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Poor removal of protective clothing ‘contaminates’ health staff

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More than a third of healthcare staff have been found to be contaminated with multi-drug resistant organisms after caring for patients colonised or infected with the bacteria, according to a US study.

The study found that 39% of workers made errors in removing personal protective equipment (PPE), including gowns and gloves, increasing the incidence of contamination.

“We should re-evaluate strategies for removing personal protective equipment”

Koh Okamoto

As a result, researchers called for a re-evaluation of strategies for removing personal protective equipment, as well as how often healthcare workers were trained on these methods.

The findings were published today in Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America.

Researchers monitored 125 staff in four adult intensive care units caring for patients colonised or infected with organisms, including MRSA and vancomycin-resistant Enterococcus.

They took over 6,000 samples from healthcare workers’ hands, gloves, PPE, and other equipment, such as stethoscopes and mobile phones, taking cultures before and after patient interaction.

Additionally, trained observers monitored the technique each worker used to put on and remove their PPE and tracked errors based on guidelines established by US regulators.

The US Centers for Disease Control and Prevention suggests two removal methods for PPE – a gloves-first strategy, and an approach that removes gown and gloves together.

The researchers, from Rush University in Chicago, also tracked a third method of removing the gown first.

A significant majority of the healthcare workers had received training on appropriate methods for putting on and removing PPE within the past five years.

After patient contact, 36% of healthcare workers were contaminated with a multi-drug resistant organism.

Contamination of healthcare workers’ PPE was more common in settings of higher patient and environmental contamination, said the study authors.

After removing their PPE, 10.4% were found to be contaminated on their hands, clothes, or equipment.

Staff who made multiple errors when removing their PPE were more likely to be contaminated after a patient encounter.

However, the rate of making errors depended on the PPE removal method, with 72% of workers who used a glove-first removal making multiple errors, said the researchers.

Examples of errors included touching the inside of the gown or glove with a gloved hand, touching the outside of the gown or glove with bare hands, and not unfastening the gown at the neck.

Given the high rate of hand contamination of those who used the gloves-first strategy, the authors recommend further research and possible reconsideration of this technique, as well as research to examine the impact of improved education for putting on and taking off PPE.

Additionally, they noted several limitations to their work, including the influence of observers on healthcare staff practices and the potential that not all contamination was detected.

Lead author Dr Koh Okamoto said: “Based on these findings, we should re-evaluate strategies for removing personal protective equipment, as well as how often healthcare workers are trained on these methods.

“An intervention as simple as education about appropriate doffing of personal protective equipment may reduce healthcare worker contamination with multi-drug resistant organisms,” he added.

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