QUESTION
EBP Annotated Bibliography Feedback Assignment
Module 1 Assignment: EBP Annotated Bibliography Feedback Assignment
Annotated bibliographies (ABs) help you organize your project’s scholarly information. This writing assignment gives you practice in writing your AB for the EBP class.
Directions: Review the Module 1 Lesson on annotated bibliographies. Use the Phan article from EBP (linked below) as your source for this assignment.
1. Create an APA bibliographic entry. The reference is listed ahead of the summary paragraphs.
2. The annotation consists of two paragraphs using the following parameters: a summary paragraph and an analysis paragraph. This assignment should not exceed one double spaced page.
Paragraph 1 (Summary): Briefly summarize the article using complete sentences. The following questions will guide you as you write your summary:
What is the article about?
What kind of study/review was done (i.e., RCT, descriptive, case study, or Systematic Review of similarly designed studies, etc.)?
What is the author’s purpose?
Is the text difficult to read or understand?
Does the author introduce the problem statement? (briefly state)
How and to whom (i.e. population of interest) was the study done?
What main findings are clinically relevant?
Paragraph 2 (Analysis): Explain how this article (source) is clinically relevant to the problem question:
What are the best Personal Protective safety practices for healthcare staff?
Explain how this article (source) is clinically relevant. How does this article add to the evidence to inform you on personal protection safety practices and/or your problem statement?
Use excellent APA 7th ed. qualities (paragraph organization, excellent sentence structure, grammar, spelling, references (including https://doi..”etc.).
I HAVE ATTACH THE NECESSARY ARTICLE
Personal protective equipment doffing practices of healthcare workers
Linh T. Phana , Dayana Maitab, Donna C. Mortizb, Rachel Webera, Charissa Fritzen-Pedicinia,
Susan C. Bleasdaleb , Rachael M. Jonesa , for the CDC Prevention Epicenters Program
aSchool of Public Health, University of Illinois at Chicago, Chicago, Illinois; bCollege of Medicine, University of Illinois at Chicago,
Chicago, Illinois
ABSTRACT
During the doffing of personal protective equipment (PPE), pathogens can be transferred
from the PPE to the bodies of healthcare workers (HCWs), putting HCWs and patients at risk
of exposure and infection. PPE doffing practices of HCWs who cared for patients with viral
respiratory infections were observed at an acute care hospital from March 2017 to April
- A trained observer recorded doffing performance of HCWs inside the patient rooms
using a pre-defined checklist based on the Centers for Disease Control and Prevention
(CDC) guideline. Doffing practices were observed 162 times during care of 52 patients
infected with respiratory viral pathogens. Out of the 52 patients, 30 were in droplet and
contact isolation, 21 were in droplet isolation, and 1 was in contact isolation. Overall, 90%
of observed doffing was incorrect, with respect to the doffing sequence, doffing technique,
or use of appropriate PPE. Common errors were doffing gown from the front, removing
face shield of the mask, and touching potentially contaminated surfaces and PPE during
doffing. Deviations from the recommended PPE doffing protocol are common and can
increase potential for contamination of the HCW’s clothing or skin after providing care.
There is a clear need to change the approach used to training HCWs in PPE doffing
practices.
KEYWORDS
Doffing; healthcare workers;
infection prevention; personal
protective equipment
Introduction
Although personal protective equipment (PPE) falls at
the lowest level of the hierarchy of controls due to the
dependence of PPE effectiveness on individual behavior,
it is a primary strategy to prevent disease transmission
in healthcare settings. Specifically, the
Healthcare Infection Control Practices Advisory
Committee (HICPAC), who provide advice and guidance
regarding the practice of control of healthcareassociated
infections to the Centers for Disease
Control and Prevention (CDC) and the Secretary of
the Department of Health and Human Services, recommends
the use of PPE in standard and transmission-
based infection control precautions.[1] Standard
precautions require the HCW to anticipate exposures
and select appropriate PPE, while transmission-based
precautions include a specific PPE ensemble for use
by HCWs providing care to patients with an infectious
disease or disease syndrome classified as being
transmitted through the airborne, contact, or droplet
route.
