• Kathryn Osei-Bonsu, Nadia Masroor, Kaila Cooper, Christopher Doern, Kimberly K Jefferson, Yvette Major, Savion Adamson, Justin Thomas, Ian Lovern, Heather Albert, Michael P Stevens, Gordon Archer, Gonzalo Bearman, and Michelle Doll.
• Virginia Commonwealth University School of Medicine, Richmond, VA.
• Am J Infect Control. 2019 May 1; 47 (5): 534-539.

BackgroundHealth care workers routinely contaminate skin and clothing when doffing personal protective equipment (PPE). Alternative doffing strategies, such as hand hygiene on gloved hands and double gloving, have been suggested but not validated by comparison against the standard Centers for Disease Control and Prevention procedures.MethodsParticipants were assigned to doff PPE following 1 of 4 specific strategies. Prior to doffing, PPE was "contaminated" with Glo Germ and fluorescing Staphylococcus epidermidis at the recommended level of 1.5 × 108 colony forming units/mL. After doffing, areas of self-contamination were detected using a black light. Cultures were taken from these areas using cotton swabs, inoculated onto blood agar plates, and incubated for 48hours. Each participant completed a survey regarding usability. The Fisher exact test and the Kruskal-Wallis test were used for data analysis with SAS 9.4.ResultsThere were 51 participants who completed the study. Breaches in PPE were observed in only 5 of 51 doffs (10%). However, 46 of 51 (90%) had areas of self-contamination that was apparent by transfer of Glo Germ to skin or clothing. A subset (16%) of these sites also grew fluorescing S epidermidis. Assigned doffing strategy was associated with bacterial contamination (P = .0151), but not usability (P = .2372).ConclusionsParticipants experienced self-contamination when doffing PPE with both a surrogate marker and live bacteria. Close attention to doffing technique is necessary for optimal results, and one-step procedures may be more effective.Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

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