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 This contamination can spread germs and place the health care
workers at risk for infection, the authors write in JAMA Internal
Medicine.
“It was surprising for the participants in the study to see that
they frequently contaminated themselves during (personal protective
equipment) removal,” said senior author Dr. Curtis J. Donskey of the
Cleveland Veterans Affairs Medical Center.
“Most of the participants appeared to be unaware of the high risk
for contamination and many reported receiving minimal or no training
in putting on and taking off (personal protective equipment),” he
told Reuters Health by email.
Contaminated personnel can also spread pathogens to other
susceptible patients.
The researchers recruited doctors, nurses and other health care
personnel such as phlebotomists and physical therapists at four
Cleveland-area hospitals to participate in the simulations. More
than half of the 435 simulations were performed by nurses.
The participants put on protective gowns and gloves in their usual
manner and then had a small amount of fluorescent lotion placed in
the palm of their hands, which they then rubbed between their hands
for 15 seconds to simulate dirtied gloves, then smeared the gloves
over the chest and abdomen area of the gown. Then the gloves were
exchanged for clean ones.
After they removed their gloves and gowns in their usual manners,
researchers used a black light to check for lotion contamination of
the hands, forearms, neck, face, hair or clothing.
Skin or clothing contamination happened 46 percent of the time, more
frequently during glove removal.
Researchers also noted whether participants had used proper
protective equipment technique, e.g., wearing gloves extended over
the wrists of the gown, gown removed first by pulling away from the
neck and body, and gloves removed second.
Contamination happened 70 percent of the time when proper technique
was not followed, compared to 30 percent of the time when it was
followed.
“When dealing with pathogens that are potentially fatal, the goal
has to be zero contamination,” Donskey said. “In routine care
settings, we would like personnel to be well trained and confident
that they can minimize contamination, but would not insist on zero
contamination.”
It is important for personnel to perform hand hygiene after removing
gloves and gowns since contamination could have happened, he said.
The researchers also conducted these tests with a group of personnel
who had attended special infection control sessions, with a
10-minute video presentation and 20 minutes of demonstrations and
practice in using and removing protective gear.
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Before the training sessions, these individuals contaminated
themselves 60 percent of the time, compared to almost 19 percent
after the sessions. The improvements were still seen at re-tests
done one and three months later.
“This suggests that training using fluorescent lotion can be useful
to identify minor deficiencies in technique that lead to
contamination,” Donskey said.
Recent experience with the Ebola virus in the U.S. demonstrated that
self-contamination during removal of protective equipment does
occur, but this study exposes a more widespread issue that may be
happening during routine patient care, said Dr. Michelle Doll of
Virginia Commonwealth University in Richmond who coauthored a
commentary on the new study.
“Use of gowns and gloves for contact precautions on a busy inpatient
unit is costly on multiple levels,” Doll told Reuters Health by
email. “In situations when we do decide to use these tools (for
infection prevention, we need to optimize techniques to achieve the
best efficacy possible. Otherwise it is wasteful of healthcare
worker efforts and hospital resources.”
The sight of fluorescent dye on one’s face and hands would be a
powerful and lasting lesson, she said.
“Being able to see where contamination occurs allows personnel to
make adjustments in their technique,” Donskey said. “Because
training alone did not result in zero contamination, there is a need
for other approaches such as improving (equipment) design or
disinfection of (equipment) prior to removal.”
SOURCES: http://bit.ly/1NBRjqz and http://bit.ly/1jklyFS JAMA
Internal Medicine, online October 12, 2015.
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