To prevent disease transmission in healthcare
settings, PPE must be used consistently and correctly
by HCWs to prevent exposure and the transport
of pathogens to their bodies. The infection of
two nurses with Ebola Virus Disease (EVD) in
Dallas, Texas has been attributed to PPE failure or
incorrect PPE use.[2] Simulation studies in which
the PPE of HCWs are contaminated with pathogen
surrogates have shown that improper PPE doffing
practices may result in contamination of HCWs
skin and clothing.[3,4]
In this study, we characterized the PPE use and PPE
doffing practices of HCWs providing care for patients
with viral respiratory infections in an acute care hospital.
Our approach was direct observation performed
inside of patient rooms. Previous work has documented
that HCWs compliance with PPE use is relatively low
and that doffing practices are inconsistent, but much of
that work involved observations outside of patient
rooms, or in the context of simulation.[5–7] The contribution
of this work is the description of doffing
CONTACT Rachael M. Jones [email protected] 1603 W. Taylor St., Chicago IL, 60612.
Supplemental data for this article can be accessed at tandfonline.com/uoeh. AIHA and ACGIH members may also access supplementary material at
http://oeh.tandfonline.com/.
_ 2019 JOEH, LLC
JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE
2019, VOL. 16, NO. 8, 575–581
https://doi.org/10.1080/15459624.2019.1628350
practices following routine patient care among diverse
worker types inside the rooms of patients with viral
respiratory infections and labeled for transmission-based
precautions.
Methods
PPE doffing practices of HCWs who cared for patients
with viral respiratory infections were observed at a
465-bed acute care hospital from March 2017 to June
2017 and September 2017 to April 2018. HCW and
patient participants provided written informed consent.
HCWs were eligible to participate if they were
adults, able to communicate in English, and provided
care to a patient with a viral infection that had consented
to participate in the study. Eligible HCW participants
were recruited at staff meetings and at
patient rooms before HCWs entered the room. HCW
participants could participate more than one time
because HCWs performed different types of care
activities and/or on different patients during each
observation. The doffing practice results were not
reviewed with HCWs following the observations. This
study was approved by the University of Illinois at
Chicago Institutional Review Board, protocol number
2015-0990.
Patients having respiratory infections were identified
through the hospital MedMined surveillance system.
Patients were eligible to be recruited if they were
adults, fluent in English or Spanish, and had a positive
respiratory pathogen panel test within three days prior
to the day of observation. The patients had a variety
of acute viral respiratory infections including: influenza
A (n ¼ 23), influenza B (n ¼ 8), and rhinovirus
(n ¼ 15); and respiratory syncytial virus (n ¼ 3), coronavirus
(n ¼ 1), parainfluenza (n ¼ 1), and adenovirus
(n ¼ 1).
The study occurred in nine units in the hospital,
which were classified into three groups: (1) Intensive
Care Units (ICUs), which included the Neurological
ICU, the Medical ICU and the Step Down unit; (2)
non-ICUs, which included the Rehabilitation/
Orthopedics unit, the Clinical Decision/Observation
unit, the General Medical Surgical unit and the Liver/
Gastroenterology unit; and (3) specialty units, which
included the Bone Marrow Transplant and
Hematology-Oncology units. The unit groupings were
based on unit workflow and patient medical
conditions.
