Are nurses protected? Observing the risk of skin contamination when donning and doffing personal protective equipment, using a Canadian protocol.

Abstract

This study aimed to determine whether the Public Services Health and Safety Association’s donning and doffing protocol for Ebola are effective in the prevention of skin and clothing contamination. Ten third-year nursing students performed a donning and doffing simulation, which included donning personal protective equipment (PPE), being sprayed with GloGerm, performing eight simulated movements, and doffing PPE. Fluorescent stains were observed using an ultraviolet scan and were documented by their location and size. Four participants (N=4) experienced at least one contamination event following the doffing of PPE. Contaminations were observed on: the left dorsal lower leg (41.3mm; 64.0mm); the right dorsal lower leg (77.9mm); the left plantar (9.5mm); the left index finger (2.8mm); the right middle finger (1.6mm); the left scapula (38.1mm); and the right buttock (57.2mm). Areas of difficulty in the protocol included donning and doffing: the gown, N95 respirator, and the outer footwear. Failures with the equipment, including breaches and punctures, also contributed to the documented contamination. Near-miss incidents were observed in nine of the twenty-four steps in the protocols and occurred a total of twenty times. Revisions to the protocols were completed and included additional information for the following protocol steps: hang hygiene, N95 respirator, gown, outer footwear, verification process.