Dental Healthcare Personnel Protocol Deviations and Self-Contamination During PPE Donning and Doffing
TAKE-HOME MESSAGE
- This study assessed the risk of self-contamination in dental healthcare personnel (DHCP) when donning and doffing personal protective equipment (PPE) per the CDC guidelines. The donning/doffing steps associated with the most protocol deviations involved hand hygiene, followed by the donning/doffing of disposable gowns. Face masks (donning) and eye protection (doffing) were also highly associated with protocol deviations.
- PPE is an important tool that can help protect DHCP from exposure to pathogens, but PPE must be donned and doffed correctly to prevent self-contamination. The results of this study indicate that DHCP contamination is common during the donning and doffing of PPE, suggesting that further education/training is needed.
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersBACKGROUND
Dental health care personnel (DHCP) may be at increased risk of exposure to severe acute respiratory syndrome coronavirus 2, the virus that causes COVID-19, as well as other clinically important pathogens. Proper use of personal protective equipment (PPE) reduces occupational exposure to pathogens. The authors performed an assessment of PPE donning and doffing practices among DHCP, using a fluorescent marker as a surrogate for pathogen transmission.
METHODS
Participants donned PPE (that is, disposable gown, gloves, face mask, and eye protection) and the fluorescent marker was applied to their palms and abdomen. DHCP then doffed PPE according to their usual practices. The donning and doffing processes were video recorded, areas of fluorescence were noted, and protocol deviations were assessed. Statistical analyses included frequency, type, and descriptions of protocol deviations and factors associated with fluorescence.
RESULTS
Seventy DHCP were enrolled. The donning and doffing steps with the highest frequency of protocol deviations were hand hygiene (66% of donning and 78% of doffing observations involved a deviation) and disposable gown use (63% of donning and 60% of doffing observations involved a deviation). Fluorescence was detected on 69% of DHCP after doffing, most frequently on hands. An increasing number of protocol deviations was significantly associated with increased risk of fluorescence. DHCP with a gown doffing deviation, excluding doffing out of order, were more likely to have fluorescence detected.
CONCLUSIONS
DHCP self-contamination was common with both donning and doffing PPE.
PRACTICAL IMPLICATIONS
Proper use of PPE is an important component of occupational health.
Click on any of these tags to subscribe to Topic Alerts. Once subscribed, you can get a single, daily email any time PracticeUpdate publishes content on the topics that interest you.
Visit your Preferences and Settings section to Manage All Topic Alerts
Additional Info
Disclosure statements are available on the authors' profiles:
Assessment of dental health care personnel protocol deviations and self-contamination during personal protective equipment donning and doffing
J Am Dent Assoc 2022 Nov 01;153(11)1070-1077.e1, KA Reske, D Park, TH Bach, HB Stewart, LC Vogt, OG Arter, D Stoeckel, HM Steinkamp, SY Liang, MJ Durkin, JH KwonFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Wearing personal protective equipment (PPE) has been a part of the fabric of infection control and the practice of dentistry for more than four decades, and many of us who graduated after universal precautions became a standard practice cannot even remember a time when you did not wear gloves and masks. We hear stories from seasoned practitioners who practiced without wearing gloves or masks but cannot imagine that now. With the COVID-19 pandemic and all its unknown variables, we have again asked ourselves, are our current PPE practices enough to protect ourselves, or do we need to change? There is no simple answer. When the COVID-19 pandemic started, we went through different stages from “it will not come to the US” to “it is here but will not get that bad and will fizzle out” and to “oh my gosh, we need to stop seeing patients and figure out what to do” all within a very short time span. This intense time allowed the practitioners of dentistry to self-reflect on the current practices and quickly put into motion solutions to mitigate the transmission of COVID-19 to and from our patients. I believe what we found was that we were not as bad off as we thought. In the daily practice of dentistry, we have been managing dental aerosols using our current PPE and mitigation strategies (high-speed suction, rubber dam, etc) quite successfully, with very few reports of transmission of communicable diseases via dental work. However, with the emergence of new diseases, we must re-evaluate our practices, and we have room to improve as highlighted in this article by KA Reske and colleagues. They found that the donning and doffing of PPE were performed improperly, especially the gown, causing self-contamination. This study group was also found to have poor compliance with hand hygiene, with 78% of participants having contamination on their hands after doffing. Washing our hands is one of the simplest ways to prevent the transmission of many viral and bacterial infections. This article provides an important reminder that the COVID-19 pandemic is not the first and will not be the last public health emergency that challenges the way we practice. We must remain vigilant in the way we protect our patients and ourselves in the daily practice of dentistry. To do this, we cannot just think outside the box, but we need to break down the box to come up with practical, flexible, and innovative ideas to rise up to the challenge.