Researchers waited outside patient rooms and performed
observations during a 3-hr period, typically
from 8 a.m. to 12 p.m. One trained observer
recorded the PPE use and doffing practices of HCWs
inside patient rooms using a pre-defined checklist
based on the CDC guideline that included: PPE
worn, sequence of doffing, carefulness of doffing, disposal
location, doffing PPE inside out, removing PPE
from the front, and performance of hand hygiene.[8]
The check list is available in the Supplementary
Materials. The correct PPE to be worn by HCWs
was based on the isolation signs mounted outside the
patient room door. For patients on contact isolation,
HCWs were to wear gloves and a reusable isolation
gown. For patients on droplet isolation, HCWs were
to wear a surgical mask with eye shield. For patients
on droplet and contact isolation, HCWs were to
wear gloves, a reusable isolation gown, and a surgical
mask with eye shield (visor). According to the CDC
recommendations, the correct doffing sequence
includes removing gloves first, followed by the gown,
the mask, and then hand hygiene. In our study,
hand hygiene was not included in the correct doffing
sequence evaluation but reported separately. Gloves
should be removed by holding the outside palm area
of one glove, pulling it off, and then holding it in
the other gloved hand. The second glove should be
peeled off inside-out using fingers of the ungloved
hand. A washable, reusable fabric gown with ties at
the neck should be taken off by unfastening gown
ties, pulling away from the shoulder inside-out, and
folding into a bundle. A surgical mask should be
removed by taking off elastic ear bands of the mask
without touching the front of the mask. All PPE
must be removed before leaving the patient room at
the doorway or in anteroom.[8] In addition, we evaluated
the doffing carefulness, defined as a removal
process not involving strong or vigorous movements,
which may generate infectious aerosols from contaminated
PPE.
Data were recorded on paper forms and entered
into a database using double data entry (Access, 2016;
Microsoft, Redmond, WA). All data analysis was performed
with the R project for Statistical Computing
(The R Foundation for Statistical Computing, Vienna,
Austria). Differences in proportions among HCW job
role groups, hospital unit groups, and patient isolation
categories were tested with the v2 test where expected
values were determined using the overall mean proportion.
Statistical significance was set at a ¼ 0.05 for
all tests. Although HCWs could participate more than
one time, observations were treated as independent in
the statistical analyses because HCWs performed different
type of care activities and/or on different
patients during each observation.
576 L. T. PHAN ET AL.
Results
In total, we observed the PPE doffing practices of 107
HCWs, with 23 HCWs participating more than once
for a total of 166 observations during care of 52
patients. Four observations were excluded from the
analysis because the observer was not able to record
the doffing activities of HCWs, giving a final sample
size of 162 observations. Sample sizes vary slightly for
some variables because not all variables were recorded
in all observations. Observations involved: nurses
(n¼63), nurse technicians (n ¼ 37), attending physicians
(n ¼ 18), resident physicians (n ¼ 15), respiratory
therapist (n ¼ 9), nurse practitioners (n ¼ 7),
environmental service workers (ESWs, n ¼ 4), nursing
students (n ¼ 3), physical therapists (n ¼ 3), medical
students (n ¼ 2), and a dietician (n ¼ 1). We grouped
observations of attending physicians, resident physicians,
nurse practitioners, and medical students into
the “provider” group; nurses and nursing students
into the “nurse” group; and physical therapists, ESWs,
and dieticians into the “others” group. The provider
and nurse groupings were based on the observation
that these HCWs performed similar care activities. Of
the 52 patient participants, 30 were in droplet and
contact isolation, 21 were in droplet isolation, and 1
was in contact isolation.
HCWs chose the correct pieces of PPE in 39 of 61
(64%) observations of care for patients in droplet isolation
and in 55 of 97 (57%) observations of care for
patients in for droplet and contact isolation. The overall
adherence to wearing the PPE specified for each
isolation categories was 60% (98 of 162). The droplet
isolation signs showed that surgical mask with eye
shield should be used, but in 36% of observations
when this piece of equipment was used, the HCWs
took the eye shield off the mask (Table 1).
Table 2 summarizes observed doffing errors. In 32
of 153 (21%) of observations in which gloves were
worn, HCWs removed their gloves incorrectly. The
most frequent glove doffing mistake, occurring in
9.8% of observations, was not removing gloves insideout.
