title: Contamination of Health Care Personnel During Removal of Personal Protective Equipment.
abstract: OBJECTIVE
  Contamination of the skin and clothing of health care personnel during removal of personal protective equipment (PPE) contributes to dissemination of pathogens and places personnel at risk for infection.
  
  
  OBJECTIVE
  To determine the frequency and sites of contamination on the skin and clothing of personnel during PPE removal and to evaluate the effect of an intervention on the frequency of contamination.
  
  
  METHODS
  We conducted a point-prevalence study and quasi-experimental intervention from October 28, 2014, through March 31, 2015. Data analysis began November 17, 2014, and ended April 21, 2015. Participants included a convenience sample of health care personnel from 4 Northeast Ohio hospitals who conducted simulations of contaminated PPE removal using fluorescent lotion and a cohort of health care personnel from 7 study units in 1 medical center that participated in a quasi-experimental intervention that included education and practice in removal of contaminated PPE with immediate visual feedback based on fluorescent lotion contamination of skin and clothing.
  
  
  METHODS
  The primary outcomes were the frequency and sites of contamination on skin and clothing of personnel after removal of contaminated gloves or gowns at baseline vs after the intervention. A secondary end point focused on the correlation between contamination of skin with fluorescent lotion and bacteriophage MS2, a nonpathogenic, nonenveloped virus.
  
  
  RESULTS
  Of 435 glove and gown removal simulations, contamination of skin or clothing with fluorescent lotion occurred in 200 (46.0%), with a similar frequency of contamination among the 4 hospitals (range, 42.5%-50.3%). Contamination occurred more frequently during removal of contaminated gloves than gowns (52.9% vs 37.8%, P = .002) and when lapses in technique were observed vs not observed (70.3% vs 30.0%, P < .001). The intervention resulted in a reduction in skin and clothing contamination during glove and gown removal (60.0% before the intervention vs 18.9% after, P < .001) that was sustained after 1 and 3 months (12.0% at both time points, P < .001 compared with before the intervention). During simulations of contaminated glove removal, the frequency of skin contamination was similar with fluorescent lotion and bacteriophage MS2 (58.0% vs 52.0%, P = .45).
  
  
  CONCLUSIONS
  Contamination of the skin and clothing of health care personnel occurs frequently during removal of contaminated gloves or gowns. Educational interventions that include practice with immediate visual feedback on skin and clothing contamination can significantly reduce the risk of contamination during removal of PPE.
authors.affiliation: Geriatric Research, Education, and Clinical Center, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio.
authors.forename: Myreen E
authors.initials: ME
authors.lastname: Tomas
authors.affiliation: Research Service, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio.
authors.forename: Sirisha
authors.initials: S
authors.lastname: Kundrapu
authors.affiliation: Research Service, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio.
authors.forename: Priyaleela
authors.initials: P
authors.lastname: Thota
authors.affiliation: Research Service, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio.
authors.forename: Venkata C K
authors.initials: VC
authors.lastname: Sunkesula
authors.affiliation: Research Service, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Cadnum
authors.affiliation: Research Service, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio.
authors.forename: Thriveen Sankar Chittoor
authors.initials: TS
authors.lastname: Mana
authors.affiliation: Research Service, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio.
authors.forename: Annette
authors.initials: A
authors.lastname: Jencson
authors.affiliation: Infection Prevention and Control Department, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio.
authors.forename: Marguerite
authors.initials: M
authors.lastname: O'Donnell
authors.affiliation: Infection Prevention and Control Department, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio.
authors.forename: Trina F
authors.initials: TF
authors.lastname: Zabarsky
authors.affiliation: Division of Infectious Diseases, Department of Medicine, MetroHealth Medical Center, Cleveland, Ohio5Department of Medicine, Infectious Diseases Division, Case Western Reserve University School of Medicine, Cleveland, Ohio.
authors.forename: Michelle T
authors.initials: MT
authors.lastname: Hecker
authors.affiliation: Department of Medicine, Infectious Diseases Division, Case Western Reserve University School of Medicine, Cleveland, Ohio.
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Ray
authors.affiliation: Geriatric Research, Education, and Clinical Center, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio.
authors.forename: Brigid M
authors.initials: BM
authors.lastname: Wilson
authors.affiliation: Geriatric Research, Education, and Clinical Center, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio5Department of Medicine, Infectious Diseases Division, Case Western Reserve University School of Medicine, Cleveland, Ohio.
authors.forename: Curtis J
authors.initials: CJ
authors.lastname: Donskey
mesh_terms: D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D004783:Environmental Microbiology; D004866:Equipment Contamination / Q000706:statistics & numerical data*; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006801:Humans; D017053:Infection Control / Q000379:methods*; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000706:statistics & numerical data*; D007362:Intensive Care Units; D009820:Ohio / Q000453:epidemiology; D000067393:Personal Protective Equipment / Q000382:microbiology*; D012189:Retrospective Studies; D018570:Risk Assessment