"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," said Koh Okamoto, MD, MS, a lead author of the study.
"An intervention as simple as education about appropriate doffing of
personal protective equipment may reduce healthcare worker contamination with
multi-drug resistant organisms."
Researchers
at Rush University Medical Center monitored 125 healthcare workers in four
adult intensive care units who were caring for patients colonized or infected
with a MDRO, including methicillin-resistant Staphylococcus aureus (MRSA) and
vancomycin-resistant Enterococcus (VRE). Researchers took more than 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 the Centers for
Disease Control and Prevention. The CDC suggests two removal methods for PPE --
a gloves-first strategy, and an approach that removes gown and gloves together.
Researchers 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 percent of healthcare workers were contaminated with a
MDRO. Contamination of healthcare workers' PPE was more common in settings of
higher patient and environmental contamination. After removing their PPE, 10.4
percent were contaminated on their hands, clothes, or equipment.
Healthcare
workers 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 percent of workers who used a
glove-first removal making multiple errors. 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, the authors note
several limitations to their work, including the influence of observers on
healthcare workers' practices and the potential that not all contamination was
detected.
See:
Posted by Dr. Tim Sandle, Pharmaceutical Microbiology
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