In 79 of 122 (65%) of observations in which
gowns were worn, HCWs failed to remove their
gowns correctly. The most common gown doffing
errors were removing gown from the front (58%), followed
by not pulling away from shoulder inside-out
(24%). In 35 of 136 (26%) of observations when
masks were worn, HCWs touched the front of the
mask while removing the mask. In approximately half
of the observations (78 of 160), HCWs touched potentially
contaminated surfaces or PPE with a bare hand
during doffing. Hand hygiene was not performed after
leaving the patient room in 9 of 137 observations
(6.6%). Among these 9 observations, HCWs touched
potentially contaminated surfaces in 6 of them (67%).
The overall incorrect doffing percentage was 90%
(Table 3), based on the doffing sequence, doffing technique,
and use of correct PPE. The percentage of
observations in which HCWs did not remove their
PPE in the correct sequence was 52%, while 40% of
observations involved HCWs not wearing all the
required PPE. The percentage of doffing errors did
not differ significantly among HCWs groups (v2 ¼
1.66 p ¼ 0.79, Table 3), nor among the groups of hospital
units (v2 ¼ 1.10 p ¼ 0.57, Table 3).
When evaluated by patient isolation category, the
percentage of observations involving incorrect doffing
sequence and overall incorrect doffing differed (v2 ¼
12.8, p ¼ 0.002). Errors were less common among
HCWs providing care to patients in droplet isolation
compared to when providing care to patients in droplet
and contact isolation. Table 4 shows the types of
Table 1. Combinations of pieces of personal protective equipment (PPE) worn by healthcare workers
(HCWs) by patient isolation category.
PPE combinations
Number of observations
Isolation category
Contact Droplet Contact and droplet
Gloves only 0 0 0
Gown only 0 0 0
Mask only 0 1 1
Mask with eye shield only 0 2_ 0
Gloves and mask, only 0 11 1
Gloves and mask with eye shield, only 0 18__ 5
Gloves and gown, only 0_ 1 1
Gown and mask with eye shield, only 0 0 1
Gloves, gown, and mask 4__ 9 33
Gloves, gown, and mask with eye shield 0 19__ 55_
Total number of observations 4 61 97
Total wore sufficient PPE 4 (100%) 39 (64%) 55 (57%)
_HCWs wore the correct PPE, according to hospital isolation signs
__HCWs wore more PPE than required by the hospital isolation sign
JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 577
PPE errors made by patient isolation: the most common
errors involved gown removal.
To evaluate the assumption that observations could
be treated independently, despite the repeated participation
of 23 HCWs, we repeated the analyses using
only a single observation for each participating HCW
and found the same results.
Discussion
Proper use and doffing of PPE protects HCWs and
patients from infectious diseases. Previous studies
have evaluated doffing practices of HCWs in hospital
and laboratory settings using both direct observations
and video recording methods, and our results are relatively
consistent with that of others, given differences
in study designs. Katanami et al.[5] assessed PPE use
by HCWs using cameras outside of patient rooms
identified for contact precautions and reported that
adherence to wearing all required PPE was only 34%.
We observed much higher compliance of PPE use
during care for patients in contact isolation (100%,
Table 1), but the comparison is limited by our small
numbers of observations (n ¼ 4). Beam et al.[6] found
Table 2. Errors observed in the doffing of personal protective equipment (PPE) by healthcare workers.
PPE or body part Error
Observed errors
By error type By PPE
No. observed Total no. % No. observed Total no. %
Gloves Not careful 14 153 9.2 32 153 21
Not inside-out 15 153 9.8
Wore outside patient room 8 154 5.2
Gown Not careful 40 122 33 79 122 65
Remove from the front 71 122 58
Not inside-out 24 122 25
Wore outside patient room 4 122 3.3
Mask w/ or w/o eye shield Not careful 25 136 18 49 136 36
Remove from the front 35 136 26
Bare hand Touched contaminated surfaces or PPE during doffing 78 160 49 6 9 67
Not perform hand hygiene after care 9 137 6.6
Table 3. Doffing practices of healthcare workers (HCWs) by job roles, hospital units, and patient isolation category.
