Half of medical workers contaminate themselves when removing personal protective equipment

Even when they don protective gear correctly, nearly half of medical workers contaminate their skin or clothing when removing gowns and especially gloves, a recent study published in JAMA Internal Medicine found.

The study, led by researchers from the Cleveland Veterans Affairs Medical Center, found the rate of self-contamination was much likelier when workers used improper technique to remove personal protective equipment (PPE)--70 percent compared with 30 percent for those who followed proper technique. The hands were most commonly contaminated during glove removal, and the neck during gown removal.

The good news: After watching a short video on proper technique and participating in a demonstration using fluorescent lotion to show "contamination," the rate of self-contamination fell by 68 percent. That rate was sustained three months later with no additional training, the study found.

"A standardized training procedure for healthcare workers on the recommended techniques for donning and/or doffing gowns and gloves is long overdue," according to an accompanying commentary written by Michelle Doll, M.D., and Gonzalo M. Bearman, M.D., both of the Division of Infectious Disease, Department of Medicine, Virginia Commonwealth University, Richmond. "The training should include educational context, proficiency monitoring, and feedback."

Immediate visual feedback using fluorescent lotion to show where workers contaminate themselves appears to be particularly effective, Doll and Bearman note. "However, a standard, accepted, and validated training program has unfortunately not been developed, and debate remains as to what constitutes best practice for donning and doffing," they said.

Doll and Bearman also noted that about 40 percent of the workers examined in the study put on or removed their PPE incorrectly. Last year, a study in the American Journal of Infection Control pegged the number at more than half. It also found that more than 85 percent failed to comply with Centers for Disease Control and Prevention (CDC) recommendations for removing PPE. For its part, the JAMA Internal Medicine study found that the CDC protocols are not sufficient to eliminate self-contamination.

Last year, amid the Ebola crisis, a survey by the Association for Professionals in Infection Control and Epidemiology found that half of hospitals surveyed either don't have a full-time infection preventionist on staff, or only have one. The organization says such infection-prevention specialists are critical for training staff on proper use of equipment, including PPE.

For more:
- here's the JAMA study
- read the commentary
- see the AJIC study

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