Risk of self-contamination during doffing of personal protective equipment


      • Personal protective equipment (PPE) is commonly used to protect healthcare workers from becoming infected with communicable diseases.
      • PPE should be donned (put on) and doffed (removed) in the correct order.
      • Various PPE protocols were tested to estimate the risk of self-contamination during doffing of PPE.
      • Most problems during PPE use were related to doffing sequences.
      • Powered air-purifying respirator-containing protocols and assisted doffing are preferred whenever possible.


      The aim of this study was to describe the risk of self-contamination associated with doffing of personal protective equipment (PPE) and to compare self-contamination with various PPE protocols.


      We tested 10 different PPE donning and doffing protocols, recommended by various health organizations for Ebola. Ten participants were recruited for this study and randomly assigned to use 3 different PPE protocols. After donning of PPE, fluorescent lotion and spray were applied on the external surface of the PPE to simulate contamination, and ultraviolet light was used to count fluorescent patches on the skin.


      After testing 30 PPE sequences, large fluorescent patches were recorded after using “WHO coverall and 95” and “North Carolina coverall and N95” sequences, and small patches were recorded after using “CDC coverall and N95” and “Health Canada gown and N95” sequences. Commonly reported problems with PPE use were breathing difficulty, suffocation, heat stress, and fogging-up glasses. Most participants rated PPE high (18/30) or medium (11/30) for ease of donning/doffing and comfort. PPE sequences with powered air-purifying respirators (PAPRs) and assisted doffing were generally associated with fewer problems and were rated the highest.


      This study confirmed the risk of self-contamination associated with the doffing of PPE. PAPR-containing protocols and assisted doffing should be preferred whenever possible during the outbreak of highly infectious pathogens.

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