A Systematic Risk-based Strategy to Select Personal Protective Equipment for Infectious Diseases

Overview

Journal Am J Infect Control

Specialty Infectious Diseases

Date 2019 Jul 31

PMID 31358421

Citations 16

Authors

Rachael M Jones

Susan C Bleasdale

Dayana Maita

Lisa M Brosseau

Affiliations

Soon will be listed here.

Abstract

Background: Personal protective equipment (PPE) is a primary strategy to protect health care personnel (HCP) from infectious diseases. When transmission-based PPE ensembles are not appropriate, HCP must recognize the transmission pathway of the disease and anticipate the exposures to select PPE. Because guidance for this process is extremely limited, we proposed a systematic, risk-based approach to the selection and evaluation of PPE ensembles to protect HCP against infectious diseases.

Methods: The approach used in this study included the following 4 steps: (1) job hazard analysis, (2) infectious disease hazard analysis, (3) selection of PPE, and (4) evaluation of selected PPE. Selected PPE should protect HCP from exposure, be usable by HCP, and fit for purpose.

Results: The approach was demonstrated for the activity of intubation of a patient with methicillin-resistant Staphylococcus aureus or Severe Acute Respiratory Syndrome coronavirus. As expected, the approach led to the selection of different ensembles of PPE for these 2 pathogens.

Discussion: A systematic risk-based approach to the selection of PPE will help health care facilities and HCP select PPE when transmission-based precautions are not appropriate. Owing to the complexity of PPE ensemble selection and evaluation, a team with expertise in infectious diseases, occupational health, the health care activity, and related disciplines, such as human factors, should be engaged.

Conclusions: Participation, documentation, and transparency are necessary to ensure the decisions can be communicated, critiqued, and understood by HCP.

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References

Koo A, Walsh R, Knutson T, Young S, McGrane K, Bothwell J . Comparison of Intubation Using Personal Protective Equipment and Standard Uniform in Simulated Cadaveric Models. Mil Med. 2018; 183(suppl_1):216-218. DOI: 10.1093/milmed/usx215. View

Kilinc F . A Review of Isolation Gowns in Healthcare: Fabric and Gown Properties. J Eng Fiber Fabr. 2016; 10(3):180-190. PMC: 4791533. View

Kinlay J, Flaherty K, Scanlon P, Mehrotra P, Potter-Bynoe G, Sandora T . Barriers to the use of face protection for standard precautions by health care providers. Am J Infect Control. 2014; 43(2):169-70. PMC: 4367448. DOI: 10.1016/j.ajic.2014.11.002. View

Gammon J, Morgan-Samuel H, Gould D . A review of the evidence for suboptimal compliance of healthcare practitioners to standard/universal infection control precautions. J Clin Nurs. 2007; 17(2):157-67. DOI: 10.1111/j.1365-2702.2006.01852.x. View

Spruce L . Surgical Head Coverings: A Literature Review. AORN J. 2017; 106(4):306-316.e6. DOI: 10.1016/j.aorn.2017.08.001. View

Garner A, Laurence H, Lee A . Practicality of performing medical procedures in chemical protective ensembles. Emerg Med Australas. 2004; 16(2):108-13. DOI: 10.1111/j.1742-6723.2004.00560.x. View

Siegel J, Rhinehart E, Jackson M, Chiarello L . 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Health Care Settings. Am J Infect Control. 2007; 35(10 Suppl 2):S65-164. PMC: 7119119. DOI: 10.1016/j.ajic.2007.10.007. View

Grillet G, Marjanovic N, Diverrez J, Tattevin P, Tadie J, LHer E . Intensive care medical procedures are more complicated, more stressful, and less comfortable with Ebola personal protective equipment: A simulation study. J Infect. 2015; 71(6):703-6. DOI: 10.1016/j.jinf.2015.09.003. View

Haamann F, Dulon M, Nienhaus A . MRSA as an occupational disease: a case series. Int Arch Occup Environ Health. 2011; 84(3):259-66. PMC: 3037496. DOI: 10.1007/s00420-010-0610-7. View

10.

Sims A, Burkett S, Yount B, Pickles R . SARS-CoV replication and pathogenesis in an in vitro model of the human conducting airway epithelium. Virus Res. 2007; 133(1):33-44. PMC: 2384224. DOI: 10.1016/j.virusres.2007.03.013. View

11.

Fowler R, Guest C, Lapinsky S, Sibbald W, Louie M, Tang P . Transmission of severe acute respiratory syndrome during intubation and mechanical ventilation. Am J Respir Crit Care Med. 2004; 169(11):1198-202. DOI: 10.1164/rccm.200305-715OC. View

12.

Roy C, Milton D . Airborne transmission of communicable infection--the elusive pathway. N Engl J Med. 2004; 350(17):1710-2. DOI: 10.1056/NEJMp048051. View

13.

Yiannakis E, Boswell T . Ebola preparedness: a personal perspective. J Hosp Infect. 2015; 91(1):8-10. DOI: 10.1016/j.jhin.2015.06.009. View

14.

Dorman L, Havenith G . The effects of protective clothing on energy consumption during different activities. Eur J Appl Physiol. 2008; 105(3):463-70. DOI: 10.1007/s00421-008-0924-2. View

15.

Hall S, Poller B, Bailey C, Gregory S, Clark R, Roberts P . Use of ultraviolet-fluorescence-based simulation in evaluation of personal protective equipment worn for first assessment and care of a patient with suspected high-consequence infectious disease. J Hosp Infect. 2018; 99(2):218-228. DOI: 10.1016/j.jhin.2018.01.002. View

16.

Zartarian V, Bahadori T, McKone T . Adoption of an official ISEA glossary. J Expo Anal Environ Epidemiol. 2004; 15(1):1-5. DOI: 10.1038/sj.jea.7500411. View

17.

Herlihey T, Gelmi S, Flewwelling C, Hall T, Banez C, Morita P . Personal Protective Equipment for Infectious Disease Preparedness: A Human Factors Evaluation. Infect Control Hosp Epidemiol. 2016; 37(9):1022-8. DOI: 10.1017/ice.2016.124. View

18.

Sprecher A, Caluwaerts A, Draper M, Feldmann H, Frey C, Funk R . Personal Protective Equipment for Filovirus Epidemics: A Call for Better Evidence. J Infect Dis. 2015; 212 Suppl 2:S98-S100. PMC: 4564541. DOI: 10.1093/infdis/jiv153. View

19.

Oconnell K, El-Masri M, Broyles J, Korniewicz D . Testing for viral penetration of non-latex surgical and examination gloves: a comparison of three methods. Clin Microbiol Infect. 2004; 10(4):322-6. DOI: 10.1111/j.1198-743X.2004.00848.x. View

20.

Kwon J, Burnham C, Reske K, Liang S, Hink T, Wallace M . Assessment of Healthcare Worker Protocol Deviations and Self-Contamination During Personal Protective Equipment Donning and Doffing. Infect Control Hosp Epidemiol. 2017; 38(9):1077-1083. PMC: 6263164. DOI: 10.1017/ice.2017.121. View