ETC 55 - Unmasking Safety: Innovations in Validating PPE Doffing Protocols with Bacteriophages

Background: Complex personal protective equipment (PPE) ensembles are used as a barrier between healthcare workers (HCW) and high-consequence threats to their safety. The measure of effective protection is two-fold: the articles that make up the ensemble must be protective of the particular threat anticipated, and personnel must be able to remove the protective garments or devices without transferring contamination to themselves. The objective of this study is to evaluate the process for removal of a complex PPE ensemble for the presence of contamination on the skin and clothing of the wearer.

Methods: Twelve staff members were placed into the protective apparel worn in a biocontainment unit and bacteriophage sprays were applied to the outer ensemble pieces. Four distinct phages were used to track results to the areas the phages were applied. Staff members removed the PPE ensemble according to a provided protocol. The hands, arms, and scrubs worn beneath the PPE were sampled for contamination from the four phages. We describe a quality assurance approach to evaluating PPE protocols and human factors in safe doffing protocols though a Plan-Do-Study-Act methodology.

Results: Our findings indicated transference of contamination was frequent among tested staff members and could be traced to multiple original PPE contamination sites. Changes were made to the PPE ensemble and to the order and guidance of the doffing protocol. Revalidation yielded a complete elimination of transferred contamination.

Conclusions: This study raises the importance of safe doffing validation to guide PPE doffing protocols in high consequence infectious diseases.