ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2019
Common Behaviors and Faults When Doffing Personal Protective Equipment for Patients With Serious Communicable Diseases.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
13 citing papers in PubMed, 2 syntheses or guidelines pooled it, 44 citations in OpenAlex.
- Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff.The Cochrane database of systematic reviews · 2020Pooled it
- Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff.The Cochrane database of systematic reviews · 2020Pooled it
- Effect of an Intervention Package and Teamwork Training to Prevent Healthcare Personnel Self-contamination During Personal Protective Equipment Doffing.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2019Trial
- Doffing procedures of personal protective equipment evaluated with lipid nanoparticles as viral surrogates: uncovering potential blind spots.Antimicrobial resistance and infection control · 2025Article
- Is there sufficient evidence to inform personal protective equipment choices for healthcare workers caring for patients with viral hemorrhagic fevers?Canada communicable disease report = Releve des maladies transmissibles au Canada · 2025Article
- The PATH to PPE Mastery - Programme for Assessment and Training in HCID (High Consequence Infectious Diseases) PPE (Personal Protective Equipment), Mastery.Infection prevention in practice · 2023Article
- Electronic monitoring of doffing using video surveillance to minimise error rate and increase safety at Howard Springs International Quarantine Facility.Antimicrobial resistance and infection control · 2022Article
- Resilience and Protection of Health Care and Research Laboratory Workers During the SARS-CoV-2 Pandemic: Analysis and Case Study From an Austrian High Security Laboratory.Frontiers in psychology · 2022Review
- Impact of Face-to-Face Teaching in Addition to Electronic Learning on Personal Protective Equipment Doffing Proficiency in Student Paramedics: Protocol for a Randomized Controlled Trial.JMIR research protocols · 2021Article
- Policies and procedures for personal protective equipment: Does inconsistency increase risk of contamination and infection?International journal of nursing studies · 2020Article
- Mastery Learning Ensures Correct Personal Protective Equipment Use in Simulated Clinical Encounters of COVID-19.The western journal of emergency medicine · 2020Article
- Human Factor Considerations in Using Personal Protective Equipment in the COVID-19 Pandemic Context: Binational Survey Study.Journal of medical Internet research · 2020Article
- COVID-19 and endoscopy services in intermediately affected countries: a position statement from the saudi gastroenterology association.Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology AssociationReview
Corrections and comments
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Authors and funding
12 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundThe safe removal of personal protective equipment (PPE) can limit transmission of serious communicable diseases, but this process poses challenges to healthcare workers (HCWs).
methodsWe observed 41 HCWs across 4 Ebola treatment centers in Georgia doffing PPE for simulated patients with serious communicable diseases. Using human factors methodologies, we obtained the details, sequences, and durations of doffing steps; identified the ways each step can fail (failure modes [FMs]); quantified the riskiness of FMs; and characterized the workload of doffing steps.
resultsEight doffing steps were common to all hospitals-removal of boot covers, gloves (outer and inner pairs), the outermost garment, the powered air purifying respirator (PAPR) hood, and the PAPR helmet assembly; repeated hand hygiene (eg, with hand sanitizer); and a final handwashing with soap and water. Across hospitals, we identified 256 FMs during the common doffing steps, 61 of which comprised 19 common FMs. Most of these common FMs were above average in their riskiness at each hospital. At all hospitals, hand hygiene, removal of the outermost garment, and removal of boot covers were above average in their overall riskiness. Measurements of workload revealed that doffing steps were often mentally demanding, and this facet of workload correlated most strongly with the effortfulness of a doffing step.
conclusionsWe systematically identified common points of concern in protocols for doffing high-level PPE. Addressing FMs related to hand hygiene and the removal of the outermost garment, boot covers, and PAPR hood could improve HCW safety when doffing high-level PPE.We identified ways that doffing protocols for high-level personal protective equipment may fail to protect healthcare workers. Hand hygiene, removing the outermost garment, boot covers, and respirator hood harbored the greatest risk and failed in similar ways across different hospitals.
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Registered trials
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