Martha Polovich, PhD, RN, AOCN
Using fluorescent lotion and a backlight, researchers examined the frequency and sites of contamination in 435 glove and gown removal simulations.
The study, published by JAMA Internal Medicine, showed that contamination of the skin or clothing occurred in 46% of the participants. Lapses in technique were observed in 70% of contamination cases, but contamination also occurred in 30% of cases where protocol was followed (P < .001).
“I have always talked to nurses and whoever I can about this topic and indicated that this is common. There just wasn’t any research to support it before,” said Martha Polovich, PhD, RN, AOCN, of the Byrdine F. Lewis Scholl of Nursing & Health Professions at Georgia State University.
“All of us who are involved in safe handling are really concerned about the possibility of transferring contamination from PPE to healthcare workers.”
For the study, investigators recruited 435 participants from four Ohio hospitals. The PPE was smeared with fluorescent lotion to simulate hazardous material, and each person was asked to remove their gloves and gowns in their usual manner.
The results were observed using a black light, and the study found that contamination occurred more frequently in the removal of gloves than gowns (52.9% vs 37.8%, P = .002). There was a similar frequency among all four hospitals.
“Most healthcare workers believe that exposure is bad. What they don’t accept is the fact that they’re likely to be exposed,” Polovich said. “This study is a piece of evidence to demonstrate that healthcare workers need to be more serious about it.”
Following these findings, the Infection Control Department at the Veterans Affairs medical center implemented an intervention over 1 to 3 months, where healthcare personnel attended training sessions on proper CDC protocol and practiced removing their PPE using immediate visual feedback.
After completing the intervention, contamination rates dropped from 60% to 18.9% (P < .001).
Evidence has demonstrated that whenever you use personal protective equipment for handling hazardous drugs, it’s likely to be contaminated—maybe only slightly—but it’s still likely to be contaminated,” Polovich said. “If individuals assume that their PPE is contaminated, they’ll be more likely to be careful when removing it.”
“We do need standardized education and training to demonstrate that healthcare workers have mastered the technique.”
In addition to education, Polovich said that she also advocates for healthcare personnel to wear double gloves. During removal, the employee would carefully remove the outer gloves, turning them inside out, and then discarding them. The hands are still protected by the inner gloves, which can then be removed safely.
“That is what many of us believe to be the best way to protect transfer of contamination from the outer gloves and from the gowns to the healthcare worker,” she said.
The authors of the study concluded that the findings suggest potential areas of improvement for PPE.
“These findings highlight the urgent need for additional studies to determine effective strategies to minimize the risk of contamination during PPE removal, to improve PPE design, and to identify optimal methods for training of personnel in PPE use,” they wrote.
Tomas ME, Kundrapu S, Thota P, et al. Contamination of health care personnel during removal of personal protective equipment. JAMA Intern Med. 2015; doi: 10.1001/jamainternmed.2015.4535.