Category
Incorrect doffing sequence
Not wearing all required/
correct PPE Overall incorrect doffing
No. observed Total no. %
No.
observed Total no. %
No.
observed Total no. %
All observations 82 157 52 64 162 39 142 157 90
Job roles
Providers 19 41 46 18 42 43 37 40 92
Nurses 30 64 47 25 66 38 58 66 88
Nurse technicians 21 35 60 16 37 43 32 35 91
Respiratory therapists 6 9 67 1 9 11 8 8 100
Others 6 8 75 4 8 50 7 8 88
Test for differences between groups p ¼ 0.33 p ¼ 0.42 p ¼ 0.79
Hospital unit
ICU 14 34 41 13 35 37 31 35 89
Non-ICU 54 97 56 35 100 35 87 97 90
Specialty 14 26 54 16 27 59 24 25 96
Test for differences between units p ¼ 0.34 p ¼ 0.07 p ¼ 0.57
Isolation category
Droplet 16 57 28 22 61 36 47 59 80
Droplet/contact 64 96 67 42 97 43 91 94 97
Contact 2 4 50 0 4 0 4 4 100
Test for differences between groups p < 0.001 p ¼ 0.17 p 5 0.002
Table 4. Personal protective equipment (PPE) doffing practices by patient isolation category.
PPE
Contact Droplet Droplet and contact
No. observed Total no. % No. observed Total no. % No. observed Total no. % p-value_
Gloves incorrect 0 4 0 14 57 25 18 92 19 0.23
Gown incorrect 3 4 75 14 29 48 62 89 70 0.02
Mask w/ or w/o eye shield correct 4 4 100 14 50 28 31 82 38 0.12
Overall incorrectness 4 4 100 47 59 80 91 94 97 <0.01
_p-value comparison of PPE incorrectness between droplet and droplet/contact precautions
578 L. T. PHAN ET AL.
that 91% of HCWs in a simulated care study made
contact between unprotected body areas and potentially
contaminated surfaces, while our study found
HCWs touched potentially contaminated surfaces with
bare hands in 50% of observations. Part of the difference
in these results may be due to the fact that we
counted contact made by a bare hand only, while
Beam et al. considered contact made by any unprotected
body part. We found that HCWs removed PPE
in the wrong sequence in 52% of observations, which
was similar to percentage of HCWs observed by
Zellmer et al.[9] Zellmer et al., however, made direct
observations outside the patient rooms, so several
components of the doffing protocol, including removing
glove inside-out and removing gown from the
front, were not captured in that study.
We found that gown doffing was the most common
doffing problem among HCWs, as HCWs
removed the gown by grasping the front of the gown
in 58% of observations. This finding was consistent
with the Beam et al.[6] study, which found that 75%
of HCWs did not remove the gown as recommended.
Reusable fabric gowns tie in the back, and the CDC
recommends that these gowns be removed from the
back—taken off by unfastening gown ties, pulling
away from the shoulder inside-out, and folding into a
bundle. However, there are different recommendations
for gown removal for different types of gowns. In particular,
the CDC recommends removing disposable
gowns by pulling the gown in the front, away from
the body, until the ties break, and then rolling the
gown inside out and removing the gloves with the
gown.[8] This approach is not feasible with reusable
fabric gowns that have woven textile ties, such as were
worn by HCWs observed in this study, as these ties
are difficult to break. A possible reason that HCWs
may frequently doff gowns incorrectly is that they
have been trained in both doffing approaches, but
over time have forgotten that the best doffing strategy
depends upon the type of gown. The impact of gown
doffing method on self-contamination, however, is
uncertain. Osei-Bonsu et al.,[10] in a doffing simulation
study involving disposable gowns, found that use
of the CDC-recommended doffing sequence that
includes removing the gown by pulling from the front
was associated with fewer participants with any contamination
by the surrogate microorganism
Staphylococcus dermidis than use of the doffing
sequence that includes removing the gown from the
back (2 of 15 [13%] vs. 8 of 12 [70%]), but no difference
was observed in the number of participants with
any contamination by the fluorescent tracer (12 of 15
[80%] vs. 11 of 12 [92%]).
