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The Right and Wrong Way to Doff PPE

Apr 30, 2019 10:00:00 AM    posted in Infection Prevention

Donning gloves has become as instinctive for medical professionals as putting on glasses in the morning is for someone with impaired vision; nobody questions it, they just do it. Ungloved hands in an operating room, after all, would stick out like a sore thumb.

What isn’t always instinctive, though, is removing those gloves properly at the end of a patient visit or procedure. Incorrect doffing of exam gloves and other PPE can negate the whole reason caregivers have put them on in the first place. As this study indicates, “Contamination of the subjects’ working clothes and surrounding environment occurred frequently during PPE doffing.” In today’s medical environments, multi-drug resistant organisms (MDROs) are a perennial threat – in fact, according to a study published in Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America, more than one-third of healthcare workers in a cohort being contaminated with MDROs after treating infected patients. With a full 39 percent of those workers observed making PPE doffing mistakes, it’s clear that small slip-ups in PPE are increasing the spread of MDROs.

Let’s take a look at where caregivers tend to go wrong in removing gloves and other PPE equipment to understand how we can all do better in preventing the spread of dangerous microorganisms.

 

Simple Mistakes With Big Consequences
MDROs collect on gloves just as they do on any other surface. While gloves prevent viruses and bacteria from collecting on the skin (or entering the body through abrasions) improper contact can also spread MDROs back to the hands of a caregiver, to an adjacent surface or even to a patient.

Take for example the following possible scenarios in which improper PPE doffing can spread MDROs:  

  • Touching the inside of the gown or gloves with a gloved hand. If a caregiver reaches beneath a gown to scratch an itch, it can transmit MDROs to clean clothing or skin.

  • Touching a gown with bare hands. If a bare-handed caregiver brushes against an unclean gown after a procedure, MDROs collected on the gown can get picked up the caregiver at the point of contact and hitch a ride into another sterile territory.  

  • Not unfastening the gown at the neck. Haphazardly removing a gown or wrestling with it to get it off as quickly as possible might be tempting. Failing to take care in gown removal, however, can easily spread MDROs.

These are only a few of the myriad potential scenarios in which PPE doffing slip-ups can undermine otherwise meticulous PPE usage. The good news, though, is that proper PPE doffing is something that we can control; the best practices are there, we just have to adhere to them with care.

 

The Right Way to Donn and Doff

The CDC has created an in-depth, easy-to-read infographic that demonstrates PPE doffing best practices. When it comes to glove removal, the CDC advises that you:  

  • • Peel one glove off by pulling it by the palm with the other gloved hand;

  • Wash your hands or use hand-sanitizer immediately if you suspect that at any point in the doffing process you touched anything contaminated.  

  • Holding the removed glove in your still-gloved hand, insert your un-gloved fingers under the wrist of the remaining glove and pull it off inside-out, then discard.


For each PPE accessory, there’s a right way of doffing, and there’s a right order for doffing as well. So stay on top of the best practices – and make it a habit!

 

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