Healthcare workers caring for infectious patients sometimes make mistakes when removing personal protective garments, resulting in contamination of clothes or equipment with antibiotic-resistant bacteria, another small study on hospital contamination has shown.

Over a six-month period, Dr. Koh Okamoto of Rush University Medical Center in Chicago, and colleagues observed 125 healthcare workers, including 83 nurses and 24 doctors, in four adult intensive care units at their hospital. Half of the doctors and nurses had received formal training in the use of personal protective equipment for the Ebola virus within the previous year, and 90 percent had received “donning and doffing” training within the previous five years.

During the study, the workers oversaw 95 patients with contact precautions for methicillin-resistant Staphylococcus aureus, or MRSA, as well as vancomycin-resistant Enterococci and multidrug-resistant gram-negative bacilli.

The research team collected 6,000 samples from 5,000 sites around the ICUs, including items that had touched the patient’s body and environmental surfaces such as blood pressure cuffs, call buttons and sinks. They also tested the healthcare workers’ hands, gloves and gowns before and after patient interactions. In addition, they watched the “doffing,” or removal process, and recorded errors based on Center of Disease Control and Prevention guidelines, which recommends removing gowns and gloves together.

According to a report published in Infection Control and Hospital Epidemiology, they found that more than a third of the healthcare workers acquired a multidrug-resistant organism during a patient encounter. Notably, four healthcare workers had it on their hands, four had it on their clothes or jewellery, three had it on their stethoscope, and two had it on their in-hospital mobile phones. About 70 percent of environmental sites had organisms, especially items that were close to patients such as blood pressure cuffs, call buttons and bed rails.

Overall, 49 workers, or 39 percent, made multiple doffing errors and were more likely to have contaminated clothes after a patient interaction. For instance, all four healthcare workers with hand contamination made errors while removing their gowns and gloves. In particular, hand contamination was 10 times higher when gloves were removed before gowns.

“Our study occurred in a real-world busy ICU setting where the rush of crisis care makes simple slip-ups more likely,” Okamoto said. “This allowed us to better observe donning and doffing methods and potential errors of various healthcare workers.”

Simple interventions are needed that reinforce the preferred order of doffing, which could reduce contamination, he said. Removing gloves and gowns together as a unit, for instance, seemed most helpful in preventing self-contamination.


REFERENCE: Okamoto et al: Impact of doffing errors on healthcare worker self-contamination when caring for patients on contact precautions;