There is an uncertainty in the CDC recommendations
regarding whether HCWs should wear a mask
with eye shield, or simply a mask, when in close contact
with a patient in droplet isolation.[11] In our
study, the hospital required HCWs to wear a surgical
mask with eye shield in patient rooms identified for
droplet isolation, and this was indicated on the isolation
sign mounted on the room door. However, we
found that in more than one-third of observations
when the mask was used, HCWs took off the eye
shield while providing care for patients. It may be
that HCWs remove the eye shield when wearing prescription
eye glasses, but this aspect of the PPE use
was not specifically recorded. Removal of the eye
shield can increase the risk of exposure to splashes of
infectious material to the facial mucous membranes of
HCWs, but the eye shield offers much less protection
than indirectly vented goggles with anti-fog coating or
chin-length face shield in conjunction with a mask, as
recommended by the National Institute for
Occupational Safety and Health to protect the conjunctiva
from infectious aerosols.[12]
In our study, we had a very high incorrect overall
doffing rate (90%) because we evaluated the doffing
technique, doffing sequence and the use of correct
PPE. However, all doffing errors are not likely to contribute
equally to the risk of disease transmission to
HCWs or patients. It is plausible that touching contaminated
surfaces with bare hand and not performing
hand hygiene are the highest risk doffing errors
because they increase the likelihood that a HCWs
leaves the patient room with pathogens on his or her
hands. This issue will be explored in future work that
integrates measures of virus presence and concentration
on environmental surfaces, PPE, and HCWs.
Many factors may contribute to lack of compliance
with PPE use during care for patients in contact and/
or droplet isolation and with incorrect doffing, including:
incorrect interpretation of the isolation signs,
workload, under valuing the importance of PPE,
under estimation of risk, or lack of knowledge of the
correct PPE and correct doffing protocol.[13] Although
more complex than the PPE ensembles used in transmission-
based precautions, human factors analyses of
the doffing process for enhanced PPE ensembles used
to care for patients with EVD, have highlighted
numerous opportunities for PPE failure and self-contamination.[
3] Gurses et al.[14] concluded that safe
doffing of PPE requires knowledge, skills and attitudes,
not just instructions for the sequence and
JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 579
technique for how to remove pieces of PPE. Our
observations suggest that HCWs are not familiar with
the sequence and technique for how to remove pieces
of PPE, but training that builds knowledge and skills
and changes attitudes may motivate HCWs to utilize
the correct sequence and technique. This requires a
more comprehensive approach to training than is
commonly employed today; one that includes knowledge
and practical, hands-on experience. Hands-on
training in PPE was commonly used with enhanced
PPE ensembles during the Ebola Virus Disease outbreak
of 2014–2015, and trainees identified hands-on
training as has having the greatest influence on their
confidence to care for Ebola Virus Disease patients.[15]
Such training could be integrated into HCWs’ clinical
competency skills tests. Clearly, the evidence in this
and other work demonstrate that the current
approaches are inadequate to obtaining the desired
PPE doffing behaviors from HCWs.
Our study had more observations of nurses and
nurse technicians than HCWs with other roles (Table
3), which is consistent with the relative number of
room entries that other studies have reported for
HCWs of different job titles.[16] Although the PPE use
and doffing practices of nurses and nurse technicians
were not different from HCWs with other job roles
(Table 3), nurses and nurse technicians have frequent,
intimate contacts with patients that may increase their
exposure to pathogens, putting them at increased risk
for occupationally acquired infectious disease and
transferring pathogens outside of the patient room.
Our study is subject to several limitations. First,
our study only observed HCWs who provided care for
patients with viral respiratory diseases, and it is possible
that HCWs behave differently when patients
have different diseases, including those that result in
contact and/or droplet isolation, due to the perception
of risk. Second, there is a concern that HCWs may
change their behaviors when being directly observed.
In this study, however, the poor compliance with the
recommended PPE doffing protocol suggests that
HCWs were unable to implement the correct practices,
even when observed. Finally, our study was conducted
at a single acute care hospital, which may
affect the generalizability of our findings to other
healthcare settings, as work practices may vary
between hospitals.
