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Health care worker gown, glove procedures key to contamination risks

Health care worker gown, glove procedures key to contamination risks

Better strategies are needed to ensure health care workers don't come in contact with contaminants while removing personal protective equipment, experts say.

In 46% of cases, health care workers contaminated their skin or clothing while removing protective gloves and gowns, according to a study by Cleveland-based researchers from the Cleveland Veterans Affairs Medical Center, MetroHealth Medical Center and Case Western Reserve University School of Medicine.

Contamination occurred in 70% of cases when the removal technique was incorrect, according to the study, published by the Journal of the American Medical Association on Monday. But even when proper protocols were followed, contamination occurred in 30% of cases.

Experts agree the results are unsurprising.

“Obviously the protocols are not adequate,” Tom Fuller, assistant professor and safety program director at Illinois State University in Normal, Illinois, said in an email. “(Personal protective equipment) protocols in health care are often developed by medical practitioners without actual training in industrial hygiene or experience in contamination control … In the chemical and nuclear industries, workers have extensive training and experience in protecting themselves from hazardous materials.”

However, it's “a relatively new concept for many practitioners, even those with many years of experience,” despite the potential for contamination by a “broad range of agents,” such as tuberculosis, HIV, hepatitis, whooping cough and influenza, Mr. Fuller said.

To conduct the study, researchers had 435 participants at four Ohio hospitals remove personal protective equipment smeared with fluorescent lotion to simulate germs. Participants included nurses, physicians and allied health care personnel, such as physical therapists, radiology technicians and social workers.

Each of the four hospitals had a similar frequency, with contamination occurring more often during the removal of gloves (53%) than the removal of gowns (38%), the study says.

“When you do something hundreds of times a day, like don and doff gloves, you do tend to get complacent and not follow the procedures you were trained on,” said Lauri Laudano, network safety officer with Seton Healthcare Family in Austin, Texas, and assistant administrator of the health care practice specialty for The American Society of Safety Engineers. “But when the staff knows they're facing a high-risk case, like Ebola or (Middle East respiratory syndrome), they recognize it's a high-risk situation and take much more care.”

Correct techniques

Study authors considered techniques to be correct when the gown was donned prior to the gloves; the gloves covered the wrists of the gown; the gown was removed by pulling away from the neck, shoulders and body; and the gloves were removed at the same time as the gown, or one at a time without touching bare skin.

Gloves didn't cover the wrists in 113 cases, gowns were removed incorrectly in 44 cases, gloves were donned prior to gowns in 33 cases, and contaminated surfaces were touched during glove removal in 31 cases, according to the study.

To ensure proper protocols are being followed, Ms. Laudano recommends conducting peer observations and complimenting workers when they don and doff personal protective equipment correctly to reinforce good behaviors.

Continually retraining workers is also important, experts said.

Mr. Fuller said hospitals “need to develop their own policies and procedures and call upon the expertise of industrial hygienists with experience in infection control to be an integral part of the team.”

One problem identified in the study was that only one size gown was available at each of the four hospitals, making it difficult for petite, large and tall workers to follow procedures.

Though such workers comp claims are rare, it's important to increase training and improve procedures to reduce the risk of contamination, experts said.

Ms. Laudano said she can only recall one claim in recent history. It was filed by a health care worker who said she contracted scabies by touching her skin while removing her gloves, Ms. Laudano said.

Meanwhile, two nurses contracted Ebola last year after treating a Dallas hospital patient who later died from the infectious disease. As a result, the U.S. Centers for Disease Control and Prevention tightened safety rules nationwide for all hospitals that treat patients with Ebola.

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