Using human factors engineering to improve the effectiveness of personal protective equipment protocols and design

Effective personal protective equipment (PPE) doffing prevents healthcare workers (HCW) from contaminating themselves and their patients, in addition to curbing the spread of pathogens. HCWs may encounter a variety of PPE design during regular practice, some of which may be unfamiliar to them and require specific doffing strategies. Yet we know very little about the underlying causes of HCWs self-contamination while doffing. We used principles of human factors engineering (HFE) combined with a qualitative design approach to evaluate the risks of HCWs’ self-contamination during PPE removal. We recruited seventy HCWs from two Midwestern academic hospitals to participate in a PPE donning and doffing simulation study. In the first scenario, participants were asked to don and doff three mask designs (n=10), two gown designs (n=10), or two glove designs (n=10). In the second scenario, participants with different levels of training (n=40) were asked to don and doff the same PPE ensemble (i.e., surgical mask, over-the-head gown, and nitrile gloves) under distraction and non-distraction conditions. In all scenarios, participants were instructed to doff in their usual manner. Doffing performances were photographed and video-recorded. Subsequently, we reviewed the video recordings with participants and conducted think-aloud interviews about their performance. We analyzed the data using thematic analysis and found that participants often self-contaminated while doffing. We observed that different PPE designs may not be interchangeable and may require HCWs to use unintuitive doffing techniques. Participants used their previous experiences to create new donning and doffing strategies when doffing unfamiliar PPE. However, this practice sometimes caused them to use inappropriate doffing techniques, resulting in self-contamination. These finding have important implications for organizations’ policies and procedures regarding the PPE design, doffing protocols, and HCWs’ training and education.