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Contamination of skin, clothing frequent during removal of gloves, gowns

In the process of removing contaminated gowns and gloves, health care workers frequently contaminated their skin and clothing, according to findings published in JAMA Internal Medicine.

Myreen E. Tomas, MD, a researcher affiliated with the Cleveland Veterans Affairs Medical Center, and colleagues conducted a point-prevalence study and quasi-experimental intervention to assess contamination.

The study evaluated health care personnel at four Cleveland-area hospitals from October 2014 to March 2015. The hospitals included a VA medical center, a community hospital, and tertiary care university and county hospitals.

Personnel participated in simulations of removal of contaminated isolation gowns and nitrile gloves. They donned the equipment in a typical way and rubbed fluorescent lotion on the gloves and gowns to simulate contamination. Participants then doffed the equipment using their typical technique. Researchers assessed contamination by using a black light.

The infection control department at the VA medical center in the study implemented an intervention after finding frequent contamination. Health care personnel received education and performed contamination simulations after initial training, as well as 1 and 3 months afterward.

Results showed that 435 simulations were conducted in the study and contamination occurred during 200 (46%) of the simulations. Contamination was more frequent with glove removal than gown removal (52.9% vs. 37.8%; P = .002) and with incorrect technique than correct technique (70.3% vs. 30%; P < .001).

Tomas and colleagues also reported that the intervention reduced contamination immediately after training (60% before contamination vs. 18.9% after; P < .001). At both the 1-month and 3-month follow-up, contamination reduction was sustained (12% for both time points; P < .001).

"In four hospitals, contamination of the skin and clothing of health care personnel occurred frequently during removal of contaminated gloves or gowns," Tomas and colleagues wrote. "A quasi-experimental educational intervention that included practice with immediate visual feedback on skin and clothing contamination significantly reduced contamination during [personal protective equipment] removal in one hospital. These findings highlight the urgent need for additional studies to determine effective strategies to minimize the risk of contamination during [personal protective equipment] removal, to improve [personal protective equipment] design, and to identify optimal methods for training of personnel in [personal protective equipment] use." – by Chelsea Frajerman Pardes

Disclosure: One of the researchers reports serving as a member of advisory boards for Cubist and Merck, and receiving research funding from Clorox, Cubist, EcoLab, GOJO, STERIS and 3M.