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Personal protective equipment (PPE) serves 2 critical functions for the healthcare setting: protecting healthcare providers from occupational hazards and protecting patients from transmission of infection. PPE has come under increased scrutiny as a result of public attention to healthcare-associated infections and global experiences with emerging infectious diseases. Data suggest that despite PPE use, healthcare workers routinely contaminate their skin and clothing during patient care.1–3 Standardized procedures exist for donning and doffing PPE,4 and Tomas et al3 have shown a potential for improvement in self-contamination rates using a training program in which participants visually observed transfer of a fluorescent dye from PPE to areas of self-contaminated skin or clothing.3
Self-contamination is generally invisible, thus the downstream consequences are difficult to discern. However, high rates of self-contamination arguably defeat the purpose of PPE. In order to better evaluate PPE use at our institution, we conducted a needs assessment for a PPE training program, as measured both objectively by observation and subjectively by survey.
A convenience sample of providers from 3 inpatient units and the emergency department were chosen because of frequent PPE use on these units. The emergency department additionally uses PPE for provider protection during trauma evaluations. An observation tool adapted from Tomas et al3 was used to perform real-time assessments of donning and doffing behaviors during patient care episodes. No dyes were used to simulate contamination. Observations were conducted in close proximity to the provider in order to accurately record behaviors, thus providers may have been aware of their presence; the reason for observation was provided if asked. “Correct” glove and gown removal methods were defined using the recommendations of the Centers for Disease Control and Prevention.4
A survey was constructed using items adapted from our Ebola preparedness survey, and further revised to reflect the Information, Motivation, and Behavioral Skills Model.5 Information component questions asked about provider understanding of transmission risks in the hospital, understanding of PPE rationale, and availability of resources. Motivation questions asked the likelihood of personally using PPE correctly and likelihood of correcting the PPE techniques of others. Skills questions asked about prior PPE training, perspectives on the need for additional training, and overall confidence in PPE skills.
Students and nonclinical staff...