove removal, the frequency of skin contamination was similar with fluorescent lotion and bacteriophage MS2 (58.0% vs 52.0%, P = .45).

Conclusions and Relevance  Contamination of the skin and clothing of health care personnel occurs frequently during removal of contaminated gloves or gowns. Educational interventions that include practice with immediate visual feedback on skin and clothing contamination can significantly reduce the risk of contamination during removal of PPE.

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Figure 1.
Frequency of Skin and Clothing Contamination With Fluorescent Lotion During Removal of Personal Protective Equipment (PPE)

Overall and hospital-specific rates of contamination of skin and clothing of health care personnel after removal of contaminated gloves or gowns.

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Figure 2.
Sites of Contamination During Removal of Gloves or Gowns Contaminated With Fluorescent Lotion

Frequency of contamination by site during contaminated glove removal (n = 234), frequency of contamination by site during contaminated gown removal (n = 201), and contamination on the hands, neck, and scrub top after actual simulations.

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Figure 3.
Contamination of Personnel During Removal of Fluorescent Lotion–Contaminated Gloves Before and After an Intervention

Frequency of fluorescent lotion contamination before and immediately after an educational intervention and overall frequency of contamination for all personnel types before, immediately after, and 1 and 3 months after the intervention.

aP < .001 compared with before the intervention.

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