Conclusions
We found that deviations from the recommended
PPE doffing protocol by CDC were common, which
could increase the risk of self-contamination on
HCW’s clothing and skin after providing care for
patients having acute respiratory virus infections. In
more than 90% of the observations, doffing practices
involved errors with respect to the doffing sequence,
doffing technique, and/or use of appropriate PPE.
Common errors were doffing gown from the front,
removing the eye shield of the mask, and touching
potentially contaminated surfaces and PPE during
doffing. Given the complexity of PPE doffing and
deficiencies in HCWs’ doffing practices, a new
approach to education and training is needed.
Acknowledgments
We thank Maryshe Zietsman for assisting with data entry
and data collection.
Funding
This work was funded by the Centers for Disease Control
and Prevention cooperative agreement 1U54CK000445-01
with the Prevention Epicenters Program.
ORCID
Linh T. Phan http://orcid.org/0000-0001-8810-5971
Susan C. Bleasdale http://orcid.org/0000-0001-7448-6259
Rachael M. Jones http://orcid.org/0000-0003-1611-7900
References
[1] Siegel, J.D., E. Rhinehart, M. Jackson, and L.
Chiarello: 2007 Guideline for Isolation Precautions:
Preventing Transmission of Infectious Agents in
Healthcare Settings. Available at http://www.cdc.gov/
hicpac/pdf/isolation/Isolation2007.pdf (accessed
November 2016).
[2] Chevalier, M.S, W. Chung, J. Smith, et al.: Ebola
virus disease cluster in the United States—Dallas
County, Texas, 2014. Morb. Mortal. Wkly. (MMWR)
63(46):1087–1088 (2014). Available at https://www.
cdc.gov/mmwr/preview/mmwrhtml/mm6346a11.htm
(accessed January 2017).
[3] Mumma J.M., F.T. Durso, A.N. Ferguson, et al.:
Human factors risk analyses of a doffing protocol for
ebola-level personal protective equipment: Mapping
errors to contamination. Clin. Infect. Dis.
66(6):950–958 (2018). doi:10.1093/cid/cix957
[4] Casanova L., E. Alfano-Sobsey, W.A. Rutala, D.J.
Weber, and M. Sobsey: Virus transfer from personal
protective equipment to healthcare employees’ skin
and clothing. Emerg Infect Dis. 14(8):1291–3 (2008).
[5] Kwon, J.H., C-A.D. Burnham, K.A., Reske, et al.:
Assessment of healthcare worker protocol deviations
and self-contamination during personal protective
equipment donning and doffing. Infect. Control
580 L. T. PHAN ET AL.
Hosp. Epidemiol. 38(9):1077–1083 (2017). doi:10.
1017/ice.2017.121
[6] Beam, E.L., S.G. Gibbs, A.L. Hewlett, P.C. Iwen,
S.L. Nuss, and P.W. Smith: Method for investigating
nursing behaviors related to isolation care. Am.
- Infect. Control 42(11):1152–1156 (2014). doi:
10.1016/j.ajic.2014.08.001
[7] Katanami, Y., K. Hayakawa, T. Shimazaki, et al.:
Adherence to contact precautions by different types
of healthcare workers through video monitoring in a
tertiary hospital. J. Hosp. Infect. 100(1):70–75 (2018).
doi:10.1016/j.jhin.2018.01.001
[8] CDC.: Healthcare-associated Infections Protecting
Healthcare Personnel. Available at https://www.cdc.
gov/hai/prevent/ppe.html (accessed May 2018).
[9] Zellmer, C., S. Van Hoof, and N. Safdar: Variation
in health care worker removal of personal protective
equipment. Am. J. Infect. Control. 43(7)750–751.
doi:10.1016/j.ajic.2015.02.005.
