Clinicians’ Donning of PPE in a Simulated Cardiac Arrest of a COVID-19 Patient Reveals Room for Improvement

Personal protective equipment (PPE) protects healthcare workers and patients. Data on guideline compliance on how to dress (donning) or remove (doffing) PPE and the assistance among multiple participants (buddying) are limited. This study by Kraus, et al. (2024) assesses the quality of donning, doffing, and buddying of PPE in a simulated medical emergency.

Physicians handled a simulated cardiac arrest of a COVID-19 patient in this study. Adjacent to the victim, PPE was available. The appropriateness of PPE choice was assessed by using video recordings, with each individual participant being analyzed from the beginning of the simulation scenario from two perspectives regarding the selection of items during donning and doffing, hygiene aspects, time, and team support (buddying). The primary outcome was the number of participants being appropriately protected, defined as both wearing (a) all PPE items provided, and (b) all PPE items correctly at the time of first patient contact (FPC).

At first patient contact 21% (91/437) were correctly protected. One or more incorrect PPE items were found in 4% (19/437), whereas 61% (265/437) wore one or more PPE items incorrectly. In 14% (62/437), one or more PPE items were missing. The time interval between donning start and FPC was 66 (55–78) sec. Time to FPC was longer in correctly than in incorrectly protected participants 77 (66–87) vs. 64 (54–75) sec; p < 0.001) and decreased by 7 ± 2 s per PPE item omitted (P = 0.002). Correct doffing was observed in 192/345 (56%), while buddying occurred in 120 participants (27%), indicating that they either assisted other participants in some manner (verbally or physically) or received assistance themselves.

The researchers say their findings imply a need for education in correct and timely PPE donning and doffing. Donning PPE as intended delayed FPC. This and the influence of buddying needs further investigation.

Reference: Kraus S, et al. Under Armour – Use of personal protective equipment for simulated CPR of COVID-19 patients: an observational study
Antimicrobial Resistance & Infection Control. Voll. 13, article number 55 (2024).