[10] Osei-Bonsu, K., N. Masroor, K. Cooper, et al.:
Alternative doffing strategies of personal protective
equipment to prevent self-contamination in the
health care setting. Am. J. Infect. Control
47(5):534–539. doi:10.1016/j.ajic.2018.11.003
[11] CDC.: Isolation Precautions Guidelines Library Infection
Control. Available at https://www.cdc.gov/infectioncontrol/
guidelines/isolation/index.html (accessedMay 2018).
[12] NIOSH.: Eye Safety: Eye Protection for Infection
Control - NIOSH Workplace Safety and Health
Topic. Available at https://www.cdc.gov/niosh/topics/
eye/eye-infectious.html (accessed June 2018).
[13] Okamoto, K., Y. Rhee, M. Schoeny, et al.:
Importance of healthcare worker personal protective
equipment in reducing doffing errors—Correlation
with HCW characteristics and perceptions.. Open
Forum Infect. Dis. 3(suppl_1):1389. doi:10.1093/ofid/
ofw172.1092
[14] Gurses, A.P., A.S. Dietz, E. Nowakowski, et al.:
Human factors–based risk analysis to improve the
safety of doffing enhanced personal protective equipment.
Infect. Control Hosp. Epidemiol. 40(2):178–186
(2019). doi:10.1017/ice.2018.292
[15] Bleasdale, S.C., L. Brosseau, C. Fritzen-Pedicini,
et al.: Experience of Chicagoland acute care hospital
in preparing for Ebola virus disease, 2014-2015.
- Environ. Occup. Hyg. 16(8):582–591 (2019). doi:
10.1080/15459624.2019.1628966.
[16] Cohen, B., S. Hyman, L. Rosenberg, and E. Larson:
Frequency of patient contact with health care personnel
and visitors: Implications for infection prevention articleat-
a-glance. Jt. Comm. J. Qual. Patient Saf. 38(12)560–565
(2012). Available at https://www.ncbi.nlm.nih.gov/pmc/
articles/PMC3531228/pdf/nihms421967.pdf (accessed
June 2018).
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Answer
Evidence Based Practice Annotated Bibliography
Phan, L. T., Maita, D., Mortiz, D. C., Weber, R., Fritzen-Pedicini, C., Bleasdale, S. C., ... & CDC Prevention Epicenters Program. (2019). Personal protective equipment doffing practices of healthcare workers. Journal of occupational and environmental hygiene, 16(8), 575-581. https://www.tandfonline.com/doi/full/10.1080/15459624.2019.1628350
Summary
The article Personal Protective Equipment Doffing Practices of Healthcare Workers by Phan, Maita, Mortiz, Weber, Fritzen-Pedicini, Bleasdale and CDC Prevention Epicenters Program (2019) seeks to educate healthcare workers on the risks associated with doffing practices. According to the article, during the doffing of personal protective equipment (PPE), bacteria or viruses can be transported from the PPE to healthcare workers' bodies, placing them at the peril of infection vulnerability. The article's authors used the descriptive research approach to gain accurate and reliable data. The purpose of the study is to educate healthcare workers about the risks associated with doffing practices. The authors introduce the problem statement by indicating that PPE comes least at the hierarchy of control due to its effectiveness on personal character. The article is intended for healthcare providers. The main finding of the study that is clinically relevant is that the proper management and doffing of PPE protects health workers and patients from transmissible infections.
Analysis
The article is relevant to EBP since it offers reliable information relating to doffing, including healthcare providers' approaches to ensure appropriate doffing. According to the article, the best PPE practice is for healthcare workers to follow precautions to anticipate exposures and select appropriate PPE. The article is clinically relevant since it provides reliable statistics such as the difference experienced when PPE practices are correctly executed. The article is significant in protecting safety practices and problem statements since it centers on doffing uncertainties.
References
Phan, L. T., Maita, D., Mortiz, D. C., Weber, R., Fritzen-Pedicini, C., Bleasdale, S. C., ... & CDC Prevention Epicenters Program. (2019). Personal protective equipment doffing practices of healthcare workers. Journal of occupational and environmental hygiene, 16(8), 575-581. https://www.tandfonline.com/doi/full/10.1080/15459624.2019.1628350
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